Tuesday, September 22, 2015

Izzy's NICU Stay

Where to begin?  It was late Saturday night, the day after Isabelle was born and the nurse, Sara took her for the standard 24 hour checkup.  Mike and I had gotten essentially no sleep in over 40 hours, so Sara offered to keep Izzy with her for a few hours so that Mike and I could catch some shut eye.  We were all to be going home in the morning.

Here is the last picture I took of Izzy before she went to the NICU.  Saturday night at 11:11PM.  We had no idea anything was wrong at this point.

At about 2:30 AM Sara and the neonatal nurse practitioner came in and said they had some bad news.  Well, that woke me up fast, as those words are never something that a parent wants to hear.  She said that during Izzy's exam she was breathing fast (80-100 times per minute).  She wasn't working hard to breath and otherwise looked OK, but that respiratory rate had Sara concerned.  So they drew some labs, fully expecting them to come back normal.  But her WBC count and C-Reactive Protein were high, indicating infection.  They then drew blood cultures and did a chest X-Ray, which was hazy, which was possibly indicative of pneumonia.  How on earth did that happen?  They didn't know, but assumed that she aspirated something during delivery.  She was coughing and gagging up clear fluid (likely amniotic fluid) earlier in the day, which I told them.  But it didn't look speckled, as if there was meconium in it or anything.  And amniotic fluid in and of itself wouldn't cause pneumonia.  But because of the X-Ray and the lab findings combined with her exam, she needed to go to the NICU for IV antibiotics.

My response was, "So she can't come home tomorrow?", to which the nurse practitioner replied, "Definitely not."  She would need to be in the NICU for at least 48 hours and possibly up to 7 days.  My heart was crushed.  What was going on?  It didn't help that I was so completely spent after my labor, a new baby, and severe lack of sleep.  I bawled.  I mean, I was a basket case.  Sara was so sweet and she tried to console me, but I was just so overwhelmed and upset and exhausted that I couldn't think straight.  I'm sure Mike thought I was overreacting big time, but I truly couldn't help it.  So I layed there from 2:30 AM until after 4AM and cried in my bed until I was allowed to go over to the NICU to see her.

I got a pump from the lactation consultant, pumped a whopping 1ml, and marched it over to the NICU for my baby.  They wouldn't be letting her breastfeed while she was breathing so fast.  Seeing her in the NICU was actually very reassuring to me.  She didn't look sick.  She didn't even need supplemental oxygen.  She had the normal monitors on and had an IV in her left hand, but she was sleeping comfortably under the warmer.  We visited for awhile and then headed back to our room to try to catch a few hours of sleep.  I knew there would be no way I could sleep until I saw her and saw that she was doing OK, so once I did I was able to sleep for awhile.

First NICU pic

Izzy's spot

The nurses even make little name tags for the babies :)

We went back to visit again around lunchtime on Sunday and she still looked good.  The NP showed us her CXR and told us her lab results, which were improving already. (WBC went from 25 to 20, bands from 26 to 7, and CRP went from 2.5 to 2).  Mike held her and it was so interesting to see her respiratory rate go down when he did.  She just needed a little bit of Daddy in her life ;)

Later on her respiratory rate was a little bit better, so they let me try to nurse.  Izzy was utterly uninterested, so we just snuggled for some skin to skin time.

Around 3 in the afternoon I got REALLY severe cramping after I pumped, to the point where the pain was almost unbearable and I thought "something must be radically wrong" (to quote Grandma Dougherty).  Mike had left to rent a breast pump for me, so I was in the room alone.  I called my nurse for some Motrin, but the intensity of the cramps kept increasing so badly that I was shaking and I kind of started to panic.  My nurse, Robyn did a straight cath to make sure it wasn't my bladder being too full.  Nope, that was fine.  The midwife, Jane did an internal exam to check for clots.  Now that was hands down the worst pain I have ever experienced in my life.  Ten times worse than labor (thanks to my friend the epidural).  It took all that I had not to scream.  But, after all that, no clots either.  They drew some labs, (which of course took the phlebotomist 3 or 4 times to find a vein), and labs were normal too.  so they determined that it was just very severe uterine cramping.  I got 10mg of IM morphine and 25mg of Phenergan, and the pain began to subside.  An hour or so later it was gone.  Very, very weird and scary experience.

