December 30th – 3 Weeks Old

We’re just about at the end of December and already the boys are three weeks old.  In some ways it feels like they were just born a few minutes ago, but in other ways it feels like they’ve been around forever.  We’re really enjoying getting to know them, and we’re grateful for the outstanding care they get at the hospital.  We’re also excited to get them home at some point soon.

Kristen and I spend a fair amount of time with them every day.  When we get to the hospital, we do a three-minute scrub, just like we’re going into surgery.  If you visit the boys in our home when they get here, you can expect to be asked to do something similar until the summer of 2016.  🙂

All three boys continue to make many positive gains and all are growing.  Here are their weights and lengths as of December 30th:

  • Samuel: 3lbs, 10oz | 16.93 inches long (43cm)
  • Jacob: 3lbs, 12oz | 15.16 inches long (38.5cm)
  • Charlie: 3lbs, 6oz | 15.16 inches long (38.5cm)

I had a prediction that at least one of the boys would be 4 pounds by New Year’s Day, so Jacob may make me look good.

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Our first family portrait.

On Tuesday, we got to hold all three boys.  It started with a question to the nurses on Monday.  We wanted to see if Jacob, who is doing so well, could visit with Samuel to give him some brotherly love and help him kick it into gear on the breathing.  The nurse told us their policy and how it was unlikely, but she came back a few minutes later with “surprisingly good news” and an offer to hold all three at the same time for some photos.   That was an instant heart-melt for both of us, and we couldn’t wait for Tuesday.  The pictures turned out pretty darn good.

Samuel

Samuel continues to have his struggles with his breathing.  He’s on the Vapotherm machine still, and his oxygen levels range anywhere from 24% to as high as 39% on the 28th.  The goal is 21% – which is what you and I breathe without any effort.  The 39% was an all-time high for him on the Vapotherm machine, and that’s not a good thing.  That was a bad day for him.

Sammy can’t tolerate being on his back for very long and all the time spent on his stomach, with his head turned to the side, is causing his head to be misshaped a bit.  He’s not having as many interactions with us as his brothers, so he’s got a long way to go.  But we give him lots of hugs, kisses and pep-talks each day.  It’s not a competition with his siblings, but it’s hard to see them doing so well and while Sammy works so hard to breathe.  He just gets exhausted.

We talked to the doctor on Monday and he says the PDA that Sammy has is about 2x what he normally likes to see.  Samuel’s is about 3mm, where the typical PDA is 1.5-1.8mm.  Treatment options include waiting it out – which is the current course – or try indomethacin, the same thing that Charlie had.  It work well for Charlie, and I’m not entirely clear why it’s not being tried with Samuel.  Now’s not the time for me to play doctor, though.  These guys are good at what they do, so there’s a method to the madness.

Still, let’s keep things in context.  We’re not even to 34 weeks of gestational age yet, so it’s not entirely unexpected for at least one of the boys to not be doing as well as the other two are doing.

Jacob

Jacob is the rock star so far.  This week we “popped the top” on his incubator and he is able to maintain his own body temperature at an acceptable level, so far.

He only has a few things hanging from him these days.  He has his feeding tube up his nose and into his belly; he has his heartbeat monitors and he has his pulse-ox monitor on his foot.  He continues to have “brady’s” periodically, but he self-recovers quickly.

Since he’s now in the open air, we’re getting to interact with him more.  We have clearance to just come in and pick him up if we want.  We still are mindful that he’s a premature baby who needs a lot of sleep and just a little interaction, but it’s hard to ignore him since (a) he’s so darn cute and (b) when he’s alert, he makes eye contact and wants to interact!

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Tada!

Kristen brought in some clothes and we’re now able to dress him.  Kristen put him in a premie outfit on Tuesday and it actually fit!  Unfortunately the little guy couldn’t keep all his milk down, and he threw up all over the outfit.  So I changed him into a new onesie.  On Wednesday, he threw up all over Kristen!

Just as I’m getting good at changing diapers, we now throw in a new wrinkle of complexity: clothes.  So I’m going to have to get used to unbuttoning, changing and then reassembling.  I’m slow now, but I’ll get it in time.

