Pictures with Papa Doug

Here are the pictures that were supposed to be with the previous post..Papa Doug and Cohen! The Internet connection at the Ronald McDonald House is rather terrible and did not want me to post pictures! Cohen looks really big in the pictures, but that is because he was wrapped in 4 blankets! He is getting bigger though...I swear!

February 26, 2009

Happy Birthday Cousin Elizabeth!

Cohen had a really mellow day. He slept for most the day, and even through the nurse having to completely strip his incubator because he overfilled his diaper :) The nurse had me wait to do his 9am cares until he woke up, so by 11am the diaper was over its capacity for pee. The hold on cares (diaper, temp, and probe change) is due to the fact that Cohen’s sole job right now is to sleep and expend the least amount of calories on anything else but growing. So if he is not awake at 9, 12,3, 6, am/pm, then that care is held off until the next care time or until he wakes up. He won’t go more than two care times without care. Feeds continue whether or not Cohen is awake. Hooking up his gavage tube does not disturb him and he needs his calories.

Cohen continues to reflux, and is now actually spitting up some of his residual. The Doctor has increased the dose of his reflux meds, so hopefully this will help out. We are on a routine to up his oxygen about 45 min prior to feeds. Instead of having him work through episodes of de-satting prior to feeds, the increase in oxygen will hopefully make his feeds go much more smoothly.

At one point today both Cohen and his roommate were having episodes of A&B’s…together. They both had the same nurse and she had to stand in the middle of the room and wait and see which baby needed help. Luckily both babies are on caffeine so they were able to pull themselves out it. I was right there to help with Cohen if needed, but it was still rather interesting to see how a nurse would choose one baby over another. (And now I know why they don’t like to have the same nurse to one room of babies!)

Papa Doug and Mema Lodi arrived home from Hawaii/Portland today and stopped by for a visit. It was so nice to see them and for them to see how much Cohen has changed in the last 2 weeks! A whole 7 oz makes such a difference on a little baby, both Doug and Lodi thought he looked bigger and much more like a baby. Papa Doug was able to hold Cohen, but next time its Mema Lodi’s turn. It was news to me, but apparently Cohen is doing so well with his holding times that he can have more than 1 per day! Now if only I could just snuggle him all day long….

February 25, 2009

Cohen's incubator. The quilt was donated to the NICU, and one of Cohen's nurses snagged it for him. It is currently keeping the bright daylight out of his eyes.
This is Cohen's whiteboard. Every day the nurse puts her name up along with who the the buddy is and who the charge nurse is. All the parents of long term NICU babies have totally decorated their area. I am slowly getting there, but I am still in denial of how long we will be here. I tell Cohen about his big brother and I show him Carter's pictures so that he'll know who he is when he gets home. (Yes, I am fully aware that Cohen can't see anything at this point...wishful thinking)

Cohen had a great day! He did not have any A&B’s, and he’s up to 36cc/feed! He is not gaining very much weight on just the breastmilk, so his milk will be fortified with extra calories to help him put on weight. When he reaches 4lbs 12oz or 34 weeks, whichever comes first, he will begin learning to “nipple.” They will start with bottles first and putting him to empty a breast. The only bad part about having too much milk, is it is hard for tiny babies to figure out how to suck, swallow, and breathe without drowning…..we had the same problem with Carter :) Taking all feedings by nipple (bottle nipple or breast), and no A&B’s are Cohen’s tasks to master before he can be discharged. They would like him to be breathing without respiratory support (i.e. off all oxygen), but they do send babies home with oxygen. In talking with the doctor today, it still looks like we will be here until April.

Cohen is still battling reflux. The meds and elevated incubator don’t seem to be doing the trick. The good news is the reflux is not as bad as it could be, as he is not spitting out any refluxed residual. The only thing of concern is that his O2 issues episodes start about 30 to 45 minutes before he eats, and continues through his feeds, so his reflux is not limited to just feeding time. The doctor’s plan is to keep it under control with the current meds and see if he’ll just grow out of it. As a parent, it is frustrating to see him so uncomfortable and not being able to fix it!

The ROP eye exam will be done when Cohen is 33 weeks gestation, which is in 2 weeks. This is one of Cohen’s last potential premature birth complications. He still has a risk for cerebral palsy, but his doctor’s don’t see any outward signs of CP at this point.

I had a really great day as well. My friend Stefanie came and rescued me from hospital life and we had a new mom’s afternoon of Olive Garden, Nordstrom, and Baby Gap. I had so much fun just relaxing and doing something normal…thank you so much Stefanie!!

We are officially “Skypers”! What an amazing invention…I was able to see and talk to Carter and John tonight. Carter said “momma” and blew me kisses. It was so much better than just talking on the phone. John is doing such a good job with Carter, I am so thankful and so impressed. I can’t wait until my other boys get here!

February 24, 2009: 2 Weeks!

Cohen had quite the morning. I had just gotten to his room, said good morning to him and began to unpack my bag, when Cohen started de-sating. This is where his O2 levels reach the 80’s and the alarm goes off as the numbers continue to decrease. I went over to him, as I always do, to make sure his face wasn’t buried and his cannula was in his nose. Check, and check. Then, all of a sudden ALL of his stats crashed to zero: Respiration's and heart rate…I’ve never seen the nurses in his unit move so fast! They pushed me out of the way and began doing chest compressions and cranked up his oxygen. In less than a minute he was back to breathing. It was the scariest event we’ve had since his birth. The nurse said that this was fairly normal for preemies, and we are lucky that at 14 days old this is the first time his stats reached zero. Regardless of how “normal” it is, I wasn’t at all prepared for it.

He continues to have O2 issues. His oxygen was at 50% for most of the day, but at about 4:30 he was stabilized at 30%. The doctor still thinks it is related to reflux. Even though Cohen is on two meds for the reflux, he is still suffering. He sticks his tongue out like he is about to spit up and he makes a wincing face… throughout his feeds. He is up to 30cc/feeding so there is more volume in his tummy. He now eats in the “sitting” position. So instead of doing kangaroo time, I know hold him upright for an hour while the pump sends milk into his belly. Even with this, his gills started turning blue and his sats were still very low. The nutritionist will be contacted to see if thickening the milk would help with the reflux. His doctor is still considering the CPAP, but is going to give Cohen another day or two to see if any of the new ideas have an effect on him.

