NICU information

A neonatologist finally came to see me today to talk about what to expect in the NICU. She spoke mostly in terms of, "Well, once they get to be 32 weeks..." The NICU folks seem to have two major milestones - 28 and 32 weeks.

Once the babies get into the NICU, they'll get started on IV fluids and put in a warmer. How things go from there depend on how healthy they are. At a basic level, we probably won't be able to hold them much until they are more stable. We can be with them and hopefully hold them every three hours during care sessions (diaper changes, feedings, etc). The longer they stay in me the more likely we'll be able to hold them and bottle/breast feed sooner. Also, if they come out healthy-ish, we can start "Kangaroo Care" or skin on skin contact. If we can't hold them right away, we should be ale to hold their hands or stroke their faces (this is where you can cue my tears). The length of their stay obviously depends on how far along they are and how healthy they are. She said that babies born at 32 weeks are typically in there until 36 or 37 weeks. Babies born earlier usually have to stay until they would have been considered term babies. The girls will be allowed to co-sleep with each other once they are off some of their tubes. Speaking of tubes....

Here's what we can expect in terms of equipment and monitoring:
1) A cardio-respiratory monitor to measure heart rate, temperature, blood pressure, and breathing.
2) A chest tube to keep air from getting inside the chest. If air gets inside the chest, it makes it harder for the lungs to expand and breathe.
3) An endotracheal tube (ETT) that goes from the mouth or nose, past the vocal cords, and into the trachea. This is called intubating and it assists breathing. The kind of sad thing is that because it interferes with the vocal cords, we won't be able to hear any crying (again, you can cue my own tears at this point).
4) Feeding tubes. Preemies get fed by "gavage" or a method where a small tube is inserted into the nose or mouth and goes down into the esophagus and stomach.
5) An incubator to help the babies maintain their body temperature.
6) A ventilator to provide breaths of certain sizes at certain rates.
7) Catheters to allow them to take blood and give IV fluids.

We can expect a lot of neonatal tests including, but not limited to:
1) Blood tests for all sorts of things like infections, effectiveness of breathing, and other blood components.
2) Ultrasounds to look at brain hemorrhaging. She said babies born at 32 weeks usually don't get this. However, with mono/mono twins they'll probably do it no matter what because they're at an increased risk for passing blood clots to each other.
3) Depending on how old they are when they come out, a retinal eye exam.

Some of the problems they may have in the NICU include:
1) Anemia
2) Apnea (stops in breathing). She said that at this hospital, they don't really discharge babies with an apnea monitor for the home. Instead, they wait to discharge until the babies can go at least 5 days without an apnea episode. Apnea can occur with pretty steep heart rate drops. Almost everyone I've talked to with a preemie has had to learn how to tap on their babies to get them to breathe again.
3) Gastroesophageal reflux (GER) where the babies will spit or vomit up food.
4) Intraventricular hemorrhage (IVH) or bleeding on the brain.
5) Respiratory distress syndrome when the baby's lungs aren't fully mature.
6) Retinopathy which is an eye disease. I'm not sure, but I think this is mostly fixable with laser surgery.

And lots more - too many to list. In terms of lifelong disability, once we get to 32 weeks we'd be looking at learning disabilities, ADHD, etc. She said the earlier they're born and/or the sicker they are in the NICU, the greater the chances of these problems. The good news, I'm past 28 weeks so some of the really, really scary stuff is hopefully past. If they're born before 32 weeks they'd get an evaluation from a Part C agency (for those not in the "biz" Part C is the early intervention program. All of Alex's therapies came out of Part C).

I also asked (just because how the heck would I know) if the babies wear clothes in the NICU. She said not for awhile.

I think that's it.

Take care,
Kris