We've had a busy afternoon. This could be long. I apologize in advance.
We decided at 28 weeks that we wanted the NICU doctors to come back in and give us an update. I was a little nervous but this was a MUCH better conversation than the first one. The first one honestly just wasn't good. They were giving us survival rates and chances for developmental problems for a 24 weeker and they weren't very encouraging to say the least. This time things went much better. I'm going to try and summarize the conversation below. The NICU attending that came in was from Egypt. She was very comforting and really seemed to know what she was talking about. Her accent was a little thick so the resident that came with her took some notes for us. Bear with me on the information below...
Also, keep in mind that this stuff is very general and can change from week to week. This info is based on Gaines' current gestational age of 28 weeks.
In four weeks we have gone from a 60% survival rate to an almost 90+% survival rate. I don't remember where we started, but as of 28 weeks there is only a 25-30% chance of a developmental delay. That's encouraging to me because we know that even at 40 weeks, you aren't guaranteed a healthy baby.
They told us that at this hospital they didn't like to put a baby on a ventilator. If possible they prefer to use a CPAP machine. They feel like the ventilator just isn't the best choice for a variety of reasons. They still use them if they have to but they prefer not. The CPAP basically just keeps his lungs a little inflated so that they don't fully collapse (not sure if that's the right word). Basically this just keeps the baby from having to use so much effort to reopen them with each breath. The ventilator in essence breathes for the baby. First of all, they'd have to put a tube in his throat for that and they are harder to wean the baby off of. Also the CPAP machine uses just room air most of the time and not oxygen. Apparently prolonged use of oxygen can cause eye problems?
There is a chance that he could need a blood transfusion at some point if they determine he doesn't have enough iron in his blood. Iron carries oxygen to the brain and other organs but I think babies don't normally have the iron needed until closer to 34 weeks. That about covers the breathing.
There is a valve that goes between the baby's lungs and heart that is open in all babies. In term babies this valve generally closes on its own. In preemies it might not and they treat it with ibuprofen. In rare cases they have to do a procedure to close it but apparently even this is minor.
Brain bleeds are still an issue. Rarely this can be a problem for 40 week babies so its not a concern that we can ever mark off the list until he's here and doing well. They are however less likely at this point. There are four different grades of brain bleeds. The first is not a real concern and really the second isn't either. Third and fourth grade bleeds are the ones that can cause the developmental delays. They will do an ultrasound of Gaines' brain at 3-5 days, 14 days and at 4-6 weeks or right before he goes home. The likelihood of a bleed goes way down after the first few days.
They will insert a PICC line (I think...this or an IV I can't remember) for a short time that will be used to give Gaines nutrients. They will also put a tiny tube down his nose or throat into his stomach that will be used to feed him until he's about 33-34 weeks when he's old enough to start sucking and swallowing.
Right after Gaines is born they will do a blood culture to test for any infection. That will take a few days to get results on so in the mean time he'll be put on antibiotics. If the culture comes back clean, they will discontinue the antibiotics.
All in all they think that he'll be in the NICU until about 1-2 weeks before or after his due date. However, the nurses have told me that in general, it sooner than this. I guess we'll see.
My favorite attending came in tonight. She'd been on vacation for about a week and was glad to see that we were still here. We basically just chatted with her for about 30 minutes. Mostly just conversational stuff but she did reaffirm the other doctor's analysis of my sonogram earlier this week. I did find out that she isn't a regular OB. She is a Maternal Fetal Medicine Specialist which is a little more specialized than an OB...from what I understand. Either way we like her and I think Beau and I feel more at ease whenever we know that she is working.
Tonight they kept me on the monitors a little longer than normal. Gaines' heart rate looked great but they thought they saw a couple of contractions. I didn't feel them but they said that's definitely what they were. There weren't any others so they let me off and just told them to let me know if I felt anything tonight. I think they were from me laughing while I was hooked up but no one seems to buy that explanation. I need to find out if Braxton Hicks contraction show up on the monitor. I know that I feel those from time to time.
I think that's probably about it for today. I'm tired and need to get to bed. I hope I did the NICU info justice and didn't totally butcher it. Please keep us in your prayers. 28 weeks is awesome but 30 plus would be so much better. Please pray that Gaines continues to get stronger and for no infection or labor for me.