We moved rooms again! The baby we roomed with has a genetic condition that is not compatible with life, and his parents were taking him home to pass away. We moved to consolidate babies again, and also to give that family some privacy as they left. Very sad. But, our new room is fantastic and I told my favorite nurse that I wasn’t moving Cohen from this spot unless it was to take him home! We are in the room next to our first room, so it is in the back of the pod. We have the window area that is furthest from the door, and I get to actually look outside during the day! Cohen did well with the move, but when he got into his new room the natural light made him look extremely orange. His doctor was called and another liver screen and bilirubin level was ordered. I highly doubt it is his bilirubin because he stopped passing meconium days ago. His temperature was elevated at about 3pm, so he is currently naked to see if that brings down his temp. I am praying the elevated temperature was from the mounds of blankets and not due to a fever. I will be calling later tonight to check on him. The results of the liver screen should be back by morning.

February 23, 2009

Well, it finally happened; Cohen’s IV failed. The Doctor decided that there was no need for a new IV or a PICC line…so Cohen is officially IV free! He did really well during the procedure; he held my finger, sucked on a binky, and hardly cried. The tape was so sticky that his nurse had to cut the tape out of his hair. I was able to give Cohen a bath because his IV came out. I will say bathing a 3lb baby with cords, monitors and oxygen is not very much fun, and rather stressful. Like any baby, he was not happy when he was cold…but once he was dried off and had a new diaper, I wrapped him in a warm blanket and he was asleep in seconds. I am taking the warm blanket idea home with me….

Cohen is eating and pooping well. He is 3lbs 6oz. Due to the IV coming out, his feeds are increased 1cc/feed until he is up to full feeds. The medication for reflux is helping him, but he is still having oxygen level issues. He has one more day to resolve his episodes before he is put back on CPAP. When I left tonight he was still at 30% oxygen.

So, today was overall quite uneventful. I have a feeling that as Cohen continues to grow and get stronger these blog postings will become quite boring. But in this situation, boring is good!

February 22, 2009: Oh, Cohen.

Can you say "We look like Daddy"! Look how much the two boys look alike!


We moved rooms today in an effort to combine babies and make double rooms. We went from sharing a room to sharing a room…so we were already in a double occupied room. AND, the room we moved from continues to have Cohen’s roommate, all by herself. I’m still not sure why it was necessary to move rooms, especially because no consolidation occurred. I really liked our room in the back; it was quiet and we had the space farthest from the door. The new room is at the front of the pod and our space is the one right next to the door.

Regardless of the fact that I despise change, the move wasn’t very helpful for Cohen. His O2 sats were still having problems during the night, but changed for the worse with the move. He was on 23% before he was moved. During the moving process, the transport nurse hooked him up to the 100% oxygen tank for the short stroll across the pod. When they tried to put him back on the 23%, he was not having it. His nurse thought maybe the sensor was tired and John thought the calibration of the new room’s machine was different than the other room, but after checking both and having no positive result, Cohen’s oxygen was turned up. He was between 35-40% this afternoon. His Doctor was called because such a drastic change in oxygen is a sign that Cohen is headed back to the CPAP. The Doctor wanted to put him back on CPAP, but Cohen’s nurse convinced the doctor to try something else first. So, the route the Doctor is taking is to treat him for reflux. Cohen is now on two medications and it is the Doctor’s hope that the change in O2 sats is the result of reflux which could have started due to Cohen having an immature GI tract, the increase in feeds, and the fact he is no longer on the TPN fluids (which had zantac in it). He will be given 2-3 days of the medication to see if his O2 sats improve. If not, he will more than likely go back on the CPAP. Did I mention this whole NICU thing is a roller coaster??

We did have some progress today…Cohen pooped on his own! Twice! Yeah! He is also digesting his food well. He started the morning at 18cc, and by this evening he was up to 20cc, and by morning he should be up to 22cc! As I said before, the more breastmilk he digests the more the IV fluids are decreased. I can’t wait for that IV to come out of his head!

Today John and I found out that once Cohen’s O2 sats are regulated he will be able to have a window visit with Carter once a week! His nurse will bring Cohen, sans incubator, to the front door of the NICU windows so that Carter can see his little brother! Cohen’s nurse today said it was important for Carter to see Cohen so that he has a better idea of what is going on. At which point I thought to myself, didn’t I just tell you that Carter is only 16 months old??? He won’t have a clue what is going on until Cohen is home …and even then, I’m not sure what he’ll be thinking.

Speaking of Carter, he came home today! I went out into the hall to meet him and Cindy (John’s mom) and he looked at me and said “Hi”, paused, calculated in his head who I was, then came running to me…all the while calling me dadda and signing daddy. I went into the hospital just as he mastered the “momma” thing, so I will give him a few more weeks to figure it out again :) As I was visiting with Carter, John came out of the NICU…Carter looked at him, then looked at me, and sort of had a moment of not knowing who to go to. It was so cute, but so sad because it just showed me how much he has missed us. John and I are going to set up Skype so that I can see and talk to Carter more than just on the weekends. It is amazing how much he has grown up in the last week. He has more words and is pretty much running now. And the cutest thing ever…when I said “Carter, time to go bye bye” he bent over grabbed my Coach purse, put it on his shoulder and started walking and saying “bye, bye” , “bye, bye.” I tried to get a picture of it, but as soon as I got the camera out he dropped the purse and became more interested in trying to convince me to give him the camera.

I spent some quality time with Carter while John finished some homework. It was only 2 hours, but seeing as how it was the most one on one time I have had with him since Feb 1, it was perfect. Unfortunately, shortly thereafter John and Carter had to start making their way back to Moscow. This weekend went by way too quickly for my liking.

February 21, 2009: OUCH!

