The Good, the Bad, and the Terrific

And a view from the NICU...

And actually he's looking much better than he was.

First the terrific:

Isaac's blood sugar continued to yo-yo through the night. This morning they tried taking him off of the insulin again to see how he'd respond. 25 minutes after eating his sugar was 135! An hour and 10 minutes it was 165. He hasn't had such low numbers after eating while off of insulin. His sodium and potassium levels were likewise good. His blood sugar went up again to the 200s several hours later, but for a brief time he didn't need the insulin. They are now going to try shots of insulin to see if they are able to control his sugar that way. He doesn't have much in the way of fat to disperse the insulin so it's an iffy proposition. All those blood draws leads into....

The Bad:

Even though they draw tiny amounts of blood, he's a small fellow to begin with and can't spare a whole lot of blood. The phlebotomist (she tests the blood) ran a hematocrit. He's a bit anemic and somewhat dehydrated. The doctor recommended either more saline or a blood transfusion, while strongly recommending a transfusion. Eek! I truly wish I could give him blood (he only needs a few teaspoons and we share the same blood type), but there's a delay with screening it, plus they probably wouldn't let me since I gave birth so recently. In all the times I have given blood, I never thought it was something one of my children would need. It's kind of a mixed feeling; I'm grateful, and I'm a little leery. I went ahead and authorized it though, because I do think it is something he needs. Since he has a low RBC his oxygen levels have been on the low side, so they've put him back on oxygen. Darn.

The Good:

Isaac is a very good eater. When I'm not there they do bottle feed him the expressed milk, but he still knows how to nurse well. I asked if they could cup feed, but apparently that isn't something the nurses at Primary's are trained in and they aren't comfortable with it. The only other option is tube feedings, and I can't imagine Isaac being happy with another tube down his body. Plus, he seems to relish eating and I don't want to take that pleasure away from him.

Since he is eating so well now, they removed his artery line that ran through his umbilical stump. I guess there is a higher risk of infection and complications with leaving the line in place now that he's eating regularly. Instead the line is now through his wrist (not pictured because this was taken earlier). This way he doesn't have to be poked in the heel every time they want some blood from him. He's also much, much more alert. I got to hold him for about an hour while he looked around, gazed at the lights, me, anything that moved... I think he is feeling a little better.

Progress 2

Came home from the hospital from 9 to 1 to rest a bit.  Checked in by phone and his sugar was down to the high 300s.  Normal is around 80-150 in a newborn.  Got back to the ICU and it went down to 280 260 240 208.  They check it hourly.  So it looks like next reading it will be under 200, at which point they are going to stop the insulin, wait an hour, and let Rachel nurse him and see what happens to his sugar level.
Best case scenario, the insulin he's already had will be the jump start his body needed to get things figured out and he'll be all set.  More likely, the endocrineologist thinks he will need insulin shots for a few months and he hopefully has "transient neonatal diabetes" versus "permanent neonatal diabetes."  They need to switch him to shots so we can take him home.  Actually there will be two transitions, the first to "normal" insulin shots and a second to "long duration" insulin after they're sure he's not going to swing the other way into low blood sugar from the insulin, "which is where you get the siezures" and other Bad Things so we are all for taking things slow and steady.
The just wheeld in an ultrasound machine to see how his pancreas looks.  "I'll take the images, and the radiologist will review them and dictate a report."  So we'll have to keep you posted on that.

A Sleepy Baby

Isaac started out quite eager to nurse the first few days, however, shortly after my milk came in he's been pretty sleepy. He's a little bit jaundiced, but not bad at all. The pediatrician thought it looked very minimal. So that is not the problem...

He does have a good latch and a strong suck, and he nurses through a letdown and for a few minutes afterwards. The problem is I have to wake him up to feed him most of the time. And he can be hard to rouse! I'm setting an alarm at night, because he doesn't reliably wake up. I've never encountered this problem before. Isaac also does not root and act hungry like Matthew and Melissa did. So far I've tried diaper changes, tickling his spine and toes, and undressing him partially with mixed results. Anyone else gone through this? Ideas? Suggestions?

I plan on weighing him tonight. Keeping my fingers crossed that he's gained some weight...

Peanuts

A couple savage peanut sightings at church today:

- We spotted a man with a fairly young (3 months-ish) baby curled up asleep in his arms. Matthew pointed: "Baby! Nerse!" Yes, Matthew -- that's a baby, but no, daddy's don't nurse.

- After tossing a ball in nursery, Matthew turned to me and asked, Duh srow? "I don't understand," I had to tell him. "Duh srow?" Oh... "Yes, that was a good throw."