First days at home

Things have gotten quite busy since we brought the little guys home from the hospital.  We're just surviving from one feeding to the next right now (about every 3 hours).  The time in the NICU put them on the same schedule so our work is relatively easy and they are very easy going babies (right now).  We just went to the pediatrician and they've both put on weight so we're happy things are going so well.  The major reason NICU babies end up in the hospital again is for feeding issues, but not these boys!  Having so many extra hands has been helpful.  

Davis is adjusting well so far.  I asked him at bedtime if he likes being a big brother and he gave an enthusiastic yes in reply.  We have been making special efforts to each spent quality one on one time with him.  Yesterday and today Kristen and Davis played play-doh and Grandpa and I took him on his last zoo trip of the year.  We have very great support from Grandma and Grandpa which allows us to spents lots of great time with all our sons.

Home!

Today we were bless to be able to bring Alex and Evan home from the hospital.  It has been fabulous to have all three of our boys at home.  So far, one advantage of being in the NICU seems to be that they are on a very regular schedule: about every three hours they are both up and ready to eat and be changed.

Here are some pictures from coming home from the hospital:

Alex

Alex

Evan

Alex and Evan

Davis and Evan

Davis and Alex

Davis and Alex

Davis helping push the boys out

Our three boys at home

Our Boys

Davis and Alex

Davis and Evan

Davis and Evan

Davis and Evan

Davis helping feed Evan

Davis, Evan and Dad

Brining Alex and Evan home today

Kristen just got off the phone with the nurses and doctor in the NICU and we get to bring Alex and Evan home today.  Kristen is grabbing a last shower and then we are going to pack everybody up in the swagger wagon and head to the hospital to get the boys.

YATU

Yet Another Twins Update:

We had two visits with the twins in the NICU today.  Kristen and her mom went this morning and Kristen, her dad and I went this evening to see Evan and Alex.  They are both improving rapidly and had their oxygen and feeding tube lines removed sometime last night.  They seem to be eating well, both are taking around 50 ml of food each feeding and their weights are stable at this point.  They both had a carseat test that involves putting them in their seats for two hours and monitoring their blood oxygen levels.  However, only Evan passed which we theorize may be related to a missing insert in Alex's seat.  He will be re-tested tonight with the insert included.  We are very hopeful that Evan and Alex will be able to come home by Friday, and maybe as early as tomorrow.  Kristen talked to the pediatrician this morning and he was certain that both boys would be home by New Years.

Grandpa and Alex

Mommy and Evan

Alex

Evan

Kristen and Alex + Grandpa and Evan

Dad and Evan + Mommy and Alex

Dad and the Boys.  They are more stable than they look but we have to learn how to juggle babies

Baths and feeding

Kristen and I came into the NICU to see Alex and Evan for their baths and 8:00pm feedings.  Kristen gave Evan his bath then breast fed him a little bit while I gave Alexander his bath.  She tried to feed Alex but he didn't get it worked out yet. 

There seems to be a pretty good chance we could take the little squeezers home on Thursday, but they still need to make some more progress before they are ready to come home.

Snow and Trains

Christmas

I'm posting this on my phone from the NICU while holding Evan, so I don't have any pictures to share right now.  This morning, the first morning with mom home from the hospital, we woke up to an inch of snow on the ground to open our family christmas presents.  After shoveling some snow with Davis and traditonal strawberry waffles for breakfast, we got down business of opening presents.

Davis has a blast and stayed very focused on opening presents and being a big helper to everybody.  I think he got the best present when he found mommy at home when he woke up.

Twins Update

Alex and Evan are both progressing really well. 

Evan has come off his IV and was able to take 40ml from a bottle on his last feeding.  He still has a feeding tube and high flow air, but he is quickly moving towards meeting the going home criteria: taking all his food from bottle/breast, maintaining there temperature and breathing on thheir own.  They will continue to turn down the flow rate on the air until they are comfortable removing it.

Alex is also progressing well.  He still has his IV, but is currently taking a 40ml bottle from mom and can come off the IV if he finishes it.  He is also still on high flow and that is being turned down.

The doctor said it could be as soon as 48 hours for them to come home.  After their air tubes are out, they will need to be monitored for at least 24 more hours.  It certainly seems like the end of this phase is in sight.

Another Alex and Evan Update

The boys are doing much better this morning.  Both kiddos have been changed from CPAP to high flow air and have their bed heaters turned off.  They are both being monitors closely for any signs of breathing distress and are having their CO2 levels checked regularly.   Since they are off the CPAP machines, Kristen and I have been able to hold both of them.  This morning, when I got to the hospital, Kristen was holding two sleepy little guys in the rocker.  One of the nurses took a picture which I will scan and post later.  I was also able to hold both the little ones (at different times) and loved having a sleepy little fellow curled up in my arms.