Poor Cohen! The new IV in his arm failed and there were no good veins in his other arm or legs, so now our little man is sporting an IV in his head! John said the first attempt at putting it in his head didn’t work, so they had to re-do it. Ugh! On a bright note, he loves having both arms free AND now he can wear his long sleeve t-shirt!

On to some good news....Cohen is making fantastic progress with his feeds. He is up to 14.5cc/feed! Due to such an increase, his lipids and fluids (the fats and nutrients) are slowly decreasing as his feeds increase. The goal is to have him at a point where he is getting all his nutrients and fats from breast milk and completely off the IV. He is still not pooping without the help of an enema. We are much happier with the order for an enema if he goes 24 hours without pooping. John did most of Cohen’s care time today, so he was in charge of the “effect” today’s enema had :)

Cohen had some problems in the middle of the night with his oxygen percentage. He did not want to come down to his 21% previous low, and fought pretty hard to keep it at 25%. His morning nurse tried again, and thankfully was able to get him comfortable at 21%. However, we watched the nurses play with his levels all day, but Cohen has decided that 23% is where he would like to be.

It is so exciting to have John here; it was a long week without him! I didn’t have to wait on the shuttle to take me to and from the hospital (on their scheduled times of course)! I absolutely LOVED seeing him interact with his son as he is the best daddy in the entire world. He didn't even hesitate when I left him (I had to pump!) to do care time even though he hasn't done it before! And watching him hold Cohen was priceless. However, it didn’t take John very long to realize that hospital days are long and tiring. In an effort to spend some time together away from the hospital, we tried to run errands in Spokane..but I found myself getting very anxious and nervous being away from Cohen for so long (and it really wasn’t that long). In the end I was able to spend some time with John and John was able to spend time with both Cohen and I. It was a productive Saturday. The only thing missing?? Carter! Who will be here tomorrow!!

February 20, 2009

The liver screen and labs came back clear, so Cohen’s lethargic demeanor is likely from growing. He was much more alert at times, but he also had some deep sleep that caused him to have a few minor A&B’s.

Unfortunately, the nurses had to up his oxygen to 30% (previously at 21%) because his O2 sats were hovering in the high 70’s, rather than high 90’s where they should be. It was lowered to 25% around 5pm. But in true Cohen fashion, he greeted daddy by decreasing O2 sats again, so he went back up to 30%. By 9pm, the nurse had tried several more times to decrease the oxygen percentage to his usual 21%, but had no luck. She was able to get him stabilized in the 90’s at 25%, so that is much better than 30%, but we would like him to be at the 21% he was at this morning. The goal is to get him using no oxygen…so decrease in percentages is what we are looking for, not increases.

Had a rough morning with feeds, but by the afternoon he got it together and digested his entire lunch time feed of 11cc!! Huge improvement of the 4cc a couple days ago. A big reason for the increase in digestion was he was given another enema to help him poop. All I can say is the enema had a positive effect….I just wish he had saved it for daddy :) He had 2 good poops from the enema, and that allowed him to pass more meconium.

John arrived around 5pm and Cohen’s nurse let us do care early so that John could get a full 30min of holding time before we had to leave for shift change.

We also had a visitor!! My friend Stefanie came to visit Cohen. She brought him some adorable preemie onesies and a “germ free” Tigger for his incubator. Tigger has a soft rattle to him, so I shook it for Cohen and he just looked around moving his head side to side. He then threw a fit because it was care time again, but as he was crying he kept stroking and grabbing at Tigger. It was adorable. Thank you so much for visiting us Stef, come back really soon!

In other news, Carter is 16 months old today…..where does the time go?

February 19, 2009

Today was a pretty mellow day for Cohen. He slept for a good portion of the day, but he did open his eyes during kangaroo time. During this Kangaroo time Cohen learned about how Jennifer Aniston still holds on to Brad Pitt’s phone messages. He was so interested in it that before I could finish reading him the article he was fast asleep. Ha Ha.

Cohen is not tolerating the increase in feeds, which is a little disappointing. The Doctor and I were hoping the increase would force his system to poop, but instead he is just not digesting the milk. It’s rather disgusting when the nurse sucks the left over milk in his belly into a syringe to measure it and then pushes it back in his NG tube. This is usually done right before the next feed, so that milk had been in his tummy for 3 hours! I know he can’t taste it, but I’ve certainly smelled sour breast milk and I can’t imagine how that feels in his poor tummy. Due to his lack of digestion, his feeds have been scaled back...again. Because of this, his orange color, and his change in alertness, the Doctor has ordered a lab draw to check for infection and liver function. We are praying for a negative result and hoping his problems are just due to an immature GI system.

I really hope Cohen’s system will learn how to process his feeds better in the next couple of days. This has been his only hurdle thus far, and while very minor, it is still keeping him from making great progress.

Cohen’s nurse put a NICU onesie on him so that he wasn’t so naked. (She mentioned something about babies this size needing clothes…like she really needed to convince me of the importance of clothing my child! I tried to explain to her that I have no ability to go shopping, and the gift shop didn’t have his size available…) Anyways, the onesie he is wearing in the pictures is for babies 3-5lbs…notice how huge it is on him! Oh, my tiny little guy….In about 18 years when Cohen is 6-5 I will look back at these pictures and laugh!

John is coming up tomorrow and Cohen and I can’t wait to see him (and the TV!). Cohen really enjoys playing with John’s chest hair and it keeps him entertained during kangaroo time J We love you John, and drive safe!

February 18, 2009

Cohen slept all day today! I think I only saw his eyes twice…he didn’t even open them during care time where I royally make him mad with changing his diaper and taking his temp. Don’t get me wrong he was still pissed, but he kept his eyes closed when he cried. I think he has just had so many changes over last few days that he is just worn out. One of these changes occurred this morning when his gavage tube was moved from his mouth and into his nose (nasogastric tube or “NG tube”). He is generally much more comfortable now than he was with the mouth tube, but he does not enjoy the NG tube come feeding time. He makes a really awful sound; it kinda sounds like he’s gasping for air, and I can’t say that I enjoy that much. His nurse said that would go away once he gets used to the NG tube.

