Updates on Nolan

I wanted to share a little bit more about kangaroo care for those who don’t know anything about it. It’s pretty neat stuff!

Kangaroo care involves placing the baby in skin-to-skin contact with the parent (most research has been done on kangaroo care with mom, but dads can do it, too). Baby wears only a diaper and maybe a hat, and is placed on his stomach on mom’s stomach, with his head sideways between her breasts so he can hear her heartbeat. They then get wrapped together to keep baby’s outside warm.

Kangaroo care “originated” (I know, it’s more like “back to what we used to do”) in Bogota, Columbia in 1983 when some doctors tried it because they simply didn’t have enough equipment, beds, whatever, to keep babies warm. They had moms hold babies in kangaroo position pretty much non-stop as a kind of emergency measure, and discovered that infant mortality dropped very significantly and the babies were able to go home dramatically faster! It has since been adopted by many NICUs in the US and elsewhere, and studies have been done that mostly support these amazing results.

In some ways, it seems self-evident that having mom and baby together would be good for baby, but the cool thing is the specifics of why it’s good, and how that goes against some basic preemie care rules (like, reducing movement and transfers of baby as much as possible because those cause baby to work much harder to stay stable). Here are some of the things that happen with kangaroo care:

• temperature synchrony: mom and baby regulate each other’s temperature. When baby gets cold, mom’s chest temperature goes up to compensate. Apparently it works in reverse, too, though I imagine mom can do a pretty good job of regulating her own temperature.
• improved breastfeeding: the close contact increases mom’s milk letdown and babies are much more likely to begin breastfeeding spontaneously.
• respiration and heart rate improvements: doctors, nurses and parents have noticed decreased apnea episodes, decrease in ventilator oxygen requirements, decrease in brachycardia episodes, and a more stable heart rate.
• more restful sleep: we can all relate to the importance of that one!
• more rapid weight gain: possibly because of the more restful sleep, which allows conservation of calories
• faster discharge: many babies are discharged significantly faster
• parents benefit, too: the NICU can feel like a very powerless place for many parents, and kangaroo care allows parents to take a very important role in the care of their baby. Plus, obviously, you get to hold your baby!

Just so you know, I’ve gotten most of this information off the internet. It’s probably not all exactly right, but I think it’s not too far off, either. Here are some sites that talk about it if you want to read more:

• Wikipedia
• Midwifery Today
• Prematurity.org

Pretty nifty, huh?

-Maria

Here’s a picture of Kara holding Nolan!

i just wanted everyone to know that nolan is stable, he is slowly being weaned off the ventilator, his weight is up and drumroll please, kara held him for the first time today, in kangaroo care position which is flat on her chest. thank you everyone for your thoughts and prayers and keeping the love generation.

Today we are trying to figure out what to do with ourselves now that we can’t convene at the hospital as easily. (The NICU waiting room is not a comfortable place to be for a long time.) Spending long days in the hospital isn’t fun, but it does give you a place to be together and a way to get information as it is available.

Today the news is good. They’ve begun the slow process of weaning Nolan off the ventilator. They started by reducing the tidal volume a little bit. Today they will also start feeding him a bit of Kara’s milk by tube, which will help him get the many benefits of breast milk. Yay!

He looks good, and especially stylish because he has a glowing fiberoptic blanket under him and blue lights over him to treat jaundice/excess bilirubin (a common problem). He wears a mask to protect his eyes from the light therapy. And, he has a glowing red foot! (I’m not sure what it is, but I’m guessing it is some kind of sensor.)

Kara was discharged from the hospital tonight (Monday) and went home for some quality dog love and (we hope) some quality sleep. It was nice for her to be in the hospital because it made it very easy to visit Nolan while still having private space, so it isn’t entirely good to be leaving. However, it’s really hard to get a good night of sleep in the hospital, so we hope that’s one thing that will improve now that they’re home. They live about three miles from the hospital, but traffic and parking are a pain so it isn’t quite as easy to just stop by for a visit as we would like.

Ronan’s parents, Susan and Robert, had to return home today also. Please keep them in your thoughts and prayers, as it is very hard to be far away, unable to visit, give a hug, or just sit with Kara and Ronan. The rest of the family will miss them, too, as they were a strong, calm, steady, loving presence in the waiting room with us.

