The Craig Family Logbook: Jacob's First Week

Thursday:
After delivery, Jacob was brought up to the head of the bed in the OR for me to see very quickly; then he was whisked away to the NICU (neonatal intensive care unit). The nurses in the NICU came to talk with me prior to deliver, so I had a little bit of an idea of what to expect. I was told he would probably be intubated for several days to allow them to give surfactant (to help his lungs). She told me babies born at 29 weeks typically do very well, and tend to require 6-8 (sometimes 11) weeks of care in the NICU before they are released. Jacob was put on the ventilator to support his breathing and given surfactant to help his lungs and a caffeine drip to help maintain his blood pressure. He was also started on TPN (IV nutrition) until he was stable enough to take things through the GI sysstem. They placed a UAC (an Arterial Line in his Umblical Cord Artery) to monitor his blood pressure continuously, and allow easier access for his ABGs (blood gas lab to check on his breathing). He also had a little sticker that continuously monitored his temperature. He was placed in a special radiant warmer bed with a tent over him to help keep him warm while allowing easy access to his lines in case of an emergency. About 2 hours after birth, the nurses had Jacob stabilized enough to have visitors. Jason, Justin, Mallori, and Mimi all were able to go up and see him. Mallori brought her camera and video camera and took lots of pictures and videos for me to see! I was stilled in Labor & Delivery until they were able to get me stabilized.

Daddy with Jacob

Little Man with all of his lines hooked up.

Little Feet!

For a size reference...

Aunt Mallori

Mimi

Friday:
The nurses were working hard to get both Jacob and me stabilized. My blood pressure was still out of control, and I had to remain on the magnesium for 24 hours after he was born. The nurses continued to watch my lab work following delivery. My liver enzymes and kidney function continued to rise for 24 hours after delivery. The doctors told me this reassured them that they made the right decision to take Jacob so early.

The nurses told me that Jacob's lungs were "sicker than the average 29 weeker" and he would probably require support from the ventilator for a little longer than they initially expected. They were watching him closely and drawing ABGs (labs to check his oxygenation) every few hours. They nurses told me they would do an echocardiogram of his heart to make sure there was not something going on with his heart. Jacob's weight today was down to 2 lbs 2.1 oz. However, they do expect them to lose a little at birth.

Casey had driven ALL night Thursday night from Fort Worth to come see her new LITTLE nephew and got to Memphis EARLY in the morning Friday! My Mom and Cousin Nancy also drove to Memphis today, and were able to go up and see the baby earlier in the day. Jacob had lots of visitors and everyone was able to check him out... except me! It was soo hard to wait and let everyone else see him, but I wanted him to know he had a lot of people who loved him and cared about him! He was already such a special baby, and has all of us wrapped around his tiny little fingers.

My magnesium dose finished about 9 pm, and I was allowed to be wheeled upstairs to see Jacob for the first time since the OR at about 11 pm. I was so excited to get to see Jacob! I thought he was such a pretty baby! I also started examining his features... It was really hard to tell much about his face with the ET tube from the ventilator and all the other stuff on his face. I still thought I could see A LOT of Jason in his face but he looked very dark skinned and looked like he was going to be built like me. He had a very long body! After visiting with Jacob, (Jason had to pry me away from his isolette) the gang (Jason, Justin, Mallori, Mimi, and Casey) went home to get some rest. By now, Everyone was very tired and headed home to get some much needed rest. Before Jason was able to get settled in at the house the alarm company called to report the motion detectors had set the alarm off at the shop. Jason and Justin hurried to the shop (about 3 am) to check out the situation. It appeared that someone had made entry to the shop but nothing was missing. This was going to make for a very long day tomorrow...

My first time to outside the OR to see Jacob

Saturday:
Jacob made his arrival before I was able to have my baby showers, and Mallori had planned a baby shower for my Memphis friends Saturday, June 4th. We had made plans to move it to the hospital since we were planning on spending the next few weeks in the hospital. :) So... With his unexpected arrival on Thursday we decided to go ahead with the shower as planned on Saturday. I was able to get up and take a shower, and Casey and Jason helped me get ready while Mallori, Justin, and D'Andre setup the shower. Mallori had made lots of treats and decorations -- all of which were "his color" of aqua and had really cute airplane accents. She also made these really cute signs to put up all around the hospital to help direct people to the shower. I LOVED the cupcakes and aqua icing, and we were able to share the left overs with the nurses. After the shower, they had my blood pressure and labs stabilized and I was allowed to go upstairs to a postpartum room, which was much more comfortable.

The food table and decorations!

Another picture of the table

Diaper Cake with Jacob's Lovey ... It is now in his isolette!

The signs that were placed around the hospital to direct people to the shower

Looking into the conference room where the shower was

The people at the shower

Presents...

A picture of me at the shower... I was still unable to stand up too great.