Speaking of feeds, Cohen did remarkably well with the .6cc increase, that his doctor wrote for a .5cc increase each feeding! The goal for low birth weight babies is to get them to full feeds which is between 140cc/kg and 160 cc/kg. That equals out to 25-30cc/every 3 hours. Once he is taking full feeds, his IV can be taken out. However, those numbers are a huge contrast to Cohen’s reality of 4cc’s every 3 hours. He has a ways to go before he reaches full feeds. I was hopeful that with the newest increase that Cohen would make some progress quickly, but then he decided to not take his feeds at 3pm and 6pm at all, so that may put a damper on the newly ordered increase. Two steps forward, one step back.

Also, this afternoon Cohen decided to turn orange. Seriously, he went from a beautiful pink baby color to jaundice orange in a period of 3 hours, and of course after the doctor had made afternoon rounds! He does not have any lab work ordered, so the nurses are going to watch him and if he gets more orange they will request a check of his levels. It is not that big of a deal if he goes back under the lights, but I would like them to figure that out sooner rather than later! Cohen needs to start pooping so he can get the remaining meconium out of his system which will help with the jaundice.

Overall, the biggest concern with Cohen right now is keeping his IV site infection free and making sure he doesn’t catch any bugs while he is here. IV sites do not last forever and Cohen’s has been in for 5 days. The little veins are not as big as adult veins (shocking, I know) so IV’s fail much quicker in tiny babies than in adults. His nurse is a little concerned that the IV will not last through the night. If that does happen a decision will be made in regards to whether or not another IV will be placed or if a PICC line would be more appropriate. Either way he will have to get poked again, but the IV is less evasive than the PICC line. Both have their pros and cons, so we will just have to go with what the doctors think is best.

As you can see, Cohen is doing great. Like I said before, he has avoided 3 major complications that babies of his gestational age are at risk for. He has one last test before I can say he has avoided all complications, and that is the ROP exam. ROP stands for Retinopathy of Prematurity. It is a potentially blinding eye disorder that affects premature infants weighing less than 3lbs. The smaller the baby, the more likely the baby is to develop ROP. Cohen was in the 90th percentile for a 29 weeker, so I am hoping this will work in his favor for avoiding ROP. I am not sure when he will be tested for this, but I will of course update with any information I receive in regards to his results.

In other news…only 1.5 more days before John comes to visit!! Not that I have been counting the days, hours, and minutes…. (Though I have been counting the seconds with regards to Carter coming home…) I miss my other two boys and I cannot wait for the day the FOUR of us are back to living a normal life!!

February 17, 2009: 1 Week Old!!

Cohen had a GREAT day! He is starting to get rid of his “head gear.” His bilirubin level had another decrease, so he is officially off phototherapy and the sunglasses are in his memory bag (temporary until I either scrapbook it or find a box). And… because he has been doing so well keeping his oxygen sats up while on the nasal cannula, his Doctor wrote an order to stop the alternating CPAP/cannula and just have the nasal cannula. What does this mean? COHEN IS OFF CPAP!!! (and his little face isn’t covered with the scuba mask) This isn’t necessarily a permanent thing, as he has to continue to have consistently high oxygen sats in order to stay off the CPAP. So, potentially he could go back on it, but I know how much he dislikes the mask so I am hopeful that will be enough incentive for him to do well with the cannula. His A&B’s are very rare now, and usually only occur when the cannula is out of his nose. His little head is so small the tubing has a hard time staying in place…I’ve seen both prongs in one nostril, the entire thing blowing air into his eye and at one point I caught him with it in his mouth and sucking on it!

Cohen had two poops after the enema and tolerated all feedings today without any residual, which has earned him an increase in feeds. It is only a 0.6cc/feed increase (so he gets 2.5cc/feed total), but it is forward progress and that is what we like to see.

The antibiotics he has been on since birth have also been stopped. The nurse and I finally solved the mystery of why he was on antibiotics. (We asked the Doctor) Cohen was born with mild “wet lungs.” Wet Lungs, or more accurately called transient tachypnea of the newborn, is slow absorption of the fluid in the fetal lungs. This fluid makes taking in oxygen harder and the baby breathes faster to compensate. The condition is more likely to develop in babies delivered by c-section because the fluid in the lungs does not get squeezed out as in a vaginal birth. Cohen will have a chest x-ray tomorrow to confirm he no longer has wet lungs.

And, although it is against his nurse’s wishes, the Doctor is holding off on giving Cohen a PICC line for a day or two. A PICC line is a thin flexible tube that is threaded through a vein in the arm to the vena cava. It will be used to deliver medications, fluids and necessary nutrients. The PICC line will replace his IV because it is more stable and will last longer. If his feeds increase significantly, then he will not need a PICC line. But, it is more likely than not he will get one by the end of the week.

I got to hold Cohen for 2 hours today. Because he is off the CPAP I was able to sit on the couch (its more like a padded bench) and kick my feet up and just snuggle with him. We caught up on all the Hollywood gossip that we missed this last week, and by the time I was done telling him about the crazy octuplet mother, he was passed out.

Finally, I am sad to report that because Cohen has the IV in his arm, and the fact the gift shop was out of XS (up to 3lb) short sleeve onesies, Cohen did not get to wear clothes today. I did, however, get him a teeny tiny blue hat! It was quite the reality check when I tried putting the” up to 3lb” long sleeve shirt on him and he was swimming in it! He can just rock the diaper until he puts on some weight!

February 16, 2009

Today was an interesting day as I got a lot of new information about Cohen. I was at the hospital when Cohen had a change in nurses (not a shift change, though) so I was able to hear his first nurse go over his history with the new nurse. Apparently Cohen is considered “29 and 3”, which means he is being treated as having been born at 29 weeks and 3 days gestation. However, according to my due date Cohen was 30 weeks and 4 days on February 10. I asked the nurse about the difference, and she said that because due dates are often incorrect by a week or two, with premature babies their treatment is based on the Neonatologists assessment of gestation at birth. So, we are to consider Cohen as a 29 weeker, and thus 11 weeks early!

