Day 5 - January 28, 2013

I think I've forgotten to mention a few things from previous days, so I'll do a quick review. Since the doctors were unable to establish umbilical lines in Aubrey, she was given a PICC line on Day 3 or 4.  PICC stands for Peripherally Inserted Central Catheter, which is fancy talk for an IV line that, in babies, is inserted in either the leg or arm and pushed up the vein until the end is right at the opening of the heart.  The nice thing about PICC lines is that they last a very long time compared to regular IV lines.  Also, really concentrated fluids, like IV nutrition (called TPNs), can be given through PICC lines.  The disadvantage of PICC lines is that they can cause infections.  Also, blood products can't be given through baby PICC lines, so if blood is required, a separate regular IV line has to be established.  All that information is probably way more than you want to know. Sorry.

Speaking of IV nutrition (TPNs), both girls are getting these, as well as some fat to give them energy and nourishment.  They won't be able to get any milk orally until they are more stable, which is believed to be in a few weeks.  Andrea has been pumping 8 times a day starting the day after the girls were born, and we put the milk, or whatever it is, in a freezer.  My opinion is that pumping is a very strange thing.  Hopefully this doesn't make Andrea cry, but I chuckle whenever I see her hooked up to that machine (which we get as a free rental from Kaiser).

Both girls are also getting about 2 to 6 chest X-rays each day.  These are done for a variety of reasons.  X-rays show how well inflated their lungs are, which then helps to make adjustments to the ventilators.  Also, X-rays show if the ventilation tubes and PICC lines are in the right place.  I'm not really sure what the long term effects from all these will be, but I don't think all that radiation does much good for anyone....

After all that text, you readers deserve some pictures.  This first one is Paige on her belly in a little nest thingy. If you notice the shades over her eyes, that means that she was also getting phototherapy due to increased bilirubin levels.

This next picture is Aubrey on her belly.  Note that the bruising on her face is still pretty bad.

Both girls really seem to like being on their bellies in the fetal position.  Usually their oxygen requirents go down when they're on their bellies. Both girls are kind of treated like rotisserie chickens.  They're constantly being turned, and their neck positions are also frequently adjusted.  Coming into their rooms the first time each day is always fun to see how they're positioned.

Since you readers are doing such a good job reading me, here's a bonus picture of when Andrea got to have our dog come visit her while she was in the hospital before the girls were born.

It had been almost a month since they had seen each other.

In the NICU, routine head ultrasounds are done every Monday and Thursday.  Being a Monday, both girls got an ultrasound.  Recall for Aubrey from Day 4 that an ultrasound had shown 8 mm of subdural fluid and a grade 1 bleed.  Today's ultrasound showed that the fluid had reduced in size to 5 mm, and the bleed was no worse.  That's good news!  That means that she might not have to get head surgery.  Paige's ultrasound showed no problems.

The girls' doctors could also hear heart murmurs in each one. My understanding is that most preemies have some type of heart murmur, so this wasn't a surprise to anyone. Both girls had an echocardiogram today, also, which is fancy talk for a heart ultrasound.  The results showed that both girls have a patent ductus arteriosis (PDA), and Paige also has a patent foramen ovale (PFO).

If you don't feel like clicking on those links, I'll briefly describe what that means.  Prior to birth, babies don't need to use their lungs, so the body creates a shortcut for blood to bypass the lungs.  When a baby is full term and takes his or her first breath at birth, these shortcuts usually snap shut and slowly disappear.  Since Aubrey and Paige are preemies, these shortcuts didn't snap shut.  Most of the time, a PFO isn't a problem, so Paige's doctors aren't concerned about that.   PDA is a different story, though.

If you looked at the hyperlink above for PDAs, what can happen is that the lungs will get too much blood pumped to them, and the babies will get symptoms of congestive heart failure and pulmonary hypertension.  Left untreated, that's bad news.  Sometimes PDAs go away on their own, but the twins' PDAs are both fairly good size, so that would be unlikely. The first treatment option is a drug called indomethacin.  This drug constricts the PDA shortcut to help it close.  If that doesn't work, then surgery has to happen.  As far as surgeries go, PDA correction is a fairly simple procedure.  If you looked at the picture in the link, you'll notice that it is not heart surgery.  The surgeon makes a small incision between the baby's ribs and puts a clamp on the PDA. That's pretty much all there is to it.

Imdomethacin, the drug used to treat PDAs, places babies at an increased risk for bleeding and for GI tract perforations (holes).  Due to Aubrey's lung bleed, she is currently not a candidate for indomethacin.  Paige has had no bleeding, so she was started on indomethacin today.  She'll get a dose once a day for three days, and then another heart ultrasound will be done to see if it worked.

Whew, that was a lot of information. You all deserve another picture.  Let me see what I have...... OK here's Aubrey in her open incubator with mom and dad on her birthday.