Jacob continues to be socialized with breast feeding, but he’s still in the very early stages.  I hope he’ll be in full swing by next week.  He’ll start getting a bottle on Friday.  He should be in a regular bassinet by then too.

Charlie

Charlie may be the smallest boy in weight and I’m beginning to understand why:  He’s the biggest pooper!  This kid has diaper explosions all the time and changing his diaper’s an adventure.  The nurse and I had a funny experience changing his diaper today.  We’ll skip the details, but let’s just say it took us four diapers before he finally stopped pooping!

Seriously though, he’s doing very well. Just like Jacob, he’s down to the bare minimum of wires connected to him.  He’s breathing completely on his own, and I’m guessing it will be just a few more days before he can pop his top too.  I think gaining some more weight will help get him there.

He likes his pacifier a lot and when his eyes are open, he’s constantly interacting with you, examining all the things that are going on around him.  He’s a snuggler and loves hanging out with mom.

Here are some photos from the past few days.

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Todd and his boys!
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Jacob wears his monster jammies.

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Kristen and her babies!

Merry Christmas from the Mazza boys

We spent Christmas Day at the hospital with the boys.  All continue to do well.  Charlie made the biggest news today with the removal of his oxygen tubes.  It’s just a trial, but the nurses hope the doctor will write orders to permanently remove it is he continues doing well.

Jacob is just Jacob.  No big news other than he’s now 3.5 pounds.

Samuel continues to try and wrap his mind and body around the idea of breathing.  He’ll get it eventually.

We decided to take some pictures of them in a stocking. They certainly are cute.  Merry Christmas to all! 

Jacob
  
Samuel opens his eyes for a picture
  
Charlie without his oxygen tubes
 

December 23rd – Two Weeks Old

We’ve made it to the two-week mark and the boys continue to progress nicely.  There’s no end in sight for the hospital, but it’s now part of our daily routine and we can see real changes in the past two weeks.

First, we went to our two-week visit with Dr. Won this morning.  Kristen’s C-section cut was reviewed and the glue was removed.  I have to say it’s a work of art.  I’m fairly certain nobody will ever know she has a C-section.  It’s really, really good.  Dr. Won did a great job in putting her back together.

Dr. Won also told us the lab report on the placenta’s came back, and she now knows what caused the premature birth.  Jacob’s placenta was starting to get infected, so it ruptured.  We don’t know what caused the infection to start, but the rupture is a natural reaction to protect the baby from the infection.  That’s what started everything.

OK, on to the kiddo’s.

Samuel

(Note: Thanks Mom for pointing out it’s not Sammie with an IE as I typed earlier in the week, it’s Sammy with a Y)

Sammy is doing just fine for 32 weeks, 5 days, but when compared to his brothers he’s not doing as well as quickly.  He’s tied for the lead when it comes to weight: 3lbs, 4oz.  He’s not as long as Charlie though.  He’s only gained a fraction of an inch.

Today the cardiologist did an echo on his heart to see if this is impacting his breathing.  The pediatric cardiologist stopped by and told us everything looks good.  He has a PDA – a hole in his heart – but it’s normal and no concerns.

Samuel is back on the light therapy for jaundice.  He’s the only baby still in this but his numbers for bilirubin are improving.

Samuel goes through light therapy.

As we were visiting today, Sammy lost the rest of his umbilical cord, so he has a normal belly button now.

Jacob

Jacob is doing the best of everyone.  The nurses tell us his apnea and brady’s are occurring less – none overnight last night.  That’s great news.  He weighs in today at 3lbs, 4oz and he’s at the maximum feedings.  He’s technically 10 grams heavier than Samuel.

Today he started breastfeeding and Kristen says he was a champ, fully latching off and on for about 30 minutes.  That’s great news.  We’re not sure how much he took in, since the suck/swallow reflex is just building up.  But it’s possible and likely he got something.  We’ll keep working on this and build his skills in the next few days.

Jacob also lost his umbilical cord today, so he can finally get a real bath.  We’ll do that tomorrow.