Cohen tolerated one whole feeding today! His first few feedings ended in the same residual as previous days, but his 2pm feeding he digested completely and only had a “smidge” of residual. He does have an incredible amount of air in his tummy due to the CPAP, and he loves it when the nurse sucks the air out. Complete feeds are back on and he is receiving 2cc/feed. We are praying he begins to tolerate his feeds consistently. The more consistent he is, the more he will be fed and thus the faster he will grow. I realized that it sounds like Cohen is not getting any food because of his minimal feedings. However, in addition to the gavage feedings (tube in his mouth), he is receiving hyperalimentation. This is a solution that goes directly into his bloodstream via IV and gives him necessary nutrients like proteins, carbs, vitamins, minerals and fats. So, contrary to what it may look like, Cohen is getting plenty of sustenance. He is 3lbs 1.2 oz! Now if only he would poop on his own…..he has not had a bowel movement since his first enema so another enema was ordered today. I had the pleasure of cleaning the resulting poopy diaper! The Doctor said his bowel sounds were good, so his little body just needs time to get his system working together.

During the Doctor’s rounds he said that Cohen’s heart did not sound like it had a murmur and because neither he nor the other Doctor and nurses had ever heard a murmur it is very likely that he will not have a PDA. The Ductus Arteriosus is a small vessel which allows blood to bypass the lungs . This vessel is open when the baby is in the womb, but usually closes shortly after delivery. Sometimes in premature babies the vessel fails to close on its own and this is called Patent Ductus Arteriosus. PDA is treated with either medication or surgery to close it. We feel very blessed that Cohen’s does not appear to be open. This is another common preemie complication that he has avoided!

I did kangaroo care with Cohen this morning and again he did really well; no A&B’s while I held him! He did have an AandB this evening, and need a little assistance to come out of it, but again this is very common for a preemie baby. All in all his caffeine is treating him very well.

Now for the best news of the day….Cohen’s bilirubin levels were 4.3 today and his doctor wrote the order to stop phototherapy! He will have his levels checked tomorrow, so absent any major activity with the levels, our baby will no longer be sun tanning! I am so excited to not only to see his eyes all day and get much better pictures, but this also means he can officially wear clothes! The gift shop has micropreemie items so I am going to get him his first t-shirt tomorrow…I can’t wait! There are special shirts that are easy to take on and off a baby with monitor wires and IV’s and it is small enough fitting up to 3lbs.

Oh, and more great news: we now have a long term room at Ronald McDonald House! I will move rooms tomorrow morning. The only difference in the room is the new room is larger, and it is missing the TV and cable! I’m not very excited about the lack of TV…I am hoping there is at least cable so John could bring our extra TV up.

February 15, 2009

Cohen had a much better day today! His doctor finally put him on caffeine to help with his breathing problems. Caffeine is a stimulant that is given to him via IV; Cohen gets one dose per day. He apparently had more A&B’s during the night, and his nurse had enough of the waiting game! His doctor was waiting to give him caffeine because the caffeine can cause problems with digestion and input and output (how much goes in v. how much comes out), and because Cohen is already having difficulties in that area he did not want to aggravate his problems. However, after looking at his A&B chart, he agreed it was time to give Cohen a daily “cup of joe.”

The nurse said the caffeine made an impact almost immediately. Not only is he having fewer A&B’s, when he does have an episode he is able to pull himself out of it. Side Note: Cohen has been rather interesting with his A&B’s, usually there is a decrease in Respiration and then the heartbeat slows, but with Cohen he drops both respiration and heartbeat very quickly and at the same time. Now, with the caffeine, as his heartbeat drops into the 40’s and 50’s, he is able to bring himself out of it and back into the 150’s/170’s, without having to be physically stimulated. It is still counted as an A&B, but he is given credit for bringing up his stats on his own.

His feeds are still minimal, as he has not had another poop since the enema. Cohen will start to make real progress once he gets this digestion and elimination thing under control. My mom says we might as well sign him up for a double hernia surgery before we leave…Ha, ha, and I would have to agree!

A highlight of today was I got to do Kangaroo care twice, and the first time was for a whole 40 minutes! Talk about the quickest 40 minutes ever! He behaved himself this time and was really calm; he only had 1 A&B during the second time I held him. He eyes were open and he was really alert…that is until I rocked him to sleep! It was the most amazing feeling in the world. A little strange because in reality he should still be inside my belly, but just holding his little body and feeling him move was simply a feeling I can’t even describe with words.

Another highlight of today was we got into the Ronald McDonald house! We were told in the beginning that the waiting list was so long that it was doubtful we would still be here when a spot opened. We got a call this morning, right before we moved hotels, saying there was a temporary room available and that we are first on the list for a long term room. With the temporary room we have to move out on Friday night and move back in on Sunday afternoon. However, if a long term room opens up before Friday we will just move rooms within the house. Cohen’s NICU roommate will probably be discharged this week and his parents have a long term room, so I don’t think it will be too long before we get into a long term room. The house is pretty nice; John describes it as a depressed sorority. Our room has two double beds, a bathroom, dresser, desk and TV with cable. There are family rooms with play areas and computers (they have wireless, too) , 4 kitchens everyone shares, one large dining room , free laundry, and even 25 cent diet coke machine! The only bad part is we get one shelf in the refrigerator and one freezer shelf…and for someone who doesn’t cook I really need space for my Lean Cuisines! Staying here has taken a huge load off our shoulders with regards to where I would stay during the week… since it is the cheapest “hotel” on the planet.

John went back to Moscow today to study for an upcoming test. Good news is there is no possibility of John missing this test because of the birth of our baby . Carter is spending some time with Grandma Cindy and Papa Rick in Ellensburg (THANK YOU!!) to allow John ample study time.

It is going to be an interesting few weeks, but once we have a routine for visits and what not I think this difficult time will only make John and I stronger as parents and as husband and wife. I will say, aside from seeing Cohen every day, the highlight of my weeks will be when my other boys visit!

February 14, 2009

It’s funny how quickly you lose track of time and days when your life revolves around the NICU. I didn’t realize it was Valentine’s Day until about noon!

I was discharged last night, so today was my first day outside of the hospital in 14 days! It was nice to get out and get some fresh air, but I also felt a huge sense of guilt not being so close to Cohen. It is definitely going to take some time to get used to being a “van”ride away as opposed to going up one floor.

