Sunday, February 15, 2009

Evening Update (2/15)

Max's head circumference grew an unlikely 0.25 cm to 41.75 cm.  Whenever we see a measurement that isn't reported in half-centimeter increments we suspect that the nurse is rooting for the "right" answer and squeezing the tape measure a little harder than normal.  This could be the return of abnormal CSF production, which would require a shunt.  Certainly Max's recent head ultrasound points in that direction.  Or he could just be having a growth spurt.  Only time will tell, and we're good at waiting.

When I got to the NICU this morning, I realized I hadn't seen Max for a few days.  He's grown, and seems much more like a normal baby.  I was so excited to see Max that I tried to do everything fun with him all at once.  I changed his diaper, put on his cream; we did some leg exercises, I changed his outfit, and all in the cramped confines of the NICU crib.  Because Max's wedge takes up so much of his crib, he was actually head-down for much of this rodeo. It never registered with me that Max was in the early part of a feed, so I was a little surprised when he vomited part of it back up.  He seemed much happier after I had cleaned him up and put him in a new new outfit, this time with the help of nurse N.  

N. agreed that Max had outgrown his NICU crib, and ordered a big boy crib from the peds service.  As show put "he's big enough now for a quote normal baby unquote crib".

I held Max while his feed went in; I talked to him about my job and sang the do-re-mi song.  On balance, he seemed to prefer the singing.  He was uncomfortable while the feed was going in.  As Carolyn has noticed, he prefers to sleep through the ordeals.

The NICU team were so excited by Max's oral competence overnight that they ordered one attempt at oral feeding per shift.  If he is awake and in good spirits, the nurses are supposed to try to bottle feed him but not the provoke oral aversion.  They're supposed to go very slowly and give him lots of breaks because his feeds are still going in quite slowly.  They don't want his mouth to get ahead of his stomach.

So, today, nurse N. gave Max 43 ccs over about 40 minutes in the afternoon.  And this evening, nurse R. 20 ccs over 20 minutes.  He would have taken more but we suspect that he was exhausted from his bath.  R. gave Max a new nuk-style pacifier, which he liked.  In addition, after losing a pacifier and being unable to retrieve it, Max stuffed his fingers in his mouth and soothed himself.  Max's older brother Felix, as revealed by this photo taken when he was three weeks old, also enjoyed sucking on his fingers.