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Monday, October 25, 2004  

Status Report

M. Tiny’s still in the hospital, and it looks like he’ll be there for a little while longer. Sometimes they tell us two weeks, sometimes they tell us seven to ten days. It’s already been two weeks, so theoretically we could be at the halfway point. It’s pretty much up to him.

There are four criteria for letting a preemie go home from the hospital. They are as follows:

One: The ability to maintain a steady body temperature. He graduated from the incubator more than a week ago, and now he spends a lot of time sleeping with a hat on, wrapped up in blankets tighter than a burrito from Chipotle. He has a routine that he goes through every three hours: taking his temperature, changing his diaper, a listen through the stethoscope, and a feeding. By far his least favorite part of this is the temperature. He absolutely hates having the thermometer jammed in there.

I think he’d actually prefer it if we stuck it up his ass.

For some reason, he gets really irritated when we take his temperature via the armpit. I think it’s just because he doesn’t like having his elbow pinned against his side for the time it takes to get a reading. By contrast, when a nurse collected a "butt culture"—which involved poking a cotton swab up his fundament—he took it with total equanimity. But on the other hand, there’s a big difference between riding a Q-Tip and riding a thermometer.

Or so I’m told. Status: Complete.

Two: The car seat test. I don’t remember car seats being such a big deal when I was little. In fact, I remember my two-year old cousin riding standing up in the front seat of the car. The fact that that same cousin is now married and pregnant should give you some idea how long ago that was.

These days, you’re not even allowed to bring a baby home unless you have a suitable car seat. And the baby has to be tested in it.

I thought making M. Tiny undergo a test for the car seat was a little unrealistic. I mean, really, how often are we going to require him to fasten himself in it? Hardly ever. Then Trash explained that it’s really the seat that’s being tested, and we do the strapping in. That made a lot more sense. But then I got the alarming visual of what that test might entail; would we strap him in and then attempt to tip him out? Is it an automatic failure if inverting the seat dumps him on the floor just one time, or do they make us try for two out of three? Then Trash explained about how they just look at where the straps go across his body, and I abandoned my plan of smuggling him out in a laundry sack so as to spare him the ordeal I’d imagined.

As it turns out, Trash’s grandma got us just about the best newborn car seat you can buy. It’s got the highest safety rating, the best restraints, the toughest construction, everything. I’d sit in it myself. But M. Tiny is too small for it, at least for now. We’re just going to have to get an interim car seat until he grows into the newborn one. Unless he grows into it before he’s allowed to leave, which would probably require us to stick ice cubes under his armpits before we take his temperature. Status: On hold.

Three: Consistently finishing bottles for three days. Right now, every three hours, he gets forty-some cc’s of formula in his belly one way or the other. If he’s awake enough, we’ll start with the bottle. Full-term babies are generally born knowing what to do with a nipple. That’s the sort of thing that’s supposed to get hard-wired into their brains during the thirty-fourth or thirty-fifth week of gestation. Which is where M. Tiny would be now if his gestation hadn’t ended two weeks ago. So we need to sort of train him.

It’s difficult to train someone to do something when he doesn’t understand a word of English, or indeed a word of any language on Earth.

At first we were all cuddly and attentive and encouraging during his feedings. He loved the attention and the love and the snuggling, but he wasn’t making much progress. Now we balance him on one forearm and practically ignore him so he can concentrate on his job, which is eating. Tonight when he decided he was finished, he only had seven cc’s left.

As I may have mentioned before, the portion of the feeding that doesn’t get sucked in through his mouth gets forced in through a tube that goes up his nose. Now, I’ve been to some restaurants where they’re a little aggressive with the dessert cart, but this is ridiculous. Status: In progress, and at the very least, three days out.

Four: Demonstrated independence from the heart-rate and respiration monitors. There’s a screen over his bed that used to monitor his pulse, breathing, and blood-oxidation level. The latter got too boring, always hanging around the ideal numbers of 99 and 100, so he got unplugged from that. He’s still got the other two.

Before a patient is released from the NICU, he or she is hooked up to an instrument called an MMR or something. This basically records every moment of the EKG and respiration monitors for twenty-four hours. What the doctors look for on the record is a total lack of things like apnea, asystole, tachychardia, myocardial infarctions, and other things that set off automatic alarms. The MMR test is typically done one to three days before the patient’s release. M. Tiny isn’t that close to the exit yet, but his readings tend to be pretty steady so the nurse practitioner decided to let him take a crack at it, just to see how he’d do. He got plugged into it this afternoon. We were instructed not to disturb him any more than necessary, in order to prevent spikes in the readings.

Tonight, my quiet, sweet-natured boy had his first totally unprovoked temper tantrum, working himself up into a state of unexplained rage while I sat by his crib reading to him. He took his first "super-gulp" during a feeding, a not uncommon phenomenon whereby babies apparently get tired of eating and breathing at the same time and decide to see how long they can concentrate on just the former. And he pulled that feeding tube partway out of his nose, requiring the nurse to slip it back in and retape it to his face, always a favorite experience for him. Status: Almost certainly in need of a do-over.