Looking back, this was a really bad day for Jacob, and I don't think any of us realized how sick he was... Jacob's weight today was holding at 2 lbs 2.1 oz. Jacob's bilirubin had gone up and they put him on a biliblanket. Mallori said he looked like a "little glow worm"... He did! The biliblanket also is very common even in full term babies, and the lights help the babies immature livers break down bilirubin. Jacob's chest xray look really bad this morning, and the nurses and doctors were not happy with how much support he was still requiring from the ventilator. Jacob also had an echocardiogram today, and they told me that his PDA (Patent ductus arteriosus- A hole in the heart that is needed before birth but should close after birth) had not yet closed. I knew from nursing school that this was not that big of a deal and many preemies and even full term babies have a PDA that takes a little while to close. They believed the PDA could be exacerbating his lungs further and decided to treat him with Indocin. Because he was requiring so much support from the ventilator they decided to move him over to an oscillator. These are special ventilators that are better for very "stiff" lungs. It allows the machine to hold the alveoli in the lungs open continuously rather allowing them to collapse between breaths. They also decided to give him a 2nd dose of surfactant. Jacob was holding his own and several nurses told me what a fighter he was, but he was being so fiesty and moving so much (and pulling out his tubes) they were worried about how many calories he was burning. The nurses had to begin giving him some Fentanyl to help him calm down.

The little glow worm! He has sunglasses in too!

Sunglasses... Before Daddy added the Oakley graphics

Mallori decorated his room for me! He has the cutest room in the NICU!

View from the door!

Sunday:
Jacob was up to 2 lbs 2.9 oz today He was still on the oscillator & biliblanket, and still had the UAC. We probably over did the stimulation yesterday with people from the shower coming in to see him in addition to all the family that was in town. Today, the nurses would not let anyone in to see him. They had his door closed, blinds down in his room, and they said they were clustering their care so they only had to go in there when they had to. Jacob was very sick today and needed a few days to rest. We all stood at the door and peeked in at him, but it was hard to see much more than the glow. They decided to give a third round of surfactant, but were hoping he would begin to make his own soon. They told me this usually happens by 5 days old. By Sunday night, the nurse practitioner, Lynn, was more optimistic about his progress and she believed the Indocin had helped. His ABGs were better and they were able to decrease his settings on the oscillator. Mimi, Granny, and Nancy all headed home today. I talked Casey into staying another day because she was so tired from all the events I was afraid of her driving that far by herself.

Monday:
I began to settled into a routine today... Get up go see Jacob, get some errands run, Go see Jacob, go to bed. I was unable to drive for 2 weeks, and I was dependent on everyone to haul me around. Mallori really helped me keep my sanity over these first two weeks and kept my mind busy so I didn't have too much time to think about not having him home. There were a few break downs along the way, but I have prayed many prayers over the last few weeks thanking God for such an amazing support system. Jason and I have been blessed with amazing friends and family!

Jacob was also beginning to improve. His ABGs were better and he was ventilating better however, his chest xray still looked bad. The doctors are planning on doing another Echo in a few days to check the status of the PDA. Tonight the whole gang (Justin, Mallori, Jason and me) were all able to come see Jacob. We took several pictures and we were able to touch him a little more than we had been. I was able to kiss him for the first time! Amazing!

Debbie (one of the many awesome NICU nurses) makes special hats for every holiday. This was a leftover from easter to test out the size!

Holding Mommy's hand

.... I think this is Daddy's pinkie

Tuesday:
Jacob was back up to his birth weight today... 2 lbs 6 oz! Mallori drove me up to the hospital again today, and we worked on washing all of Jacob's clothes and doing a little shopping for some essentials around town. The nurse practitioners had several good updates today on Jacob's progress. The nurses said that he was tolerating weaning on the oscillator and they had him down to 21% O2 (room air). They were planning on trying to extubate him tomorrow if his chest xray was stable and he was stable throughout the night. Jacob was tolerating stimulation much better today, but we decided not to mess with him too much. We thought he might need a little extra rest so he would do well when he was extubated. The echocardiogram showed the PDA still open, and they decided to treat him with a second round of Indocin. Jacob's bilirubin was down, and they were able to take him off the biliblanket!

Wearing my new custom hat

The start of Jacob's custom clothing line ... He is too small for even the preemie hats and clothes!

The full line... 5 blankets and 11 coordinating hats... A BIG thanks to Aunt Mallori for the sewing help!

Wednesday:
Today was a big day for Jacob! Jacob was scheduled for an ABG and chest xray about 5 am, and they were going to make a decision on extubating him after that. But, Jacob couldn't wait for that! He extubated himself about 3 am, and was able to maintain his heart rate and oxygen saturation just fine. They started him on a high flow nasal cannula at 4 L @ 35% and were able to wean him down pretty quickly. Mallori was still driving me around... She also was our photographer today! She is really good at using her camera, and Jacob always seemed to smile when she would talk to him. We had a really fun day taking pictures... We coincidentally wore the same shirt today, but it made for some cute pictures! Jacob's color looks much better today!