Report Card Day

Today we had our second family meeting with the attending doctor.  The current attending is going off service after the weekend, so it was a good opportunity to get her assessment of Lucas and Olivia's progress over the past two weeks.  It's really helpful to have these meetings, as it allows us to step back from the day-to-day and get a bigger picture, plus address any concerns we have.  Again, the babies got an overall very positive report. 

The attending began by asking us for our sense of how the kids are doing, with any questions or concerns, and then she would go through her report on each of them.  We started by talking about Lucas (being twin "A" means he gets to go first a lot in the NICU) and his breathing.  He's been a superstar since the beginning, but has struggled a bit more this week, with a return of some bradys and heavy breathing.  This was our primary concern, and one that the attending had been considering as well.  She explained that she's been closely following his breathing all week and if things don't get easier for him in the next couple days, she will probably put him on medication to help clear out his lungs.  He seems to have a little fluid in his lungs, the result of micro aspirations as his lungs mature.  This is completely normal, the attending explained, but we want to address it if Lucas can't on his own.  We are big fans of recognizing when the babies ask for help and giving it to them. 

Other than Lucas's breathing, he got a glowing report.  All has looked normal for him since the beginning in regards to cardiovascular and neuro.  Lucas will get an MRI before discharge to look for a handful of abnormalities that couldn't been seen on the head ultrasound.  As she explained this, the attending noticed what was apparentely a really concerned look on my face,  I make a terrible poker player and it's scary to hear a doctor talk about your baby's brain development.  She reassured us that while nothing is certain until the test is actually done, Lucas has all the odds in his favor for normal development and learning outcomes - he's getting maternal breastmilk, has high maternal education achievement, and nothing out of the ordinary observed in his behavior.  Olivia is in pretty much the same boat.  Although they did see a bleed in her early head ultrasound, as the attending told us, neither she nor the previous attending on service nor the radiologist were particularly impressed with it.  Since the follow up scan showed it nearly resolved, she's looking at the same situation - and advantages - as her brother.  For both babies, the preliminary eye exam showed premature retina, to be expected at this age, and they'll get a follow-up exam before they leave, and then probably another after discharge.  They will be mostly out of the woods once their retinal development is complete - it's at about 75% right now - although preemies do have an increased risk of short-sightedness.  I tried not to make too big a deal out of this as I realized I was sitting in a room with three very accomplished people all wearing glasses.

When we started talking about Olivia, the attending proposed a plan to try taking off her cpap tomorrow.  The attending will wait until she can be available to watch Olivia closely for a couple hours, and if she appears to be struggling, she'll go back on for a couple more days until she's ready.  Although it has been frustrating to keep hearing "another day or two" all week, we are really impressed with the progress Olivia has made this week on her breathing, and believe in her ability to fly when tested.  We'll keep you posted.

We also got to start talking about what will happen when the babies come home, which is pretty exciting. It now appears pretty likely that both babies will go home on monitors, which basically make a really loud noise if the babies forget to breathe.  The attending said that Georgetown is more conservative than many other nurseries in the use of monitors, but that other parents say that the monitors actually allow them to sleep easier and that it's frequently easier to wean the babies than the parents.  Most little ones are off the monitors by 43 weeks adjusted gestational age, so if they do come home with them, it won't be for long.  With monitors, parents are required to have CPR training, but the attending told us that in her 10 years at Georgetown, parents have only had to use their training twice.  Pretty good odds.  The other big difference between our babies and a normal term baby coming home will be their eating habits.  Because they will need extra calories for a while, Lucas and Olivia will do a lot more bottle than breastfeeding at first.  This balance will shift over time, until they can primarily breastfeed, but Dad will definitely have plenty of opportunities to help out with the feedings :)

We saved the biggest question for last - when did the attending think they'll get to come home?  If they continue their progress, she's predicting another three weeks, when they're about 37 weeks.  This is pretty exciting, especially because it's possible that about half that time will be spent in the step-down nursery, which has a lot less beeping, which will be nice for the nerves of Mom and Dad, and works on getting them into a daytime/nighttime routine.  Our nurse today called it the cabbage patch, where babies go to hang out and get plump. 

The final word from the attending was that she's very pleased with the progress both Lucas and Olivia are making.  Sometimes the big picture can be really beautiful.