The are also both taking bottles now so they might have their feeding tubes and IVs removed as a next step.  They need to get their bottle volumes up considerably still, but it is great to see one wire at a time come off of them.  Since they have come off the CPAP, Kristen is able to try and breast feed them.  However, when she tried with Evan, he was just too sleepy and ended up cuddling instead.  We've heard that it will take a long time fore them to breast feed, perhaps as long as 4 weeks.  She will try again this evening when they are more active.

I just got back from giving both the boys their bottles.  Evan took a little longer than Alex; it was great to hold one boy then the other and be a part of their care while they are in the NICU.  Alex finished his 18ml and immediately started snoring.

Here is a video of Alex in my arms this morning.

And here are a few picture of the guys from last night and this morning:

Evan last night with his CPAP still on

Evan's Bed

Alex this morning

Alex this morning

Davis visit and Kristen update

Davis, Grandma and Grandpa came for a short visit this afternoon.  Davis was very happy to show mom his matchbox cars he carried in from the car in his pocket and Kristen got a homemade lunch brought to her.  Grandma and Grandpa got to see Alex and Evan for the first time in two days while Davis spent some time with us.

Right now, assuming she is cleared, the plan is for Kristen to come home late tonight so she can sleep in her own bed and "do Christmas" tomorrow morning.  Alex and Evan will be here for a while, so Kristen is 51% ready to leave.  Staying another night, while possibly easier, creates a number insurance hurdles that we don't care to jump through.  Since we are really close the hospital, coming and going is pretty easy.  Since Kristen would leave early tomorrow if she did stay, the appeal of home, Davis, Domino and Lilly is winning out.

Davis liks to have his picture taken

He got a few minutes of snuggle time with mom, but didn't really know what to do

Davis on Christmas

Here is a very very long video of Davis opening his Christmas presents from Santa.  We have decided that our tradition will be that Santa brings presents for the stocks and that family presents will be wrapped and under the tree.  This morning Davis, Grandma and Grandpa and I opened his stocking.  Later, I took Kristen's, Alex's and Evan's to the hospital for mom to open.  When Kristen comes home, either Monday or Tuesday, we'll do the family presents under the tree.

Here is a shorter one of him and me:

Evan Update

Evan is doing much better since my last update.  He has come off the intubation and is on a CPAP machine with no added oxygen, just like his brother Alex.  I'll be headed over there in 10 minutes or so to drop off some milk and get an update from the nurses or doctor, depending on who is there. The plan for both boys is pretty much the same: ween them down to breathing room air unassisted, slowly and one step at a time.  At this point, I don't really expect either kiddo to come home before Wednesday at the earliest as the pediatrician is inclined to go really slowly with them.  The criteria for them coming home is: breathing room air on their own, maintaining their own temperature and taking all their food from either bottle or breast.

Twins Update (+Kristen)

Alex


Alex is still on the CPAP machine and is relaxed and doing well.  He may go to high flow air (no extra pressure relatively soon).  He is eating well and peeing a lot, which according to the pediatrician is a sign that he is past a lot of his early lung difficulties.  He said that babies, especially those given IVs retain a lot of liquid and when they start to recover/mend up they need to get rid of it all.  Kristen spent at least half an hour holding the little one this morning.  Our very very blond boy slept happily on her chest.


Evan

When we went to the NICU to see the boys at 8:00 last night, Evan was really laboring to breathe.  He was breathing very fast, with his stomach moving a lot with each breath and his oxgen level had been turned up to 50% (room air is 21%).  The doctors did an check and found that he had a small hole in his lung which had caused air to become trapped between the lung and the chest.  They drained this air with a needle and placed him on intubation and gave him surfactant to help his lungs develop and recover (Alex had received this on day one).  The hole will heal by itself, but the concern was that with forced air from the intubation, air could leak into the chest again which would require a chest tube to drain (an incision + tub).  Fortunately, Alex responded really well to the intubation and is much more relaxed and doing well this morning.  They are closely monitoring his blood gases (CO2 levels) and there is a chance he could come off of intubation and onto a CPAP machine today.

Kristen


Kristen is recovering from surgery well.  Her recovery is probably going along faster than it would be if the boys were in the room with us.  She is able to get lots of rest and take things very easy without the stress of trying to nurse two boys.  Because of the changes with Evan, she did not get much sleep last night.  Kristen is getting up and moving a lot and was able to walk down to the NICU and back this morning when she couldn't sleep.  There is a chance she could stay in the hospital one more day, but that would be because Alex might be able to come home on Tuesday but she would normally be discharged on Monday.   We'll see if that is something that she wants to do and her doctors is okay with.

Twins update

The twins status is largely unchanged.  We don't really expect to take either kiddo home with us when Kristen is discharged on the 26th, but we are hoping to be surprised.

