Much Better!

The day after his infection

 
Joshua is doing much better since my last post. His infection, whatever it was, seems to be much better. The doctors have stopped the antibiotics and the breathing machine. He is back to eating 29mL and he is very happy about that!  Thank God for all the doctors and nurses that take care of him every day and night.

Joshua had to get another IV in his arm =(

Joshua has had only 2 bradycardias since his episode of several, and they were much less severe. Please continue praying for him to quickly grow out of these and continue the development of healthy strong lungs. I held Joshua three times yesterday and once today....so I have certainly got my fix. The nurses seem to be offering a lot more than twice a week, but I wont ever turn down holding our little peanut. He is 3 pounds and 10 ounces as of last night. He was 3 pounds and 12 ounces, but he lost 2 ounces while he wasn't eating.

Today Joshua had his first eye exam. As premature babies, the blood vessels in the retina are more likely to develop abnormally because of all the oxygen they are put on for their breathing. The doctor said, he didn't see anything he wouldn't expect as a preemie, just a couple abnormalities that should fix themselves. He has a follow up in three weeks so hopefully everything will be normal by then.

As always, thank you so much for all your prayers and support. Hopefully this set back will be his only one and he will get to come home soon. Unfortunately, the NICU is like a roller coaster, there are good days and bad for all the babies. It looks as though Joshua won't quite be ready to come home for Christmas, but that is ok. He is getting some good rest and growing leaps and bounds every day and mommy and daddy are proud! There is another baby, Sabrina, in the NICU that used to be Joshua's neighbor before she moved to a different room, and she was born September 5. Sabrina was born at 24 weeks and we've been told she is a fighter. I ran in to her mom just yesterday, and she told me Sabrina was going to get to come home for Christmas. Part of me wished it was Joshua that was coming home, but I'm so glad it was Sabrina. Her family has been through a lot in the past 3 months, and they deserve to spend the holiday with their little girl. Congratulations Sabrina!!

One step forward....and two steps back

They say no news is good news from the NICU, so yesterday afternoon when I got a call from the hospital my heart started beating a little fast. It was Dr. Foster, the neonatologist, and when the doctor calls, you know its probably not good. Joshua had a cluster of bradycardias and apneas. Basically he had several episodes back to back of not breathing and very low heart rate. One of the episodes was so intense, he didn't start breathing after stimulation, so they had to start breathing for him. The doctor's assumed it was some sort of infection that caused this, but they really don't know for sure. Joshua had to be put back on the breathing machine, they stopped his feed, his IV had to be put back in, and they started antibiotics. I guess that is more like 4 steps backwards for him. Seeing Joshua this way was reminiscent of how he was about two weeks ago, and it wasn't a good memory. Of course, it was very hard to see him this way, especially after all the progress he had made in the last week.We left the hospital a little down last night.

Today at 8am,  he was doing much better. His breathing had stabilized, and his blood culture came back negative for an infection. They decided to restart his feeds at 5 mL, he was getting 29mL, and they took him off the breathing machine thank God! He tolerated his food well, in fact it went down super fast and he was soooo happy after that. His little nose can get a rest now, that darn cpap machine is so invasive, his nose is all bruised and his eyes are all puffy from the air pressure. Hopefully when I see him tomorrow at 9am, he will look like himself again. As always, I will continue to keep everyone updated, and hopefully with good news. Thank you for your continued support and prayers. I think Team Altman will sleep good tonight, all three of us =)

Joshua's Third Week in the NICU

Joshua had a pretty big week! Joshua would have been 34 weeks as of this past Tuesday, so he is moving on up. This week he weighed in at 3 pounds and 5 ounces. Now that he is starting to really put on the weight, the doctors decided it was time to try him in real clothes while still in his incubator. Its so nice to not see all the wires and such attached to him, even if I still know they are there. Before we dressed him up, he got his first real bath. Before, they would bring the bath to him in his incubator, but this time he got to come out into a real tub....well as real as it could be. I think he actually really enjoyed it. He was pretty uncertain at first, but after a while he just relaxed and enjoyed it! He was pretty exhausted after the bath, so he slept really well until his next touch time.