Charlie

Charlie is doing really well too.  He’s weighing 3lbs, 3oz today.  He had some medicine to help that artery close off and that worked well.  It wasn’t completely closed when the doctors checked on Monday, but it was so small it was barely noticeable, so there’s no other medicine to take.

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Charlie chills after a diaper change.

Charlie’s vapotherm is down from 4 liters to 3 liters to 2 liters today, and he’s constantly on room oxygen (21%).  If he keeps this pace up he’ll be off all oxygen supplements in the next few days.

He’s taking his feedings like a champ.  In fact I changed his diaper at 1:45pm on Wednesday and the nurse tested for “residual” – the amount left in the stomach ~2+hours after feeding, and there’s nothing there.  So she was going to warm up his food early so he can have some more earlier.

Once he’s off his vapotherm, he can try breastfeeding with Kristen.  We introduced him to breastfeeding today but he was cranky.  He preferred to sleep during his feeding.  I managed to get a quick photo of him as he was about to doze off and close his eyes.

Charlie spends time with his mom.

After these pictures were taken, and later today, Charlie pulled out his feeding tube, so they re-inserted it through his nose.  He seems to like that better.  I also changed his diaper a bit later after his feeding and reality has set in.  This is the champion pooper of the year!  Wow.  Reality smacked me in the face today.

These boys are great and we love them like you can’t imagine.  We absolutely can’t wait to get them home.

How to treat a choking baby

Some of the things I post on the blog are simply reminders and tips for me and Kristen as we come across them.  This is one of them.  I found this on the Dads of Triplets page on Facebook, and somebody says they actually (unfortunately) needed to use this.  I hope we never have to, but at least it’s here and I can watch it periodically.

I’ll have our two-week update sometime tomorrow.

Saturday, December 19th – 10 days old

Samuel, Jacob and Charlie are 10 days old today.  Wow!  It feels like it was just yesterday that they were born.  I thought I’d give an update on each boy today.

Samuel

Sammie’s doing good but he’s still lagging behind his brothers.  He’s now 3lbs, 3oz today, and he’s eating pretty well.  He’s also spitting up quite a bit too.  Preemie’s are known for reflux, and he’s got it.  He also is the person who has the most “desats”, or desaturations of oxygen.  He has more when he’s on his back, and almost none when he’s laying on his belly.  So the nurses are keeping him on his belly most of the time.  He got his IV out today (yay!), so he only has his feeding tube still in him, plus the vapor therapy tubes.  Since he’s had some desalts, the nurses have bumped him up to 25% oxygen.  21% is normal – what we all breathe daily, so it just means he needs a little extra help.  He still has the heart murmur, but that’s nothing to be concerned with as the artery is closing.  (see more on this below) All-in-all, Sammie’s doing great for a gestational age of 32 weeks, 1 day.

I got to change Sammie’s diaper on Friday, and let’s just say it was the gift that kept on giving.  The more you wiped, the more he produced.  That’s my boy!

Jacob

IMG_7437.JPGJacob is setting the gold standard.  He’s been off all tubes for several days now and he’s really well.  He has maxed out on his feedings via his feeding tube 28mL every three hours), and today we hope to start breastfeeding him.  We don’t expect much the first day or so.  It’s mostly just an introduction to the breast.  Kristen tried about 1pm today and he was more interested in sleep than getting some food.

Jacob is also leading the way in throwing up.  The reflux is really uncomfortable for him, I guess, but he’s quite possibly the funniest spitter-upper I’ve ever seen.  He gets a funny look on his face, slowly opens his mouth and it just comes out.  He doesn’t make a sound.  He goes right back to sleep after.  It’s typically right after the feedings, so now they’re working on stretching the feedings out to 45 minutes with hope that it works well.  Still, he’s keeping most of it down and digesting well.

He still has his heart murmur, but the doctor’s say it’s getting better, which means that artery is closing. Jacob’s also suffering some desats here and there, but not frequently.  He has some apnea and brady’s (bradycardia) episodes, so the doctor’s are watching that.  But once again, for his gestational age, he’s well above all standards.