My mom, John, Carter and I ventured all the way to Babies R Us! Apparently Carter has decided to grow an entire clothing size in the last two weeks! He fits perfectly in 24 months clothes, so we got him 36 month clothes so he has some room to grow. 36 months = 3T…that’s crazy! We got Cohen a little Moose for his incubator so that it is not so lonely in there. I really wanted to get him the Nautica teddy bears that will match his future nursery (we had not started the whole preparing for baby shopping, let alone getting his nursery stuff!), but I looked at the teddy bears and they were twice Cohen’s size. I’m not quite ready to have a daily reminder of how small he is…hopefully by the time he goes home those teddy bears will be the right size!

As for Cohen, he had another “not so great” day. It went like this:

Breathing: He had numerous A&B’s (Apnea and Bradycardia) throughout the night. Again, very common for preemies, but mastering the art of breathing is an essential element he must meet before he can go home. Plus, we are not allowed to hold him until he gets these episodes under control. He had even more during the day, so his nurse was going to request that he be put on caffeine to see if that will help with the A&B’s.

He is still switching between CPAP and the nasal cannula, every 3 hours. His O2 sats are still lower when he is on the nasal cannula, but at least he doesn’t have to struggle with the large prongs (in the other CPAP machine) in his tiny nose. He will continue to be on CPAP until his breathing stabilizes and he doesn’t have any episodes on or off it. It will be a few weeks before we can expect that to happen.

Digestion: His feeds have been suspended, because even without feeds he is having a fair amount of residual. I learned today the residual is usually mostly bile but Cohen’s had some blood in it as well. They are not too concerned about the blood, as it is probably from the tube moving around or going too deep. His tube (the one that is in his mouth & goes all the way to his stomach) is now marked so the nurses can see how far in it is and it is a little bigger to allow the nurses to suck more air from his tummy. He seems to be doing really well with the new tube, but in true Cohen fashion he can’t seem to leave it alone!

He was given an enema around 9pm last night, and by 1am he had his first official blowout that required a 1am bedding change. We are so thankful he finally had a poop, albeit with some help but at this point in time, poop is poop.

Bilirubin: Cohen’s bilirubin levels only decreased by .3, which with an accuracy of +/- 1.0, and means his level is pretty much the same as the day before, which was the same as the day before that. This isn’t terrible, but it is prolonging his phototherapy. I really want him to be finished with phototherapy so I can at least see his little eyes.

A big thank you to my law friends who came to visit! It was so great to see you guys! (See, I told you he was tiny!) I really miss the normalcy of reading case law after case law (though I am glad I did not have to deal with Mr. Dailey, haha!). And Luke, I wonder if I can nominate you for contracts via email….:)

Cohen was also happy to see his Uncle Doug again and meet Uncle Levi and Aunt Angela! Oh, and I forgot to say thank you to Uncle Ryan and Aunt Kim for visiting last week!

February 13, 2009

Going into having a NICU baby, we were told it was going to be a rollercoaster ride with many ups and downs. Cohen had an amazing birth day and following two days, and we were really hopeful he would continue on that path and come home early. And then there was today. Cohen officially made some dips on the rollercoaster.

I usually schedule my visits for his care time so I can help do some of the tasks, see his little face and touch him. This morning’s visit with him was brief. His nurse said he had a few episodes of Apnea, but that was to be expected. I was hoping he would have gone the entire stay without a single episode but I guess that was just wishful thinking. He was really fussy and uncomfortable at about 8am, so she did his care an hour early and told me to come back at noon for his next care time.

Right at noon my mom and I went to see him. We entered his room to the sight of his nurse trying to get the oxygen prongs into his nose. (He switches between the CPAP and another machine every 4 hours so he doesn’t get blisters from the CPAP mask) After about 20 minutes of the nurse trying and another 15 of the respiratory therapist trying, the nurse decided to put him on the nasal cannula (which is what people usually get when they need oxygen at the hospital). The nasal cannula makes him work harder than the other two machines, but his nose was just too small and he was really expending a lot of energy and calories fighting with the nurse to keep the big prongs in his nose. The nurse said that if his O2 sats stayed in the mid 90’s, he’d probably be allowed to stay on the cannula and not go back to the CPAP. Great news considering we would be able to see his face all the time and he wouldn’t have to wear the uncomfortable mask! My mom and I left to meet John and Carter who came up from Moscow.

At 4ish, John and I went into see Cohen. He was still doing really well on the nasal cannula, only having a few drops in O2, but she did say he had a few apnea episodes. He was sleeping really well so the nurse had us return at 6pm to do kangaroo care.

At 6pm John got to do kangaroo care with Cohen. John holding Cohen made him look really really REALLY small. Cohen was pretty fussy and uncomfortable and kept pulling the nasal cannula out of his nose, which would then cause his stats to drop. After a good 15 minutes of fussing, Cohen had a brady while John was holding him. His whole little body went limp, and it took the nurses a few rough taps before he started breathing again. Needless to say, his kangaroo time was over. It was really a scary experience, and I can only imagine what John was feeling. It was a good thing John was the one holding him because I would have just freaked out (more than I already did).

The nurse put Cohen back in the incubator where he had two more Bradys before we left. She kept telling him it wasn’t nice to misbehave when daddy hasn’t seen him in a few days! I would have to agree! The nurse told us that Cohen has not been digesting his feeds at all today, and even having more residual than what was given to him. This means he has reflux and is not digesting his food. On top of that, he had not pooped in 24 hours. All systems are connected so the nurse was hoping that by giving him an enema, which would help get his little system back on track. In the meantime, his feeds were reduced back to 1cc. I don’t like moving backwards!!

We did have some good news today. Cohen’s cranial ultrasound came back negative for bleeds whatsoever, and the final diagnosis was a “normal cranial ultrasound”. We were SOOOO relieved. Bleeding in the brain is one of the more difficult complications from premature birth and can lead to developmental and mental retardation. Only a few more tests before John and I can rest easy (as easy as one can in this situation…)

We left the hospital a little discouraged with the backtrack of progress, but we know he is in good hands and hopefully we will have many more good days as compared to bad days!