So it could be a while. It could be a couple of whiles. A lot of it is up to him. He sets the pace. I just hope he decides to come home soon.

Today’s best search phrase: "The Pieter Vanden Hogan Band." That’s totally the name of my next side project.


posted by M. Giant 9:33 PM 9 comments

9 Comments:

You're really right about car seat stuff being different now. With all the unsafe car riding, dangerous playground equipment and whatnot, it's amazing any of us born before 1980 actually survived.

By Blogger CanadaDave, at October 25, 2004 at 10:14 PM  

I think the issue is he just doesn't understand yet that his own room at home is even nicer than the NICU over at Our Lady of Perpetual Physical Plant Improvement.

http://www.peds.arizona.edu/neonatology/discharge.html

Arizona (see link) has guidelines saying that THEIR babies can go home even with little 'self-limiting apneas' like M. Tiny has. You can forget to take a breath now and then, so long as you don't turn blue or slow your own heart down when you do it. Nice of them, eh?

Heck, I bet in Arizona, he could drive home, and do better than half the people on the road.

By Blogger Febrifuge, at October 25, 2004 at 10:46 PM  

Man, I go away for four days and the kid learns to eat.

By Blogger Linda, at October 26, 2004 at 5:10 AM  

M. Tiny: So young but already so in control of his parents' lives.

I love it! (I'm a little bit evil.)

By Blogger DeAnn, at October 26, 2004 at 12:04 PM  

Love reading about M. Tiny's goings ons. My little one (now 6 months old) was born 5 weeks early and underwent the carseat test. In our NICU the baby gets strapped in there with the blood oxygen monitor thing hooked up. She had to sit there for however long the car trip home was going to be just to make sure her breathing was okay. I guess with their floppy heads (actually is it the neck that is floppy?) they can end up pitched forward a bit and reduce their ability to breath efficiently. Luckily she passed and we were able to take her home. I remember thinking she was pretty good sized until I saw her in that carseat. She was looked about 50% smaller than real life. It was kind of funny and sad at the same time. Luckily she slept through the whole thing so she couldn't see my expression. She also had to be gavage fed. We got really good at trying to take her picture from the side in order to avoid having the big ol' tube in the photo. Woo hoo, preemie fun! Anyway, congrats to you and Trash!

By Anonymous Anonymous, at October 26, 2004 at 12:44 PM  

That armpit-temperature thing is apparently common to most newborns. I noticed that my newborn (who was born basically on time and average sized) also threw a complete hissyfit every time they took her temperature under her arm, but had no problem with a thermometer in her butt. I asked the nurse what that was all about, and she said they all seem to react that way. Her theory was what you suggested--that they just hate having an arm pinned down like that--and that they're just too little to notice the rectal thermometer...yet.

Congrats on the continuing vitality of M. Tiny!

By Anonymous Anonymous, at October 26, 2004 at 1:06 PM  

My son got sent home from his stay in the NICU with what became known as the Damned Apnea Monitor. Most preemies are sent home with one, and it's this contrraption about the size and weight of a medium purse filled with bricks, only with more wires. Anyway, any time my son would sneeze or cough or have gas, the Damned Apnea Monitor would blare louder than 1,000 car alarms. They make them that loud so that you can can hear them from another room, but holy moly. I found I could go from a dead sleep to six feet in the air horizontally when the Damned Apnea Monitor would go off.

I do have to say, it sounds like M. Tiny is doing fabulously. You'll have him home in no time!

-Ellie

By Anonymous Anonymous, at October 26, 2004 at 4:31 PM  

When I work in the pediatric section of the emergency room, every patient has to have a temperature taken. With kids under the age of 3, there's only one reliable way to do that -- and it is not very polite. It's also my job. I sometimes wonder how many TC-area kids will grow up to become subconsciously uneasy around bald white guys, knowing only that it's vaguely butt-related... but not knowing why.

Anyway, I can attest that many little tikes can be sufficiently distracted that a thermometer probe up the nether regions is no big deal. But it's by no means all of them. Others assume that they're being murdered in some Shakespearian way, and defend themselves with whatever combination of clenching, squirming, screaming and pooping they happen to come up with at the moment. My most worthy foe so far was 6 days old.

And hey, thanks to the earlier poster for pointing out it's "gavage," and not "lavage" like other tube-and-fluid-related stuff usually is. I learned somethin' new today. Sweet!

By Blogger Febrifuge, at October 27, 2004 at 10:15 AM  

My sister in law gave birth to nephew elder at 8 am - she went home w/ child at 11pm the same day. We did not know she was going home. We drove from Manhattan to Brooklyn w/ a newborn in his very hurtin mom's arms in the backseat of a car. It was pouring and possibly hailing. Needless to say, we were driving very very slow. and when nephew #2 we were prepared w/ a carseat.

Libragirl

By Anonymous Anonymous, at October 27, 2004 at 4:34 PM  

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