The biggest step this week was the bottle feed, or nipple feed. Until now, Joshua has received full feedings through his feeding tube (the little orange tube through his mouth). He doesn't have to do much, just relax and wait for his tummy to fill up. With the bottle feed, he has to actually work for his food. This is the biggest and most challenging task for the preemies to do. Before he can come home, Joshua has to take all 8 feedings by bottle consistently. This step, according to nurses and other moms, is the one that takes the longest. They start with one bottle a day, and before they can move up to more bottles, they have to finish the previous amount of bottles completely. Joshua and I have been practicing with his binky a lot! Having to suck, swallow, and breathe all at once is difficult and its something that preemies haven't developed the coordination for. Doctors say around 34 weeks gestation is when babies develop this, which is why they chose this week to try. Unfortunately, they gave him the bottle at his 9 pm touch time when he was super tired, so it wasn't more than a few minutes until they called it quits. We were a little bummed, but we know he will do it next time!

Currently Joshua is doing excellent, the only thing he is still having issues with is the bradycardias. Bradycardias are a preemie thing, and the doctors say its usually not until 37 weeks gestation  that they really grow out of them. Most of his bradys have been caused by spit ups. Because Joshua has a feeding tube down into his stomach, sometimes it can cause babies to have spit ups because the tube does not allow the stomach sphincter to close. When this sphincter is kept open, acid from the stomach is able to flow backwards into the esophogus and this is what causes acid reflux. They have put him on a low dose of Prevacid to help with this issue. He still seems to be having spit ups and bradys, so we will continue to pray for healthy growth and development to correct this.

Last Wednesday, I went to a support group at the hospital. Unfortunately Josh was working, but there were three other families that came to listen. The speaker was a mother that spoke about her family's experience in the NICU. The experience was touching, simply because their stories sounded so similar to what we are going through, and to see her son all grown up 5 years later gives you that feeling that there is an end to the NICU. The speaker had twins in the NICU, for over three months. They were born quite early, and had many complications.  One twin, Garret, almost didn't make it and they were told to call their priest to the hospital. Garret was there and he was cute as can be. He was running around just like a typical 5 year old, you would never guess what he went through. She gave us some great advice, and answered lots of questions for the families that were there. The hospital hosts these ever other Wednesday, so I will definitely be a regular there!

Enjoy all the photos, and as always please keep Joshua in your prayers. Check back soon! Lots of love

This video is of Joshua practicing for his bottle. He loves his binky!

Getting his first real bath and some support from Daddy

Joshua posing during his first bath

Getting swaddled after bath time!

Getting his first feel of real clothes...even if they are way too big! Dont worry mommy brought some better fitting preemie clothes the next day

First bottle...Joshua was pretty tired so it was a very short experience =)

All snuggled and warm with mommy

Studying daddy's face

Team Altman

3 Pounds and Then Some!

Prayers before bedtime

 Team Altman

Joshua sleeping

Right after bath time and wide awake!

Fast asleep after afternoon feeding

Kangaroo Time

Mommy and Joshua love being together

Spending time with daddy!

As of this morning, our little peanut weighed in at a whopping 3 pounds and 1 ounce. Joshua still looks small, but we can definitely see the difference from when he was first born. He is almost at full feeds, he is up to 26 mL every three hours- 30mL is a full feed. Because he is now eating so much, they were able to take his IV out which was supplying extra nutrients. One less thing attached to him is one more blessing!  He is making significant progress with feeding; when it comes close to feeding, he is showing signs of being hungry such as sucking on his fingers and reacting to stimulation around his mouth. Because he is starting to show signs of wanting to eat as opposed to just eating, the doctors are going to start bottle feeding him hopefully by next week. Currently there is a feeding tube that runs into his mouth and down to his stomach, so he doesn't taste anything he just feels his stomach get full. Bottle feeding is one of his milestones he must reach before he can go home. I hope he tolerates it well!