Charlie

IMG_7439Charlie’s doing really well too.  He’s up to 2lbs, 15oz. today, and he’s taking 15mL of food every three hours.  He still has his IV, but my guess is it will be out by Monday.  He’s also doing really well on the vapor therapy and I would also guess he could be off the nasal cannula by Monday too.  He’s having the same reflux issues, though not as significant as Jacob.  I got to hold Charlie today when we came in and he took his feeding like a champ.  He did the same yesterday, though he decided to share some of his breast milk dinner with my chest last night.  Lucky for me I had a blanket on to protect me.

Charlie’s heart murmur is a bit more significant than the others’, but it’s not a cause for concern.  The doctor’s did an “echo” on Friday afternoon and the pediatric cardiologist put him on some medicine.  I explain all this a bit further below.  All-in-all, the boys are doing great and Kristen and I will be able to relax a bit for sushi tonight.

Kristen:  Kristen’s doing really well.  She hopes to try driving on Sunday, and maybe by Monday morning she can drive herself to and from he the hospital.  She’s pumping furiously – about every two hours during the day and every four hours at night.  It’s really tiring, but she’s doing great.  I remember when we started dating, I envied how she would sleep for 8 or 9 or even 10 hours.  I can usually be really functional on 6.  Welcome to my world, hun!

Heart Murmur or Patent Ductus Arteriosus

images_282The National Heart, Lung and Blood institute has a great explanation of what this is on their site, but effectively the heart murmur our boys have is related to an artery that typically closes within minutes or days of being born.  Of course that’s under normal circumstances for a 40-week-term baby.  But in preemie’s, the schedule is thrown off and the baby may take a bit longer for this artery to close.

Samuel and Jacob have this closing more rapidly than Charlie, so Charlie’s getting some medicine (Indomethacin) to help it close faster.  Hopefully the medicine, and time, will close it.  If it came down to it, surgery could be an option but he’d have to be transported to Oakland Children’s Hospital.  That’s about the “worst case” or most extreme thing that could happen.  The doctor’s don’t think it’s likely, but they’ve educated us on it too.

We’ll watch it closely for all three, and Charlie will get two more doses of the medicine before another Echo on Monday.  If the results show it’s closing, more medicine may be in order, or just more time.

Misery loves company

As many of you may know I’m a lifelong Miami Dolphins fan.  You probably also know it’s a love / hate relationship and these days it’s more on the hate side.  Anyway, thanks to my dad my boys will now sit with me on Sundays in disappointment.  Here’s to a lifetime of misery ahead!  
Seriously, thanks dad!

  

Unchartered territory

Today we’re entering what the nurses called unchartered territory.  Jacob had his IV removed, and he’s not even 32 weeks old yet.  He’s 100% on his own breathing, and he’s getting 23mL of breast milk per hour with a 24 calorie fortifier.

The nurses say they don’t often see regular babies do this well, let alone a triplet.  So that was great to hear.

Jacob is suffering from some reflux, so he has been vomiting his food up shortly after he’s taking it.  But it’s not impacting his weight – he’s up to 1400 grams, or 3lbs, 1oz.  It’s kind of funny to watch him vomit.  He doesn’t make a sound and just opens his mouth and out it comes.  He almost threw up on me today – only a blanket I was holding him in saved me.  And this was after the bath that Kristen and I gave him – the first bath he’s had with us.  It was really more of a wet wipe-down.

I got to hold Charlie for a bit tonight.  He’s progressing up to 2lbs, 12oz, so he’s still the smallest.  We’ve come to the conclusion he has a different chin than his brothers.  Jacob and Samuel have my chin, which is a bit “softer”.  I think Charlie is going to be a thinner boy than the other two, and he may end up being the tallest too.  He slept most of the way through my holding, but we listened to Foo Fighters music.  I have to get these kids cultured early!

I didn’t spend much time today with Samuel.  Kristen gave him a bath, and he got excited and peed all over the place with his diaper off.  That’s my boy!

One week old today

Time flies when you’re having fun!  The boys are already a week old now, and what a difference a week makes!  We went from a scary birth at 30 weeks, 5 days to a confident group of boys who are growing each day.

