Three generations

Sleeping baby

The visiting nurse came yesterday and weighed Tessa. She's now 8 pounds, 5.5 ounces. The rule of thumb is that a preemie should put on 0.5 to 0.75 ounces per day when she's at home. Tessa is putting on almost 1.5 ounces per day! She's still only 4th percentile for her age (based on weight), but she's catching up fast.

Big yawn

Still growing

Part of being a preemie is getting a lot of attention from medical personnel, even after you leave the hospital. Since Tessa came home on June 17, she has had one home visit from visiting nurse (with another scheduled for today) and has been to the pediatrician once. She will continue to see both of these professionals once a week (each) for the next several weeks.

So far, they have been very positive about Tessa's progress. The visiting nurse told us that Tessa was very "toned," which we assume is a compliment, though we always thought babies were supposed to be fat.

During both visits Tessa was weighed and she has continued to put on the ounces. She was just over 7 pounds, 1 ounce when we left the hospital. On Saturday, when the nurse weighed her she was 7 pounds, 7 ounces, and on Tuesday at the doctor's office, she topped the scales at 7 pounds, 12 ounces! Now that we're in charge of all of the feedings and diapers, we're gaining a real appreciation for why she is growing so fast -
and for the consequences of her rapid growth.

Grandma is the best

Grandma Carol and Ted are in town this week. It's been so nice to have some family around to help with the dog and the chores (and of course to adore Tessa). Here are some of the first shots of Carol and Tessa. They are already best friends...

Settling in at home

Tessa has been home for four days and has really started to settle in. We have a little travel crib that we can move from room to room in the house and she had no problem adjusting to that. (After sleeping in a plastic bin for 8 weeks, we're not surprised that she had no problem moving to the crib.)


The last four days have pretty much been filled with three things - feeding Tessa, changing diapers, and watching soccer. During our (occasional and brief) downtimes, I've snapped some photos. Here is a great shot of Aly (our dog) relaxing by Tessa's crib with the soccer on in the background.
Aly has handled the new addition to our pack quite well. Once she realized that there was no food on Tessa (always the first thing she looks for), she decided Tessa was pretty boring. The only time she has really shown any interest in Tessa is when Tessa is upset and crying. At that point, Aly will look at us with an expression that makes it clear that she is worried about how upset our new pack member is and also that she knows that it is our responsibility to soothe her.

Homecoming

Excellent news: Tessa is home! Here's a picture of Tessa in her car seat in the NICU before we left the hospital and a picture of the family (all three of us together this time) on our way out. Thank you for all of your support, it's been a long process but a happy ending.

We're leaving the hospital with Tessa right now! She's on her way home. :)

Tessa is off the calories

Preemies are often called "feeders and growers" because a big part of their NICU homework is to eat and get bigger. In order to facilitate this, the NICU will often supplement their milk with additional calories. They assume that the milk they are eating has 20 calories per ounce and they will supplement with an additional 4 calories per ounce.

Tessa has been putting on weight at such a rapid rate (she now weighs 7 pounds 1.4 ounces) that the doctor decided to take Tessa off of the caloric supplements. Assuming she continues to put on weight, we won't need to add calories to her milk when we bring her home, which will make all the feedings easier.

Tessa outgrows her preemie clothes

Tessa is rapidly approaching seven pounds and she has pretty much outgrown her preemie clothes. There are only one or two preemie outfits that still fit her, and those barely fit (see picture below), so we've moved her up to the newborn outfits. We're very proud of our little eating machine!

Sound asleep to loud and vocal in seconds

Tessa goes from sound asleep to wide awake and starving in seconds. When we get to the NICU, we usually prep all the stuff we need for the temperature and diaper changing so that when she wakes up, we're ready to act. One time last week, I was still getting everything ready while she was sound asleep. I turned my back to get some of the wipes ready and within seconds she was wailing like a siren! Even though it's a bit of a nuisance to have a screaming baby on your hands, we find this encouraging, because the nurses have a joke that loud babies have to go home with their parents. We already have had several nurses and a doctor inform us that Tessa has crossed that line.

Some light reading for the NICU?

As Megan discussed in her post from yesterday, we had a little bit of a let down when we weren't able to bring Tessa home. We spent most of the day at the hospital (9 AM to 2 PM). During the down time (when Tessa was sleeping) we usually read. I looked over at Megan to see why she wasn't reading her book and couldn't help but laugh at her selection. She's reading All Quiet on the Western Front, which the front cover describes as "THE GREATEST WAR NOVEL OF ALL TIME." Also on the front cover is the following sentence: "On the threshold of life, they faced an abyss of death..."

