Penny's Moved and Isaak's Improved

Things are starting to look up for Isaak.  His respiratory status is improving hourly.  They keep weaning him slowly from the ventilator and hope to extubate him soon.  He'll go back to bubble CPAP.  His pain medication is also being weaned and that will likely help with extubation as many pain meds are respiratory depressants.  They put a new PICC line in so that he can get more dextrose to plump him up.  (Currently, he weighs in at 940g.)  And he's making lots of wet diapers - another good sign.  He's still receiving antibiotics and IV nutrition.

Neil visited Penelope on Sunday and her big news is that she's moved to an "intermediate" nursery since she is doing so well.  Her apnea and bradycardia episodes are minimal and largely all self-resolved.  She is still on Vapotherm and her rate was lowered from 3 liters to 2.5 liters.  Her weight is up to 780g (which is what Isaak weighed at birth).

That's all for now, but hopefully there will be more good news to come.  We still have a long road ahead of us.  There's a lot of uncertainty especially where Isaak is concerned.  So please continue to keep us in your thoughts and prayers.

Just a Tiny Update

Hehe. OK, so both of the little guys had a great day. Penelope is now on a device called a Vapotherm. It's essentially a heated and thoroughly humidified oxygen feed through a tiny nasal cannula. Frankly, that is absolutely amazing. She may very well wind up back on the CPAP but in the meantime she is enjoying a bit of time with a lot less bulk on her head. You can actually see her little face all the time now.

Isaak had a followup echocardiogram this evening to examine his Patent Ductus Arteriosus. The results reveal that he still has a small PDA. Yep, small. Previously it was classified as large so this is definite improvement. Little guy does not have any of the most concerning symptoms so the plan is to observe him and hope that A) It does not grow and B) It heals on its own. If symptoms worsen, the possibilities include another round of neoprofen treatment or, as mentioned before, surgery. He is still on SiPAP but is doing very well and is pretty much staying on room air concentrations. The transfusion really did wonders for these little guys. They will probably need another in a week or two, but it's really nice to visit them and not have constant monitor alarms going off.

Both babies are back on breast milk. Penny is up to 14ml and they have doubled the HMF in her feeds. This provides extra vitamins and calories and hopefully will spur additional weight gain. Isaak was already back up to 7ml this evening (remember that stopped his feeds for the neoprofen dosing) and will likely be bumped again tomorrow.

Weight Gains, Head Ultrasounds and More

I'll go ahead and apologize now for this post in advance.  We're both pretty tired.  (It's amazing how traveling back and forth to the hospital wears on you.)  So tonight's update will be brief.

• Daddy got to hold Isaak tonight!  We've got pictures, but they'll have to wait until tomorrow.  Isaak was so sweet though.  You could tell that he wasn't really able to focus, but he kept opening up his eyes to look up at his daddy.  Neil and I have now held both our son and daughter.  =)
• Penny now weighs 710 grams.  Isaak weighs in at 810 grams.  Both are now above their birth weights of 650 grams and 780 grams, respectively.  A couple days ago they both hit their exact birth weight on the same day.  Could they already be showing us signs of their twin connection?
• The amount of breast milk each is receiving is steadily increasing.  Isaak is getting about 8ml every 3 hours and Penny gets 7ml.  Assuming they continue to tolerate their feeds well, they will get a slight bump in the amount every 24 hours.  If all goes well, they'll be on solely breast milk by the end of next week.  (No more IV nutrition!)
• Respiratory wise, Isaak is still the trouble maker.  He continues to have several apnea and bradycardia spells each day.  Most of the time he self-resolves or needs only mild stimulation to recover.  He has been taken off of the SiPAP and placed back on CPAP.  The nurses are trying to suction him more frequently since he seems to have more gunk in his nose and throat than his sister does.  Penelope has occasional "A's and B's" - as they say in medical parlance - but nearly all of hers are self-resolved.  Neil and I have tried to get her to talk with her brother about these things.  So far, though, she has refused to set him straight.
• Despite several attempts, there is still no PICC line for Penny.  They may have to do just a plain ol' IV for her.  Her UVC in her umbilical cord is still in and still working well, but it will need to be taken out soon.  After 10 or so days, the risk of infection outweighs the benefits it provides.
  
• One of the many things that preemies often experience is a bleed in the brain known as an intraventricular hemorrhage (IVH).  So last night both Penny and Isaak had a head ultrasound. Penny's showed a mild Grade 1, possibly Grade 2, IVH that was isolated to the right side of her brain.  Isaak had a Grade 1 IVH on both the left and right.  Short-term and long-term outcomes with Grade 1 or 2 are very good.  In fact, most doctors and nurse practitioners that we've spoken with say that there is nothing to be worried about.  To be on the safe side, a second head ultrasound will be done in about a week.  This is done just to monitor and track the size of the bleed.  (Who knows...full-term babies may also have mild IVH's, but they aren't screened for them.)
  