Today was bath day, and mom got to do the honors! The bath usually wears him out, by the end of it all he is already passed out in a deep sleep. Because Joshua cannot regulate his body temperature yet, they can't actually submerge him in water, so instead he stays in his incubator and we bring the bath to him. His temperature has to be about 98.0 or above in order to give him a bath. The little gold sticker attached to his tummy is a temperature probe and it is constantly reading his temperature and automatically adjusting the incubator, or isolette, to warm up or cool down according to the reading.

In my last post, the doctors had taken Joshua off the caffeine in hopes that he would not have any bradycardias or apneas. He has been having a few, three last night, but fortunately he was able to recover all on his own without stimulation from the nurses. The other day while holding Joshua, he had a bradycardia in my arms and it was very scary. His face turned blue and his heart rate dropped below 80 bpm, the normal range is about 130-160 bpm (beats per minute). The nurse came over and firmly patted his back and his heart rate came back up.

Joshua's breathing is doing excellent. He still has his nasal cannula which is supplying him 2mL of oxygen. Hopefully they will ween him down to 1mL and then after that it comes out of his nose and he is free of another tube attached to him! He is always pulling this out of his nose and getting extra attention from the nurses. Enjoy  the photos I have posted, and check back for another update! Thank you again for your continued prayers.

The Big 5

Joshua has gained 5 ounces....I know this doesn't sound like a lot, but considering his size it is quite a lot! His current weight is 2 pounds and 12 ounces. We can't wait for him to move past the two's and into the three's!



The big question I have been thinking about is when Joshua will be able to come home. Surely the best christmas gift this year would be for him to be home on Christmas day with all our family, but we have to be patient. I asked the doctor today what she thought, and she said it is completely up to him. Joshua has to complete a checklist before he can be discharged..here are his 5 criterion:




1. No Apneas or Bradycardias for 5-7 days

2. Maintaining body temperature in an open crib

3. Gaining weight consistently

4. Feeding consistently from a bottle 

5. No other complications

Joshua's progress with these:

1. Joshua has not had A's or B's, but they think the reason for this is the caffeine. Remember the caffeine stimulates his brain and reminds his brain to breathe. So the question is, can he do this without the caffeine? They stopped his caffeine today, and they will see whether or not he starts to have any A's or B's while off of it. Hopefully he wont, because this is the hardest thing to grow out of. Babies usually have to be about 37 weeks before they grow out of this. 

2. Joshua has not yet been able to maintain his body temperature. He is in his incubator 24 hours of the day, which is maintaining his body temperature for him. Until he is able to really gain significant sources of fat, he will not be able to do this. So the weight gain is a great step towards this!

3. Joshua has this one down. He seems to be gaining about 1 ounce a day or half a pound a week. His feedings have gone up dramatically so that will certainly help with the weight gain. 

4. Joshua has not developed the capability to swallow yet. The doctors say this is something that comes around 34 weeks of gestation. Until he is able to swallow, breathe, and suck all at the same time, he will continue to be fed via the feeding tube. FYI - He hates his feeding tube; he pulls it out all the time!

5. These complications include breathing on his own, which he is doing well with. He currently has a nasal canula which is giving him very little oxygen and he is tolerating it well. 

We ask for continued prayers for Joshua and we thank everyone for all their continued support. Josh and I were able to return to church on Sunday together for the first time in several weeks and it felt great. Our pastor delivered a powerful sermon about Thanksgiving and the bible. He said the bible does not ask us to be thankful FOR all circumstances. Of course we will never be thankful for cancer, broken families, unemployment, or other unfortunate circumstances. What the bible does say is that we should "be thankful in all circumstances" 1 Thessalonians 5:18. We are sad that Joshua is not with us but even in this circumstance we are reminded how thankful we are that he arrived safely into this world and that he is receiving the best of care. We are so thankful for Joshua. Happy Thanksgiving!