Jacob at 1-week-old
Jacob at 1-week-old

Jacob:  Jacob is doing the best of all the boys.  When he was born he measured in at 2lbs, 14oz, and he slid backwards a bit in weight for a few days after, but now he’s progressing the fastest.   He was the first to get off the CPAP machine, and now he’s the first to graduate from the vapor therapy machine.  He has no breathing tubes in place – just a feeding tube through his nose and an IV in his foot.  Today he graduated to 3lbs even, and he’s taking 15ml of breast milk every three hours.  The quantity is going up by 3ml every 12 hours now.  Today Kristen will attempt to start breastfeeding him.  We reasonably expect all IV’s to be out of him by this weekend, and maybe even the feeding tube.  So he’s doing fabulous for just under 32 weeks old.  One thing the doctors are watching is a heart murmur.  Essentially there’s an open vessel or valve that is used while in utero.  It normally closes at birth, but it’s just not closed yet.  They can hear it getting fainter the past few days, so everyone reasonably believes it will close.  If necessary he can go on some medication and surgery would be the worst case option.  I don’t think we’ll need to go there, though.

Charlie at 1 week.
Charlie at 1 week.

Charlie:  It’s not a competition, but he’s in second place now.  He graduated from the CPAP machine on Tuesday and we expect he may be off the vapor therapy machine (with nasal cannula) by this weekend.  He started at 2lbs, 9oz and after sliding backwards a bit himself, he’s now gaining weight and is up to 2lbs, 11oz.  He’s still in third place with his size, but he’s growing quickly.  He’s getting about 3 ml of breast milk every three hours, and he’s going up 3ml per day.  Charlie has also developed a heart murmur, just like Jacob.  Same exact situation.

Samuel at 1 week
Samuel at 1 week

Samuel: Samuel’s doing just fine, but he’s not doing as well as the other two.  He was slow to take some feedings because he had some sort of green gunk coming out of his lungs.  The doctors think it was just his intestines maturing, but he wasn’t able to properly digest the feedings they were giving him.  He’s now starting to digest better and the green gunk is all-but gone.  So he’s advancing now.

They tried to put a PICC line – or central catheter – into him a few times, but have had a horrible time doing it.  If he starts eating and digests normally, he won’t need the PICC line.  Since they’ve poked him a lot with needles, they’re now pausing to see how things progress without it.  Inserting a PICC is a specialized procedure done by a specialized nurse.  It’s dangerous enough that we had to sign a consent to do it.  Charlie has one, but his went in right away.  Jacob has had at least two other attempts, and both failed. His veins are just really tiny!

When Samuel was born he weighed 2lbs, 12oz, and he went up right away, then down and he’s been slowing coming back in weight.  We’ll see him gain good weight as his feedings grow.  At the one-week mark, Samuel is 2lbs, 13oz.  And today, like his brothers, doctors detected a heart murmur as well.  Same situation, so we’ll just watch it over the next week or so.  We expect it will go away.

Kristen:  Kristen is doing really well.  Her C-section is healing nicely and she’s almost off all her pain meds.  It will still be a few days to a week before she can drive on her own, but she’s almost back to “normal”.  She’s pumping breast milk furiously day and night – every two hours during the day and every four hours at night.  It’s tiring, but she’s doing wonderful in trying to produce enough milk for the boys.  She’s producing more and more each day, but I have to imagine we’re going to use some donor milk at some point.

I dropped her at the hospital early this morning so I could get a car seat inspection at the Danville Police Department, so she’ll spend the whole day with the boys.  (Good news is I installed everything correctly!)  I’ll work until mid-afternoon and then will go and visit, and finish up some work in the evening. If we leave early enough, we’ll stop at Whole Paycheck and get some steaks, mushrooms, sweet potatoes and fennel and onions for some good dinner on the grill.

Time for Kristen to go home

Sunday December 13th was Kristen’s discharge date.  We stayed the day at the hospital and had a late checkout.  This gave us most of the day with the boys.  We’re both excited that we’re home in our own beds.  I’m excited to get off my makeshift bed in the back of the hospital room.  but leaving the boys “alone” was really, really, really tough and emotional.