  Thank you all again for the many prayers said on our family's behalf.  We sincerely appreciate every one of them.

Penelope and Isaak - Day 4

We hope updates decrease in frequency pretty soon but I know we have an anxious audience refreshing their browsers like mad waiting for the next update. At this early stage in their little lives each day is a big deal and everyone wants to know what is going on - we understand.

As of now, things look pretty good. Both babies seem to be tolerating mommy's milk well and it's really cute when they're fed. You put just a drop in their mouths so they can taste it and you can see their little lips smacking on the yumminess. Next they get a 1ml bolus feed through their tube. This allows them to associate the taste and sensation of the breast milk with having a full belly.

For those mommy's out there, Bekka is producing 2-3oz of milk every 3-4 hours. This is fantastic given the preterm delivery - it takes a lot of effort to get milk volume ramped up that early. She's a champ! We now have our own basket in the ICN freezer so we can put plenty away to feed them as they begin to eat more.

Bilirubin counts are just about in the normal range today and there is a good chance they will remove the lights tomorrow. We'll be able to see their little eyeballs! The twins will be on and off the "bili lights" over the next few weeks, but coming off the first time is a good step. Weights are still looking good. Penny remains at 620g while Isaak has dropped a bit more to 690g. That is still a good number and he had a bit more to give up. They'll be upping fluids and calories to keep both of them no more than 15% below their birth weight. The goal is to get both babies back to that weight by two weeks of age. 

We happened to visit earlier this evening just as they were starting Isaak's evening assessment. The result is that we have a few great pictures of him, some with his eyes open and without CPAP! Mysteriously, I can't pull them off the SD card using the laptop so you'll have to wait and see those after I get back to house and get them down/uploaded. Penny was on her belly under the lights so no great pics of her. We hope we can get a good shot of her little face very soon.

During the assessment, Bekka was able to hold Isaak in two hands (inside the incubator) while they changed his bedding. That was a very sweet moment. When I get the pics up, it will give you a better idea of his size. We really hope to be able to do "Kangaroo Care" in few more days and really get to hold the little guys. That will be a special moment.

Bekka should be discharged tomorrow. She's recovering very well from her c-section. Today, she has managed to walked all the way down to the ICN several times, getting a little faster and more confident with each trip. Not only is she recovering from surgery, but also from being in bed for 3 weeks.

What an amazing wife I have.

Penelope's and Isaak's Second Day

Today has been a pretty good day. We went back to see the babies around 12:30 (boy did we both need sleep after being up 24 hours - and Bekka had a little thing called a c-section during that time!).

Both babies are still doing very well. They are under sun lamps to take care of the elevated bilirubin levels. Most impressively, both babies have already had a BM! That's a great sign that the plumbing is working well. We also found out that since being on CPAP, Isaak has had only 1 (one) instance of apnea and Penny none! Apnea is very common with these babies as they aren't used to having to do so many things at one time and their autonomous nervous system doesn't quite do everything smoothly sometimes.

The nurses in the ICN have take 3 photos for us. They are scans of so-so prints, but at least you can see the little guys. Just a warning that they are very very "real". Remember that they aren't quite done baking! In one of the photos, Isaak really looks like a little ET doll. You will also notice that their skins are red. This is due to the last two layers not yet having developed. That should happen in the next couple of weeks and they'll have more normal skin tones.

So many things stand in their way; from infection (their little immune systems are barely there) to high risks of cerebral hemorrhage and an increased risk of cerebral palsy. That being said, they have gotten off to a running start in their very young lives. Thanks for following their story!

Friday Night Twins' Birthday Update

Tonight things are going pretty well.

Bekka continues to recover from her c-section and they should have her up and walking around tomorrow.

We made a visit to the twins this evening around 9pm. It's amazing how well they are doing. Both of them are on a bubble CPAP machine without supplemental oxygen. That's really incredible for 25 week babies on the day they are delivered.

Isaak has some bruising due to the delivery and his bilirubin levels are elevated. His little liver isn't really fully working at this stage of development so to help him out, he'll likely begin tanning sessions tomorrow. Penny is doing great and both of them have maintained their birth weights. They are likely to lose a bit of weight, but this is a good start.

We were able to see some really cute yawns and stretches and some funny but painful looking hiccups. Poor little guys shake their whole bodies when they do that!

If they are doing well, I'm hoping to make it by the house to scan some pictures taken by the nursing staff. (We aren't allowed to take pictures at this stage - we are anxiously awaiting the day).

The ICN staff has been fantastic - well really the whole OB and pediatric staff at WakeMed has been looking out for Bekka and the babies. Looks like we'll be seeing them awhile longer...

Thanks for the kind words, thoughts and prayers. Keep them coming as these little guys can use the support!