Saturday, February 28, 2009

Evening update (Saturday 2/28)

Summary: Max had a good day: he was taken around the NICU in his stroller by the nurses, he had great play sessions with Carolyn, he did well feeding from a bottle, and he hasn't vomited at all (so far).

Max's departure for HSC is moving at a rapid clip. Perhaps the clearest sign that the NICU team are prepared to let go of Max is that he is now routinely assigned "floaters"--i.e. nurses whose normal services are slow and are temporarily sent to the NICU. These nurses tend to be a little overwhelmed by the NICU and are given only the easiest patients, including Max.

However, the floaters tell Carolyn and me that they're puzzled by the attention Max gets from the NICU's regular nursing staff. Last night's floater, nurse H., said that "some other nurse" had given Max his bath and H. wasn't quite sure what was going on. Every since Carolyn brought the stroller in, it has proved a huge hit with the NICU team, and nurses not otherwise occupied will routinely take Max on little journeys over to CCN1 to visit his old friends. Many are busy with critically ill babies, but always take time to say hello as Max promenades past. For his part, Max like the stroller quite a bit. Perhaps he likes the geometry (he's held firmly in a semi-reclined position), the novelty, the sense of motion, or maybe he like to travel and see new vistas. We learnt that many NICU babies freak out when taken out under the sky for the first time. Max's sanguine reaction yesterday was either due to excellent state control or being zonked out.

Carolyn's proposed schedule has proved a huge hit with the NICU team managing Max's feeds. The schedule's key innovation is running larger feeds over a longer time: keeping the flow rate the same but also filling Max with more food. This allows him (in principle) to go longer between feeds. Carolyn's schedule featured two such long feeds in the night so that, were Max to come home, we might stand a chance of getting five or so hours of sleep per night (albeit not continguous hours). These long feeds have proved so successful that the NICU team have now converted all of Max's feeds to this format. He now is fed every four hours, over a 90 minute stretch each.

One result of this is that the time between feedings is now longer. That's more time for play and therapy between feedings. In addition, Max is quite hungry (for maybe the first time in his life) by the time his next feeding his due. Carolyn discovered that this made him a motivate consumer of bottle feeding. So much so that he drinks at a rate quite a bit faster than he's used to with the tube, raising the possibility that he might not tolerate it. Carolyn limits him to 10 to 15 ccs by mouth at these feedings and then lets him work out any remaining aggression on his pacifier.