Visitor Information

We know everyone is very excited to meet Cohen, and we feel very blessed to have such wonderful friends and family who want to see him. However, he is in a very fragile state right now and the NICU has guidelines regarding who can visit and such to help protect the tiny babies from getting sick. Cohen is considered a Micro-Preemie (less than 3lbs), so he is in the most protected group of babies. If you fall into one of the categories below, we ask that you please wait until you are no longer in the category before asking to see him. We really are not wanting to be mean or prevent anyone from seeing him, we just can't risk someone bringing Cohen a virus...and this includes us as well! Once he starts to get bigger, his restrictions will change and he will be able to have more and more visitors.

Sick/Illness Guidelines:

• During the cold and flu season, children under 18 are not allowed, unless they are the parents. However, across the hall is a room for kids to play and they have TV, games, and lots of fun stuff to do if you have kids and want to visit. On Wednesday nights there is a free dinner and a movie :)
• Anyone who has a cold, or cold symptoms or any illnesses cannot come into the NICU (parents included), cough, sniffles, runny nose, etc.
• If you have been around someone who has the flu, you have to wait 48 hours to see if you get the flu before being allowed in the NICU
• If you have been around someone with the Chickenpox or any other contagious disease, you must wait the entire incubation period before being allowed to visit.

Other general guidelines:

• The most important thing to do to keep Cohen safe and healthy is to wash your hands when you FIRST come in the door. Even though you may not hold him it is important to wash your hands when you come in the room so you don't leave any germs behind on something you may have touched. At Sacred Heart, instead of using soap and water, there are two dispensers of an antibacterial mixture that works better than soap and water. It is on the right hand side when you first walk into the NICU
• Flowers are not allowed in the nursery. If you bring some, they will hold them up front for me until we can take them home.
• Only two visitors are allowed with Cohen at one time. And at least one of the visitors must be a parent. If you come in a group, please realize that it will be a one at a time process!
• There are no visitors allowed (unless its a breastfeeding mother) during shift change. Shift change occurs twice a day 6:30am-7:30am and 6:30pm and 7:30pm.
• Cohen can have blankets and stuffed animals in and around his station! The more it feels like home and not a hosptial, the better babies do. (Babies R Us, here I come :) )
• Cohen is located in the "Far East" Bed 46B (I think...)

We hope the guidelines do not discourage anyone from wanting to visit. We think it is really important that Cohen feel how loved and supported he is. However, the last thing we want is for him to get sick...this could set him back weeks in progress! If you have any questions, or are questioning if you should visit or not, please do not hesitate to call us!

February 12, 2009

Cohen had another excellent night. No reports of Apnea! Today was a big day for him. He had his umbilical line taken out. The Doctor wasn't comfortable with the vein that the line was in, so he switched him to an IV in his ankle. There may come a time in the next week or two where he will need a PICC line, but at this point the IV seems to be working just well. He is doing really well with his feeds and is moving his limbs more and more. Both his Doctors and nurses call him "Fiesty", but I suppose it was only a matter of time before John and I had a child that resembled more of who we were as kids. Cohen's right eye is swollen shut from the CPAP machine, it was so cute watching him try to open his eye and look at me, but also sad that he couldn't open his other eye.

When I went to visit him this morning, I walked in and he was crying in his incubator. It totally broke my heart! It was a cute little cry, but because I don't care for him 24/7 I didn't know what his crying meant. I had to ask the nurse if it was okay that he was crying. She laughed and reassured me that it was okay that he was crying, and that I could offer him the mini pacifier to help calm him. I gave him the pacifier, and he really, really liked it...so much so that he held his breath. This is called Bradycarida. Babies at this gestation have a hard time remembering to do two things at once, and suckling the pacifier and breathing are included. It was a little scary watching the nurse try to get him to start breathing again! The nurse said he loves the pacifier, but he only gets it for a little bit to calm him down when he is upset because he has "bradys" if he is just given pacifier whenever he wants it.

Today was a big day for me as well! Because the umbilical line came out I was able to do skin to skin with Cohen! The term for this is kangaroo care. It was so great to be able to hold him, but "Mr. Fiesty" did not want to be still at all. He kept trying to lift his head up and turn all about...I felt like I had no clue what I was doing! He ended up getting upset, mostly from the busy day he had and because it was 9pm, so our time was very short. Once he starts to get stronger and grow bigger the more occurrences and longer time of holds we can do will increase. I told John I would save tomorrow's kangaroo care for him :)

Also, the doctor is going to start increasing his feeds to 3cc/feed to see how he tolerates that. Soon he will begin the preemie tests that will help aide in the expected prognosis of our little guy. We will keep you updated on what those tests are and how he does.

February 11, 2009

Cohen continues to do really well! He got a bath today and he looks like a whole new baby! The cutest thing is that he has a full head of platinum blonde hair. Quite the difference from Carter's brown skullet! He still has not had any apnea episodes and we are so thankful for that. He is currently under the bilirubin lights to help with jaundice. The doctor has not gotten the results of his heel prick yet, but Cohen looks a little orange so they are treating him with lights because "it's only a matter of time" before he needs them. So, with both the CPAP machine and the sunglasses, his entire little face is covered! It will be nice when he can be done with the lights so that we can see his eyes!

Cohen has "care time" every three hours. This is when the nurses turn the bili light off, give him a rest from the CPAP machine, change his diaper, and do oral care. Oral care is done by taking a swab of my colostrum and putting it in his mouth. It keep his lips and mouth moisturized and allows him to taste the colostrum. Another big event happened today...Cohen got to eat! His doctor thought he was doing so well, that he allowed him to have 1cc of colostrum through the tube in his mouth. After it was determined he did very well with the feed, the Doctor upped his feeds to 1 cc, three times a day. This is huge, as they don't usually consider beginning feeds until the baby is 4 days old!