Not exactly light reading for the NICU. No wonder she wasn't reading it!

So close...

We have been busy this week counting the days. Tessa had her last major apnea spell early Sunday morning. ("Major" being defined as an episode where she stops breathing, has a heart rate drop, and requires stimulation -- i.e., a back rub -- to resume breathing.) After a spell, Tessa's doctor starts counting the days. Monday was Day One, Tuesday was Day Two, .... and today was Day Five. Day Five is the day when you can bring the baby home from the NICU. In anticipation of Day Five, we picked up Tessa's multi-vitamins, iron supplement, and her prilosec prescription from the pharmacy, we brought Tessa's car seat to the NICU so that the nurses could monitor her in the seat for 90 minutes to make sure her oxygen levels remained stable, we cleaned the apartment, and we even gave the dog a bath. We went to the hospital this morning to bring Tessa home, but she had decided that she wasn't quite ready. She had two apnea spells this morning, including one while we were on our way to the hospital that required mild stimulation. So, today is Day Zero again.

Even if she's not quite ready to come home, Tessa is looking very cute these days. She now weighs 6 lbs, 11 ounces and, in the words of one of the nurses (which I fully endorse), she "is a real baby now."

G-L-A-M-O-R-O-U-S

Tessa had a photo shoot two nights ago while we were sleeping. When we arrived the next morning, these pictures were hanging on the wall behind her crib.

Baby scale

The NICU is concerned about making sure the babies gain weight -- and every gram counts! Before weighing Tessa, we pick out a clean blanket and outfit and put those on the scale with a diaper. Then the nurses zero out the scale and remove the diaper, and we can put Tessa on the scale with a clean diaper and get her exact weight. After she's weighed, we dress and swaddle her right on the scale. When we first bring Tessa home, a visiting nurse will stop by about once a week to weigh her.

Dinner: A Process

When you're a preemie baby, eating dinner is a multi-step process. First, the nurses mix iron and multi-vitamins into about 10 mL of milk. This turns the milk green and apparently it is not very tasty. But, if you are a very hungry baby, you'll eat it anyway.

After you eat the multi-vitamin and iron mix, you will find that you are still very hungry. Luckily, there is more milk in the next bottle (and it doesn't taste funny). And, if you are a hungry baby, you have to make sure to hold on tight to the bottle, just in case someone tries to take it away...

If you are a preemie baby, you have to stop to "catch up" on your breathing while you're eating. Sometimes you need a little encouragement to keep going...




Finally, once you've finished all of the milk (anywhere from 60-90 mLs these days), you can get back to the important work of sleeping and growing.

Tessa weighs 6 lbs 4 ounces now.

Another sleeping baby picture

Baby stroller

First line in the "how to fold" section of our new stroller's instruction manual: "Remove child from stroller."

Baby heartburn

Tessa is still having reflux, so they've started her on Prilosec, which is a standard medicine for heartburn. The hope is that the Prilosec will reduce the acidity of the reflux so that it isn't as uncomfortable for Tessa. Also, there was some hope that it would reduce the reflux-associated apnea spells, but neither the nurses nor I am convinced that it is doing that. The doctor increased her to the maximum dosage last night. Hopefully it will help with the apnea spells. At the very least, I hope that it makes her more comfortable. She definitely gets squirmy and makes a lot of faces after eating and I am sure that some of that is due to her reflux. Ultimately, this is another issue that she'll outgrow. Until then, I'm glad that there are medications to help.

Three milestones down, one to go

We mentioned before that Tessa has four milestones that she must achieve before she can come home with us: 1) gaining weight, 2) keeping her temperature up without being in an incubator, 3) eating all food without a gavage tube, and 4) not having any apnea spells (measured by going five days without one).

She has now checked the boxes next to 1, 2, and 3, which means that she can focus on one goal - quitting the apnea. She's certainly making progress in this area. A few weeks ago she would have several spells every day. Now she's only having infrequent spells. In fact, the last one that she had was ~36 hours ago. We're not convinced that she's totally finished with them, but we are confident that she's outgrowing them. As far as I can tell from my conversations with the doctors and nurses and with my outstanding internet research skills, it is purely a developmental issue. This means that she will ultimately outgrow her apnea, but that there is not much we can do except wait for her to do so.

We gave Tessa a bath on Monday and Megan snapped a great picture of Tessa looking up at me as I was drying her off post-bath. I thought you all might like to see it.