Around 8PM I was discharged...without my baby.  That was tough.  But I went to visit her at 11PM to try to nurse and then I stayed in the anesthesia call room and was able to sleep from 12-7AM.  And boy did I need it.  It had been almost 72 hours with only about 4 broken hours of sleep, and I was feeling the effects big time.  I was in a much better state of mind on Monday.

I went in to see Izzy at 8AM and her stats kept improving.  (WBC down from 20 to 17.  CRP down from 2 to 0.86.)  Her weight went down to 8lbs 1oz, but that weight loss is expected in the first few days.  My transitional milk came in overnight and I was able to pump an ounce or so.  She wouldn't take the bottle from me, so the nurse gave it to her.  And she lost her hand IV and ended up (after several attempts in other spots) with one in her scalp.  Luckily, being a PICU nurse, I was used to seeing those so it didn't phase me much.  The scalp IV only lasted a day or so, and then she got one in her foot, followed by her right hand.  4 IV's (with countless pokes) for that week long stay in the NICU.  But it's par for the course in that environment.

Look at how pissed she looks to have that scalp IV:

Here I am giving her a sponge bath:

Mommy and Izzy

Aunt Tina feeding her

The NICU's feeding schedule for the babies is every three hours around the clock: 8AM, 11AM, 2PM, 5PM, 8PM, 11PM, 2AM, 5AM.  So I trekked back there every three hours to nurse her (except for the night time feeds).  She got some formula for the first day or two until my milk came in, but after that the nurses gave her my pumped milk overnight.  Despite the fact that I didn't go overnight, going back and forth to the NICU every three hours was exhausting.  8AM, 11AM, 2PM, 5PM, and 8PM.  Every day for a week.  I stayed in the call room a few times between the 2PM and 5PM feed, but otherwise I just drove back and forth every time.  And, let me tell you, this week took its toll on the whole family.  I would nurse Izzy (or at least, attempt to), drive home, pump, eat, and drive back.  That was my schedule.  I was exhausted.  Mike was exhausted from being essentially a single parent to the older girls that week.  And the girls would cry every time I left, which broke my heart.  We were all a mess and just wanted baby Isabelle home with us.

So all week, back and forth I went.  Mike came about once a day when we could find someone to watch the older girls for us.  And Tina came with me about once a day too, which was great.  (She also hung out with me several times in the call room for some rest and HGTV, ha ha.)  Nursing was hit or miss with Izzy.  Sometimes she just would not do it, which left me discouraged.  Other times she did great, which would give me renewed hope.  But she was continuing to improve overall every day, which was all that mattered.  She was downgraded from a level 3 to a level 2 status after 24 hours in the NICU.  Her blood cultures came back clear, which was also good news.

On Tuesday they moved Izzy out of the warmer and into a regular bassinet.  Plus no more scalp IV, so she was looking less and less like a NICU baby.  And that made my heart happy :)

On Thursday morning I brought in some onesies for her to wear because she had been pooping through several outfits per day, ha ha.  Izzy has been a poop machine since day one.  I think she pooped 7 times on her first day of life!  And Thursday was the first day that she nursed so effectively that she didn't need a bottle afterward, which was great news!

Here are a few more pics from her week in the NICU:

Izzy's last dose of antibiotics was scheduled for Saturday at 2PM, but the docs moved the doses up a bit so that we could take her in the morning and Aunt Tina could see her.  (Yup, coordinating around her schedule again ;)  But we adore Aunt Tina, and what would we do without her?)  So Saturday eventually came and it was time to go home!!!  Izzy got her hearing screen done, pre- and post-ductal O2 sats measured, Mike and I signed some papers, and off we went.  It was a seamless discharge and we were so happy to finally be able to take our baby girl home.  What a great day!

In the car seat and ready to hit the road!

Daddy got her all snuggled in for her intro into the world outside of the warm, cozy NICU ;)

All in all it was a very tough week for our family.  It was trying and exhausting and busy and emotional.  But we got through it together.  And I have to say that the entire NICU staff was amazing.  They really made the whole experience about as good as an experience like that can be.  They even tried to recruit me to work there!  Yup, the nurses and even the nurse manager and neonatologist were encouraging me to come and work with them.  And it is enticing, let me tell you.  It's such a great little unit, and I think I would really enjoy it.  But let's take things one step at a time.  Our family's NICU journey is over.  Izzy is finally home, so I'm going to enjoy that and spend some time with my girls for awhile :)

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