The Beginning

Feeding Joshua his first milk

Daddy picking up Joshua

Happy Moment

Holding Joshua for the first time

Where to begin.....

It has been quite a journey just in the past 8 days, and I know the days to come will hold news of joy and possibly some tears. I have been writing down thoughts here and there when I get a chance and I thought I would share this with everyone through this blog.  It seems easier to post updates here than it does through mass emails every day, so you can tune in whenever you have time and read what is going on with Team Altman. Enjoy!

Joshua Marshall Altman was born on November 9, 2010 at 8:46pm. His arrival was bittersweet, being that he was not due until January 10, 2011. Most of you know that I was put on bed rest at about 27 weeks due to my blood pressure rising to very high levels. At 31 weeks I finally started to develop signs of Pre-Eclampsia so the doctors determined that the risk of carrying Joshua any longer was too great. He was delivered by c-section within 6 hours of making the decision.

This experience has been one that has evoked every emotion I can think of. I had dreamed about the day he would arrive and I would get to finally hold him, but unfortunately our first meeting was not until the next day. There were 5 nurses patiently waiting in the operating room for him and as soon as he came he was rushed out of the room and up to the NICU. I actually never even layed eyes on him until the next day, but Josh told me how beautiful he was. The next three days in the hospital were spent juggling time between recovering, sleeping, and wheeling up to the NICU to see Joshua. Josh never left my side, and I don't think he ever got a good night sleep in the "chair bed" that was too short for anyone over 6 feet. I really have an amazing husband who makes Team Altman stronger every day. Until baby Joshua comes home, I will refer to our family as a team because we are all working to make our family strong and healthy.

Day 7 in the NICU
After one week in the NICU, Joshua has made some great improvements. When Joshua was first born, his lungs were not fully developed. Most babies develop mature lungs by 36 weeks of gestation. Because Joshua was born at 31 weeks, he had a hard time breathing, and the nurses had to intubate him. Intubation is the insertion of a tube through the mouth and into the patient's lungs which helps them breath. As of two days ago, Joshua was extubated, meaning they took out the tube and he is now breathing on his own. What a great accomplishment for him!

Another complication that goes along with the immature lungs is Apnea and Bradycardia or "The A's and B's" as the nurses would say. Although Joshua is breathing on his own now, he can still forget to breath sometimes and this is very common with premature babies. Apnea is the absence of breathing and an alarm will sound if he has an irregular breathing pattern which consists of intervals of pauses longer than 10-15 seconds.  Bradycardia is the reduction of heart rate and an alarm will sound if his heart rate falls below 100 beats per minute. He actually experienced this last night when I was able to hold him for the first time. He was so relaxed in my arms he forgot to breathe, so the nurse had to come by and tap on his back and then he started again. It was very scary the first time, but I am told I will get used to it happening and he will eventually grow out of this.  An interesting remedy for this, they actually give Joshua a daily dose of caffeine which stimulates and reminds his brain to breathe. Caffeine affects infants differently than adults, so its not the same as drinking a latte!

Last night, was the first night I got to hold Joshua. Let me just say....it was one of the best days thus far. They actually refer to this in the NICU as "Kangaroo Care." The infant is tucked into the shirt of the mother so that there is skin to skin contact similar to the mother Kangaroo and its baby in the pouch. The direct contact between mother and baby helps to regulate his body temperature since he is unable to do so on his own yet.  Premature babies are born with little body fat and immature skin so they are unable to maintain body heat which is why he is kept in an incubator.

Joshua is finally able to digest small amounts of milk, his digestive system is still immature so the feedings consists of very small amounts, about 3mL twice a day. He has had an infection in his stomach which still seems to be there, so they are taking his feeding very slow. Because breast milk has natural antibodies from mother, it should help build up his immune system slowly.

This is quite a long post being that it is seven days wrapped up into one, so I will post shorter and more frequent posts from here on. Again we ask that you keep baby Joshua in your thoughts and prayers. Thank you so much for all the support thus far, it has been comforting to Josh and I.

Much love.