Austin & Malia's First week wraps up

Thursday was an emotional day (as if the others don't measure up!), but our morning check-in with the babies was highlighted with Cheryl's first up-close encounter with either of the babies - tummy time with Austin.  In the NICU they call this kangaroo-care (explanation not necessary), and it gives the mommy a chance to bond with her baby, a benefit that is often deprived in the intensity of a preemie birth.  The gravity of the encounter was certainly not lost on Cheryl, nor would any first encounter soon be forgotten by any mother with her baby.  It was a very intimate, sweet moment; the restless and fussy kid both inside and out of the womb had found his home on his mother's chest for the first time.  It's hard to say for certain whether Austin recognized his precise location in the universe, but it's undeniable when a baby finds comfort in the embrace of his mother.  I think this picture captures just that...

Meanwhile, Malia seemed to be a little more active than her usual self, but she had also just received a PICC line hours before our arrival and might have been a little pissed about it.  Once she calmed herself down, she began to open her eyes up for the first time (that I've seen).  It's right about this point in the pregnancy that the eyelids even un-fuse, so it was really nice to see Malia testing out her new-found sense of sight.

It takes some getting used to, how small these babies are.  With pictures, you look for points of reference like a hand or a syringe, but it doesn't really sink in until you have them in your grasp.  Austin, the bigger of the two, still has a lot of growing before he'll fit into his dad's size 10 wedding band.

Our evening session with the babies was a little harder on the parents.  We knew that Malia had been diagnosed with a "loud" heart murmur, and they were to do an echocardial ultrasound to see what was going on in there.  When we asked the nurses about the test, there was an awkward moment when they balked at answering the question and arranged to have the doctor come explain the results.  The doctor explained that the murmur was related to what they suspected, a common condition in preemies known as Patent Ductus Arteriosus (PDA).  The normal function of this duct is essential in utero, but when the baby begins breathing air after birth, it is necessary for the pathway to close.  Without this connection closed, it allows too much oxygenated blood to return back to the lungs, and can cause a number of other problems down the road.

(Photos taken from Preemies: The Essential Guide for Parents of Premature Babies (Linden, et. al), and thanks to Tom & Danielle Flowers for the awesome bible of preemies!)

So the tricky part is the much overused statement by the doctor about having a crystal ball in terms of making the right clinical decision.  The possible outcomes for Malia are:

• with time, her PDA resolves itself by closing, and hopefully presenting no symptoms or complications associated with the condition.  The condition itself is most likely a result of gestational immaturity, so time could fix the issue.
• She begins to show symptoms of a PDA complication like hypotension, pneumonia, renal complications, breathing problems.  Intervention by medication or surgery is recommended
• If PDA complications look like medication (indomethacin) would present the best possible outcome, then medications would be favored to surgery.
• Once Malia is two weeks old, the efficacy of indomethacin decreases, and the known side effects in conjunction with some symptoms might make surgery the more favorable outcome.
• If surgery is the only option to ameliorate the PDA, then she would be sent to CHOC where a specialist would perform the procedure to clamp the duct.  Fairly easy surgery to perform, but still very serious for a preemie.  (Details shown below)

So that sucked.  We had to remind ourselves that she's asymptomatic of the PDA besides the heart murmur.  The waiting game begins.  Lets hope that stronger breathing and good growth helps her resolve this on her own...