Penny loves being at Home and Isaak is Complicated

First the short update: Penny is doing great.

Really, that's about it. She had her first visit with her regular pediatrician on Friday and a follow-up today to make sure she is gaining weight. She gained 2.5 ozs over the weekend (for a grand total of 5lb 15oz) so we are supposed to just keep doing what we are doing. She is being fairly merciful to mommy and daddy by sleeping 4 to 4 1/2 hours at night after her big bottle. Mostly, she eats, sleeps and goes with mommy to see her big little brother (or is that little big brother?)

Isaak, well, he's doing OK, but his story is, as usual, more interesting (strictly in the Chinese proverb sense, of course). They managed to get him up to 12ml per hour of milk via g-tube on Thursday. They have been holding the line since, as while he's not dumping, everyone feels he's at some borderline state. They have bumped the calories a bit on his feed so they don't have to increase his TPN quite as much. He's getting a total of 3ml per hour of TPN and IV lipids so that's 80% of his calories via g-tube, which is fantastic. Even so his bilirubin has continued to climb a bit at a time. It's not really really high, but it's over 5 so they'll be keeping watch on that. It may or may not be related, but he's also a bit anemic,with a hematocrit (red blood cell) count of 25.8 (30 being normal) and a reticulocyte (immature red blood cell) count of 1.8 (5 being normal). Bilirubin is made up of the remnants of red blood cells and his seem to be going somewhere...like I said, may or may not be related. He's still on very low flow oxygen (50ml per minute). We would not be surprised if that stays the case while he is anemic.

The edema seems to be much better. They cut his lasix course short because he was doing so well and apparently is peeing up a storm. Let's hope that continues. Positive news is always welcome!

A big concern we have not previously shared revolves around his eyes. Preemies are very vulnerable to a condition called Retinopathy of Prematurity, or RoP. As has been their pattern, Penny has shown very little evidence of RoP and nearly has mature eyes, while Isaak has had more difficulty. His right eye is in "Zone 2" of development with "Stage 3" RoP. Not great, but also likely to self-resolve. His left eye is also "Zone 2" and "Stage 3" but has exhibited significant hemorrhaging. The ophthalmologist, while not entirely optimistic, does indicate it's not unlikely the situation will resolve itself. If it doesn't, he may have to have some of the hemorrhage removed from his left eye and possibly have laser surgery. They have been following him weekly and the next update will be on Friday. Outcomes are generally positive with surgery nowadays, but man do we not want to go there. This poor little fellow has seen more surgery in his short life than most people ever do.

So while all that doesn't sound particularly positive, Isaak really is doing well. He can be very alert and loves to be cuddled and to be (dry) fed by his mommy. The little guy is strong enough to actually try rolling himself over nowadays (can't do it, but does try if he's not swaddled).