Cohen was also given new digs today as well. The noises of the open bed were annoying him, so the doctor ordered an incubator for him. I happened to be in the room when they were making the change so I got an "unofficial" holding while the nurses switched out the open bed to an incubator. It was such an amazing feeling holding him, but also terrifying as he is just so little! He was pretty well swaddled, so I felt like I was holding a tiny doll. Pretty soon I am going to blink and this tiny baby will be a 6-5, 18 year old!

More of Cohen's First Day

Cohen had a great first day! As standard procedure for premature babies, he has a umbilical line that goes in through his belly button where the umbilical cord was. The Neonatologist said he is really very good at getting the line into the aortic vein, but Cohen was being difficult so he put it into a smaller vein. If he starts having problems, the Doctor will try again, but for now it is working just fine. All of this vitals have been very good and he has not had any apnea episodes. Apnea is when babies forget how to breathe.

He is currently on a CPAP(continuous positive airway pressure) which assists him with his breathing. He is breathing oxygen on his own and this just helps keep his lungs open and makes it so his little body doesn't have to work so hard. My friend Gita described it the best when her twins were on the CPAP...he looks like a scuba diver and the apparatus covers his entire face. It's hard to see him with all the wires and machines. He has a tube down the back of his throat that goes into his tummy. The nurses use this to expel air from his belly, and eventually it will be used for feedings. Right now he is currently getting nutrients and fats from the line in his belly.

We are unable to hold him until his umbilical line comes out due to the high risk of infection. It is hard having him just lay on the open bed and being unable to hold him. We do a good amount of holding his hand and applying pressure to his body. Premature babies do not like to be stroked, they like small amounts of pressure instead.

Cohen Thomas Hawkins

Here are the first photos of our little man. I didn't get to see Cohen until late Tuesday afternoon, because I was still recovering from surgery and my blood pressure would drop too low every time I tried to get into the wheelchair. John took pictures so I could at least see what our new baby looked like. However, the pictures did not really prepare me for how little he really was. When I saw him laying in his bed with all the cords and monitors, I started crying. The pictures made him look much bigger than he is; his head is much smaller than a softball!

February 10, 2009: The BIG day!!

I tossed and turned all night. I was in so much pain; it was making me sick to my stomach. At about 1:30am I called for my nurse and told her I needed more Oxycontin. I had never asked for two at a time, let alone a dosage in the middle of the night. As a precaution, she hooked me up to the monitor and saw that I was contracting 2-3 minutes. She told me before she gave me the drug she was going to call Dr. Watts (he was the hospitalist that night) to let him know what was going on. About 2:00am, Dr. Watts came in. I told him it felt the same as the previous nights, but my contractions were just a little bit more intense. He said he would check my cervix for change just in case. I saw the look on his face as he was checking me. He said in a hurried, serious tone "get the ultrasound machine, stat." I was at an 8-9. (for those unfamiliar with childbirth, you start pushing when you reach a 10.)

Dr. Watts wanted the ultrasound because he couldn't tell which part of the baby was engaged. That made me a little nervous, but his head had been down the entire pregnancy so I wasn't too nervous. It took 4 minutes for the machine to roll into my room, and it took Dr. Watts 2 seconds to determine that the baby was in the transverse position. This means his butt was the engaged part and his head and feet were up high in my belly. He was essentially in the "v" position. Dr. Watts calmly looked at me and said I would be having an emergency c-section. I told my favorite nurse, Logan, to call John. Logan was my nurse on my first night, and she happened to be on the labor and delivery side that night. She is also Dr. Watts' daughter in law! She called John with my phone (I think he answered, Hi babe, haha) and Logan told him that I was dilated to a 8-9, but that the baby was in a difficult position and I was going info an emergency c-section. She told him to drive safe. As the nurses were quickly getting me ready for the surgery, Dr. Watts asked to call John again. He told John to drive safe because I was going into surgery now and there was no way he was going to make it for the birth so he might as well make it here safely. I texted John at 2:25am and told him I loved him and that both baby and I would be fine.

I was wheeled into the OR and was given the best epidural I have ever had. Granted I only had one prior to this, but this one went in smoothly and I was numb quickly and evenly! I was given some oxygen and we were ready to go. The only thing we were waiting on was the Neonatologist to arrive. About 10 minutes later, and after a stern look from Dr. Watts, the Neonatologist arrived and the c-section began.

It was a lot of pulling and tugging. The first thing I heard was Dr. Watts ask the resident who was assisting him what specialty he was going into and the resident responded "Radiology." Wow, talk about reassuring...not!

Then at 2:50am I heard the most beautiful sound in the world..a little cry that sounded like a mix between a bird and a kitten. I couldn't believe he was breathing let alone able to cry. The whole room was very excited that he was crying. But he was whisked away to the Neonatology team (in the same room), before the surgical team could tell what gender he was. I kept hearing, "is it a girl?", "is it a girl?"...I was thinking to myself, no way I have pictures and he is not a girl! Finally one of the neonatology nurses said "No, this is all boy" The nurse by me turned to me and said "sorry to get your hopes up" I just laughed.

As Dr. Watts spent the next 45 minutes putting my organs back inside my body with what felt like a sledge hammer, the neonatology team said the baby's first two APGARs were 8 and 8 and that was very good. He was breathing on his own, and looked very, very good for a 30 weeker. They said he was a good size at 2lbs 15oz and 17 inches. I didn't get to see him, but I saw his little head as they were working on him, and it was soooooo tiny.

I was wheeled into recovery, where Logan came to see how I was doing. I had told her previously that John and I really wanted Dr. Watts to be the delivery doctor and we both wanted Logan to be working the night I had the baby. She laughed and said "looks like you guys got your way...but I would have been on 4 days a week for the next 6 weeks!"

At about 4:30a.m. (it actually felt like only minutes after I was wheeled into recovery), I saw a tall figure dressed in sweats come to my side: it was John! He looked a little nervous, and conflicted. He checked on me to make sure I was fine, but then asked the nurse where he could see the baby. Being the guy that he is, he asked me if it was okay if he went and saw the baby and I said YES!

The next time I saw John was when I was taken to my Postpartum room. We both tried to get some sleep...but we ended up waking up at 5:30-6:00am to start texting everyone our news!