Today Nolan’s “tent” was removed. This is a milestone marking the end of the first 72 hours — the tent is a plastic box over the bed that preserves a humid environment, presumably to help Nolan transition from the womb to the world. It’s removed after 72 hours. They do keep a heat lamp on him to keep him toasty warm. (The NICU is a much warmer place than the rest of the hospital!)

Nolan looks good and is squirming around. His CO2 numbers remain stable, which is great.

The family is camped out in the waiting room of the sixth floor of the women’s hospital, where Kara is staying. It’s a nice waiting room and we’ll be sorry not to have it once Kara leaves the hospital today. We’ve rearranged the furniture so we can all sit together, and there’s a fridge where we can keep food for Kara and Ronan and ourselves. Ronan’s parents, Susan and Robert, have come from the mountains, and his brother Shannon flew in from Salt Lake City last week once he heard what was happening. On Kara’s side of the family, we have her parents, Carolyn and Lynn, and her sister Maria (me) and sister’s partner Deb, all camped out in the waiting room with Ronan’s family. Kara’s brother David and his family visit as much as they can.

We are really feeling the rollercoaster of emotions today. There is so little information and what information there is, is hard to interpret because it typically boils down to “this finding correlates with this outcome to some degree, but we really won’t know for XXX time.” Yesterday was hard because the CO2 situation meant they might have to put Nolan on a bigger, more powerful ventilator, and our gut tells us that increasing equipment is a bad thing. When they didn’t have to put him on the bigger ventilator, we all felt relieved and relaxed somewhat. Today, we have gotten the results of the brain ultrasound, which showed a grade 4 bleed in the right side of Nolan’s brain. That correlates with an increased risk of developmental disabilities and cerebral palsy, though we really don’t know to what degree the risk increases. We were pretty wiped out after getting that news.

As far as the bleed goes, it is hard to say what it means exactly. It is of course a concern, because every problem complicates the picture and adds more stress to Nolan’s whole system. Cerebral hemorrhage is graded from one to four, with one being minor. The fact that the bleeding is on only one side of the brain is good. It is possible that the bleeding will spread to the other side, so we are praying that won’t happen. They will do another ultrasound in a week or so to check the status. The bleeding will resolve on its own at some point and there isn’t anything they can do to hasten the process. That means that knowing the status of the bleed doesn’t change anything about treatment. The main thing we look to is what the brain looks like after the bleeding has resolved. That’s not a question that will be answered in the short term, as I understand it.

More information will be posted as it is available…

-Maria

Kara will be discharged from the hospital later today, so she and Ronan will be heading home again for a happy reunion with the dogs.  They may be spending a lot of time at the hospital.  Once they’ve had a chance to settle in, we’ll try to update here about when they’ll be rested enough for visitors.

Food for them is covered for the next week.  If you want to join in the food brigade, Kirsten has organized that so far: kwkrueger2003(at)yahoo.com.

The NICU staff told us early on that the first 72 hours were a very critical period. Those hours weren’t without their ups and downs, but Nolan made it through, and even closed it up on a high note! We’ll take every bit of good news we can get.

The primary concern of the day was Nolan’s CO2 exchange, which wasn’t good. There were some tricks with the ventilator that eventually led to an upturn with the CO2 situation. It’s not back to where they’d like it to be, but it’s not declining anymore, so we’re pleased with that.

There are other tests and evaluations ongoing always, but the good news is that there are many systems they can definitely say are doing well. Urine output is good, blood pressure is good…

They have had to draw blood for various tests over the last few days, and we’ve learned that even a small blood draw takes a lot of blood out of our pint-sized baby, who doesn’t have much to spare. They’ve had to do blood transfusions to keep the blood volume up (not unusual in this situation). As I understand it, an infant of this size has only about 10 teaspoons of blood in his body!

That’s the last of the news for the evening…

-Maria

We finally have confirmation that Little Critter is a boy.  Drumroll, please…  His name is Nolan LaRue Ikenberry Peterson.

The NICU has very strict rules about visiting, so not many of you will have the opportunity to see in person how beautiful this little one is in the next few months. Here is a picture to give you an idea.