Alex


Alex is still receiving air from a CPAP machine (intubation was removed earlier after his CO2 levels continued to be good).  He is about to receive his last does of the standard 48-hour course of anti-biotics.  After this, he will only get more if his cultures, which take 48 hours to grow, come back positive.  He has been taking food (5ml mix of milk and formula) every 3 hours.  Alex has also had the IV removed from his belly button as they will not need to draw blood as frequently, if at all.

Evan


Evan is still getting high flow air, sometime room air, sometimes oxygen enriched.  Like his brother, he is getting his last regular dose of anti-biotics this evening.  Kristen and I both held him for about 30 minutes today, which was stressful at times for him.  The nurse said that holding them during their sleeping times is much harder on them than holding them during their active feeding times, so we are going for our next visit at 8:00 which is the start of their feedings.

Mom and Evan

Evan in Mom's arms

Pictures of Alex and Kristen

I snapped these earlier today when Kristen was holding Alex for the first time.  We are currently waiting for the boy's 8:00 and 8:30 feedings when they are active and alert.

Holding Alex

Kristen just got the best christmas eve gift.  She is currently holding Alex with skin to skin contact in the NICU.  He has come off intubation and is breathing on his own with the help of a CPAP machine with a little bit of added oxygen.  Both Kristen and Alex are throughly enjoying this bonding time. 

Earlier he had his first taste of milk and we be getting milk and formula to get his strenght up.

I will try to post pictures tonight.

Goats!

Last weekend, Davis, Grammie and I went to the Zoo.  One of the big highlights was Davis and the Goats.  We had never seen the goats before and Davis had a lot of fun petting and brushing them.  They were reasonably well behaved and only tried to eat the camera once.

Also, one of the cutest things you can do with a 2.5 year old is to give them a cupcake:

NICU Pictures

I've posted a few pictures from the NICU to my picasa web albums.  The link is below if you wish to look.  The pictures are of babies with a lot of tubes in them, but nothing traumatic.

https://picasaweb.google.com/112867246733740269006/201112Twins?authkey=Gv1sRgCI-Gy7mqlt3rTA

Kristen got to hold Evan for a little while:

Kristen is recovering.  A Cesarean is major surgery and she has a ways to go before she can be back to herself. Tonight she came off the IV and was able to walk a little bit before going in the wheelchair to see the boys.  We are both riding rollercoasters of emotions and are looking forward to the day when we can hold both boys and bring them home.

Davis visit

Davis, Grandma and Grandpa all came to visit Kristen, Alex and Evan earlier today.  Somebody was nice enough to tell Alex and Evan that Davis likes trucks and tools and they both got him special birthday presents.  We had a short visit with Kristen for Davis to unwrap his presents before we headed to the NICU to see the boys.  Davis spent a few minutes looking at the boys before we headed back to the room. Since the boys weren't moving too much, he seem to think that they were dolls.  He did understand that one was Alex and one was Evan.  It was great to see them meet and hopefully soon they will be able to interact a little bit more.

Twins update

Here is my understanding of where the twins are at.

Alex


Alex is currently being intubated to help with his breathing and is on a heated bed so that he does not have to regulate his temperature.  He is also receiving anti-biotics via IV. He will have his blood CO₂ levels checked at 9:00 pm and again in the morning.  If those are good, the intubation may be removed and he would be switched to either a CPAP or high flow air (nose plugs).  Over time they will diminish the levels of intervention until he no longer requires assistance.  One level of intervention is the type of device (intubation -> CPAP -> high flow air) and others are flow rate and supplemental oxygen levels.

Evan


Evan is farther along than Alex.  He is currently receiving high flow air through nose plus without supplemental oxygen and anti-biotics through an TV.  His heated bed has been turned off and he is regulating his own temperature while being wrapped up in blankets and a hat.  Since he is not intubated, we are able to hold him and he was able to take in a little bit of colostrum.  He will have his CO₂ levels checked in the morning only and if those are good will probably have the flow rates decreased.  He will probably need to be on oxygen for a few days but should be able to move out of the NICU table and into a crib by tonight, assuming he continues to regulate his temperature well.  The next major milestone for Evan will be to demonstrate that he can suck, swallow and breathe.

Evan Video

I just spent a little over an hour holding Evan in the NICU and captured one of his more active periods on video.

NICU Visit

Kristen and I just got bak from her first visit to the NICU.  We both got to hold Evan and touch and talk to Alex.  Alex has been intubated and while that is in place, we will not be able to hold him.  Evan spent the entire 30 minutes while I held him with his eyes open and had a good bout of the hiccups.  They are both beautiful, soft and amazing little guys.  We are both really looking forward to holding Alex, but it will probably be a little while.  He need to develop his lungs and sustain healthy breathing that maintains his oxygen levels.

We will probably bring Davis, Grandma and Grandpa in for a short visit after lunch.

Twin Pictures

These are from the OR last night.  I haven't taken any pictures in the NICU yet.

Evan

Alex

Evan

Alex

Alex

Evan