Intubations, Surfactant, and CPAP! Oh my!

Emilia is officially one week old today. Rather than dive right into the day of her birth again I thought maybe I would break things up by writing about how she is doing today.

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Emilia bundled up and waiting for her head ultrasound.

 

We have made a habit of arriving at the hospital each morning for Emilia’s feeding at nine in the morning. This gives us time to get things sorted with the animals at home, prepare our food for the day, and still get there before the doctors rounds so we can be present for any discussions regarding her treatment.

Today there was some discussion about Emilia having a bit of regurgitation last night (she is drinking MOM (mother’s own milk) mixed with a calorie boosting powder). The doctors told us that her stomach was checked and it didn’t seem to be an issue with volume or digestion, she may just not like the powder. They decided to watch and see if she regurgitated tonight again and if so they would reduce the amount of powder in her milk.

Emilia is still fed via a nasogastric tube which is a small orange tube fed through her nose into her stomach. During feeding times the required amount of milk is placed in a syringe which is then placed in a timed dispensing plunger and slowly fed down her line into her stomach. We try to give her a soother during this time so she can work on her sucking reflex (Soothers for preemies are okay! They need to learn!) and she seems to be doing quite well at it.

Emilia had a head ultrasound planned to check for any bleeding or damage in her brain. There is a risk of trauma during birth which can sometimes be a contributing factor for cerebral palsy. We’re pretty positive on this front, no one has mentioned any uneven muscle tone on Emilia, but better safe than sorry. Thankfully they bring the ultrasound right into the room so Emilia isn’t disturbed too much. She took it well and got her first hair gel!

Outside of the ultrasound she seems to be doing well. Mom and I are slowly being taught the basics from the nursing staff on how to bathe her, change her diapers, and handle her. Each time we touch her there is this irrational fear that I am going to break her but in reality I am assured she is pretty tough. I’m now at two diaper changes, mom only has one (score one for dad!). We spend time taking turns holding her and giving her skin on skin care when possible. All of this is going on while we try to sort out the paperwork associated with our sudden absence from work.

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The after-bath outfit. Her first onesie!

 

As usual the nursing staff are great. They are very patient and explain anything we don’t understand. Emilia is hooked up to leads which monitor her vital signs and the results are displayed on a monitor both in our room as well as at the nursing station outside. Every once and awhile Emilia will have a little drop in her heartrate and oxygen levels when she forgets to breathe but she has, thus far, been able to bring herself back on track. You still feel a lurch in your stomach each time that alert panel flashes red.

Mom has been pumping milk since the day after Emilia was born. I won’t get too in-depth about it but so far the experience hasn’t been that unpleasant for her. The first day or two she was mainly obtaining small amounts of colostrum. Even these small amounts were given to Emilia as it is apparently great for her nutrition. As of day seven mom is now able to pump enough that Emilia is exclusively using MOM rather than DHM (donor human milk). We went for the DHM for the interim period because we were told it was better for Emilia’s digestive system and there are rigorous safety mechanisms in place to ensure the DHM is safe.


Alright, back to day one.

When I got to the other hospital I went straight to the NICU and was shown to the room where Emilia was. Her room was at the end of the hall and as I walked up towards it the crowd of medical staff breathed some more life into the fear I thought I had swallowed. I was greeted by the staff with congratulations and allowed into the room where Emilia was being attended to by a resident doctor and nurse neonatologist practitioner (NNP), Tara.

The first order of business was an x-ray of her chest to check how her lungs were doing. Back at the first hospital they had placed her on oxygen; however, there was concern that she was still displaying too much effort in breathing. With each breath Emilia’s tiny little sides would suck deep into her chest and you could tell it wasn’t a natural movement. A portable x-ray machine was wheeled into the room and we were all cleared out for the actual taking of the x-ray.

Tara came and got me and brought me over to the nursing station where she sat me down to show me the results of the x-ray. I feel like she expected me to break down as she spoke in very soft tones but plainly explained what was wrong. Emilia had respiratory distress syndrome (RDS) due to her premature birth. Her lungs had not developed fully and lacked a substance called surfactant which is a natural lubricant which helps the lungs open fully. I was told that Emilia would need to be intubated (where a tube is placed down into her lungs) and given extra surfactant in order to assist with her breathing. I looked at the little x-ray in front of me, the umbilical IV line streaking a trail up from Emilia’s belly to her liver, and said they should do whatever they needed to. It was around this time that Tara asked me what I did for work as she suspected I was a tad too calm! If only she was a mind reader she would have known that wasn’t the case.

 With a plan in motion the resources were gathered and the procedure began. It was a surreal experience, watching a group of medical staff intubate my daughter and then inject a soapy white substance into her lungs. I recall Tara, always the educator, asking the nursing staff and respiratory therapist questions on the possible complications of surfactant use (including, among other things, airway obstruction).  I didn’t mind, I’d rather everyone have a fresh reminder of these things anyway prior to working on Emilia, but it struck me later as such a peculiar experience.

The surfactant was administered successfully without any major issues and you could almost immediately identify an ease in Emilia’s breathing. There were a few touch-and-go moments during the process when I felt my heart drop as an alarm went off but all in all it went well. She was then fitted with a CPAP (continuous positive airway pressure) mask which kept pressure blowing in through her nose, along with a bit of extra oxygen, in order to assist her breathing. I couldn’t help but notice that my daughter happened to have quite a bit in common with a certain super villain.

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Emilia Bane?

With all the excitement done Emilia was made comfy and left to rest. I settled in beside her to watch for any hint of distress like a mother hen while I waited for mom to arrive from the other hospital. Mom arrived, along with support in the form of a good friend, within a few hours. When she got to the desk at the front of the NICU they didn’t believe she was the mom at first! Who has a baby and is up and running around within 5 hours!

When Lauren arrived we were sat down by a very nice nurse who gave us some sage advice:

  1. Don’t stare at the monitors, they will drive you crazy. Watch your baby, she will tell you more about how she is feeling.
  2. Get some rest. Right now there nothing more you can do, even if you feel like you should stay at the hospital all night. Better to return rested and ready to go in the morning.
  3. Don’t be afraid to ask questions about your childs care and take and discard advice as it comes. Everyone wants the best but you are the parent (even if that notion seems scary right now!).

The whole day seems in retrospect like a strange dream. I wouldn’t say a nightmare, because obviously we were gifted with an amazing little girl, but certainly not the normal birth experience you expect. You picture holding your baby in your arms, staring into their eyes, and immediately feeling that bond. If I can offer any advice to those who find themselves in this position it is that it is okay to feel a bit robbed of that experience. No one expects to have a child in this manner. I have found though, over the past seven days, that every small achievement is another chance to recapture that moment which was stolen. It won’t be a “normal” experience, and you will have lots of mixed emotions about that, but don’t worry. You will treasure every moment you have together from here on out.

 

That’s all for now,

Damon

 

 

 

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3 thoughts on “Intubations, Surfactant, and CPAP! Oh my!

  1. What an amazing story! You have written a very concise account of this experience with humour and obvious love for your two girls. Well done.

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  2. Thank you for sharing your story and way to go on changing her diaper (preemie diapers are unusually so small)! BTW if your baby is not tolerating the powder, you may want to look into an all human milk-based caloric fortifier from Prolacta.

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    • Thanks for the advice. She lost 66 grams last night so we will see what the doctors have to say today.

      I agree about the diapers, as an older brother to three much younger siblings I’ve changed my fair share in the past. Never anything this small though!

      Like

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