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Todd’s chair bed in the back of the hospital room.

Kristen won’t be able to drive for about another week and a half.  Dr. Won told Kristen she knows she can drive when “you go sit in your car and slam on the brakes as hard as you can.  If you can’t feel it any discomfort or pain in your C-section area, you’re ready to drive again.”

I will drive Kristen to the hospital each day this week at noon, so I can be back at work in time for calls and other things I have to do.  If it’s just calls, I may work from the hospital or Panera Bread Company in Walnut Creek.  If I have other things to do, or need some really strong focus, I’ll just return home to get work done and then go see the babies after work.  Once Kristen can do her own driving, then I’ll go see the babies after work each day.

Overall she’s feeling OK.  Her pain is manageable with Percocet and Motrin every four-to-six hours or so.  We’ve rented a breast feeding pump for the house, so wake ups at 12am and 4am will be a regular thing for a while as we try and make as much food as possible for the babies.  She’s actually doing a great job producing milk for the babies.  The nurses and doctors are all happy with her production so far.

Jacob continues to do the best.  As of Monday he’ll be up to 12ml of food every three hours, while his IV goes down 1ml per day.  We expect he may be off the IV as early as this coming weekend.  Jacob is the biggest at 2lbs, 14oz as of Sunday morning.  He’s also the guy who’s opening his eyes the most to look at us.  I sat and held him for almost two hours on Sunday.  We talked about life, golf, how horrible the Miami Dolphins are and we listened to some music.  Congregation from the Foo Fighters was the first song he ever heard.  We also listened to some Beatles and some Journey.

Charlie is probably doing second-best at this point.  He’s still the smallest, but he gained an ounce to 2lbs, 10oz on Sunday.  Kristen’s been able to hold him a couple times now, including almost an hour on Sunday.  I hope to do my first hold with him on Monday evening.  He’s taking food regularly, and they got his PICC line in over the weekend.  It’s nice and stable, and that means they shouldn’t need to poke him with anymore needles until after his IV comes out.  They can inject things

Samuel’s not doing poorly, but he’s not moving at the same rate as his brothers.  He needs a PICC line installed, and they’ve had a rough time getting this done because his veins are so tiny.  He weighed 2lbs, 12oz on Sunday, so he’s lost a little weight.  He’s not getting regular feedings of milk due to some greenish fluid in his tummy.  The doctor’s aren’t too worried.  They just say his intestines aren’t quite ready for food.  We’ve held him a bit and he’s able to tolerate that.  Kristen held him for almost an hour on Sunday.

Life in the NICU; Kristen update

Shortly after the boys were born, they were taken immediately to the Neonatal Intensive Care Unit, or NICU.  John Muir Walnut Creek has a Level 3 NICU.  Only Oakland Children’s Hospital has a better unit – Level 4.  The level of care in a Level 3 is outstanding, and we’re fortunate to have such good care for our boys.

Each boy has their own room.  Jacob’s and Samuel’s rooms connect via a glass door that remains open all the time.  Charlie’s in the next room, but there’s nothing connecting him to his brothers’ rooms. Not a big deal, though as they’re all about the same distance from each other.

The nurses are absolutely phenomenal.  The neonatologists are outstanding too.  It’s worth calling out Emily, Laurie, Jane, Joy, Aimee, Ernest, Dr. Sandhu and Dr. Bennett.  I’m sure I’ve left out somebody.

Here are some pictures from the first several hours in the NICU.

 

Kristen Update

Meantime, Kristen is doing really well.  She’s been up and walking around, though there’s a little bit of pain.  But she was up and walking later in the day after the surgery.  Now she walks back and forth to the NICU without a wheel chair.  She feels lighter on her feet already.

Breast feeding won’t take place for a while, but she’s pumping now so the boys can get the milk via feeding tube to their stomach, and by swabbing a bit in their mouth with a cotton swab.  They find it tasty!  Jacob has had the most so far, and Friday night he had a few milliliters, or about just about 1/2 teaspoon.  He’s a big eater!

We’re set to be released from the hospital on Sunday, but I’m sure I’ll have another update before then.