Posts Tagged ‘NICU’

Our latest baby-feeding challenges

Monday, January 23rd, 2012

Week 1 (Oct 11)

The day Sam and Cate were born, post-delivery hemorhaging left me too weak to go to the NICU to see our babies, never mind nurse them. Further, they were really too little to nurse, but they needed to eat every three hours. So they took Neosure formula from a tiny bottle, just 1/3 of an ounce (~10 ml) at first, working up to an ounce at each feeding. The little 2-ounce bottles looked enormous next to their tiny faces. As preemies, they were so very sleepy that it was a challenge to get them to eat that much. We were only allowed 30 minutes to feed them each time, because the nurses explained that the energy required for all that sucking would quickly exceed the calories they took in.

Bill’s first “daddy nightmare” was about not being able to get Sam to eat, and he made a point to be in the NICU for the 9:00 am, noon, 3:00 pm, 6:00 pm, and 9:00 pm feedings every day to master the skill. I was only strong enough to go up to the NICU once a day, and I had less luck getting girls to eat. On several occasions, the NICU nurses took back the baby I was attempting to feed after 20 minutes to help make sure she got the nutrition she needed within the prescribed time window. The grandmothers, Baba Jean and Gram Nancy, came to the NICU on several occasions to help and learn, too.

Each baby was tethered back to her isolette, with monitors tracking their heart rates and respiration rhythm. Breathe-suck-swallow is a complicated set of motor skills, and we had to pay attention, and let them rest when they got overwhelmed. To burp the girls, the NICU nurses insisted that we sit them on our knee, holding their chin in one hand while thwacking their backs with the other, much harder than seemed appropriate for such tiny babies. Cuddling them close resulted in them falling asleep almost immediately.

Week 2 (Oct 18)

Once we were home, we continued to feed the girls when they woke every 3-4 hours. As their mouths got stronger and their stomachs grew, they quickly worked up to two ounces at each feeding. With single-minded purpose, the girls would now finish a bottle in 4-6 minutes, sometimes taking only one break in the middle to pant and catch their breath. They sucked so hard they often collapsed the bottle nipple, and at their two-week check-up, Dr. W found “sucking blisters” on their lips, exacerbated when we weren’t careful to make sure their lips were flanged out around the nipples. Dr. W encouraged us to stop using the prefilled formula and Medela breast milk bottles and begin using our Dr. Brown’s bottles with an internal vent stack to reduce pressure in their mouths.

As my anemia improved and my strength returned a little, I also nursed each of them during two feedings a day as I was able. But I only made enough milk for each of them to get half a feed from me. So even when they nursed, they also took some formula. I would nurse one baby on one boob, then hand her off to Bill to take a bottle while I nursed the second baby on the second boob. After we finished nursing, I would then give her a bottle.

Week 3 (Oct 25)

I continued to nurse each of the girls twice a day, and after renting a baby scale, we began tracking how much milk they were able to get from me. With more nursing and more pumping, my breasts produced more milk, and I hoped that I’d eventually make enough to nurse them exclusively. However, the plastic flanges for my breast pump were chafing the areola around my nipples, and it became increasingly uncomfortable to nurse or pump.

Week 4 (Nov 1)

The red, raw, chafed area on my left boob became visibly infected. Concerned that I had developed a yeast infection. Regarding their milky white tongues, I worried that our babies were getting “thrush”, and I switched to pumping exclusively for several days. We made plans to see doctors first thing the following Monday morning.

Week 5 (Nov 8)

The pediatrician checked out the girls and assured us that they were perfectly normal and healthy. Meanwhile, a lactation consultant recommended a (nearly useless) topical goo for my boob and discouraged me from taking any antifungal medication.

gas and simethicone?

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Week 10 (Dec 13)

Catie became more selective about latching to nurse. After an initial spell, she would wiggle and dismount. Then she would open her mouth eagerly like she was hungry for more, but repeatedly let my nipple graze through her open mouth without latching. At the time, I couldn’t figure out why. By the end of December, Catie began resisting bottles altogether. After nursing, she would make hungry-looking fish mouths with protruding tongue, but when we presented a bottle, she would resist latching on to the nipple. We brainstormed possible causes and remedies: Does that nipple smell like dishwashing detergent? Do we have a bad batch of formula? Has she decided that she prefers breast milk? Burping her and swapping out nipples only occasionally led to her taking the bottle. Catie’s total consumption decreased dramatically, and as a result, her rate of weight gain fell further behind her sister. As the problem worsened, we became increasingly concerned. Slowly, Sam developed some of the same issues, though to a lesser extent.

Week 12 (Dec 27)

After a week of increasingly sporadic eating, we called the pediatrician’s office and learned that their behavior was typical of babies suffering from acid reflux, when stomach contents seep into the esophagus and throat. She said reflux is common among preemies, and reassured us they will grow out of it eventually, six to nine months from now.

In the meantime, she encouraged us to keep girls upright at least 30 minutes after each feeding, and to feed them less milk/formula more often, in case trying to manage our daily routine with two babies wasn’t already challenging enough. Bouncy seats, to keep their heads elevated relative to their bellies, have become essential gear. She also “prescribed” propping the head of the crib mattresses on phone books.

In this age of internet search, we have already recycled all of ours. And we wonder: will these girls ever need to know what a “phone book” was?