In The Clear

Today's doc check gave Liam a clear on the jaundice. The yellow color is gone and Liam's weight is slowly gaining. He is at 7lbs-2oz now and looks to be at his birth weight really soon. So, all in all, we're finally back to adjusting to each other, new schedules, and new ways of doing things.

It's been looking good since Liam's come home. Emilia loves her little brother and shares her toys with him. She likes to help and tends to him, rocking his bouncer, putting his blanket on him, and patting him. So, all in all, we're settling in... finally. =)

Liam's Current Stats

Today's Bili is at an acceptable level of 12, which means it hasn't really increased since leaving the hospital. Doc still wants close monitoring, so another day of doctors and/or hospitals. Seems like it's one or the other every day.



Liam is doing well overall. He went into the bili-hospital with almost 9% loss of his birth weight, from 7 lbs-4oz to 6 lbs-10oz. Now with the aggressive bili-feeding approach and strict 3-hour feeding schedule, he has gained weight and is now at 7 lbs.

Bili Update: The Light at the End of the Bili-Tub

These past few days reminds me of the song "Blue" by Eiffel 65 as Liam and I have only seen blue while trapped inside a tiny little sterile room. Everything feels like it appropriately fits with a techno-beat blue song.

"Yo listen up, here is the story about a little guy, that lives in a blue world, and all day and all night, and everything he sees, is just blue... "




Labor and delivery was relatively short and easy compared to the past few days, which have been frustrating and tiresome. Liam has been such a trooper through all the blood draws, needle pricks, forced eye mask, and a blue tub isolation without much cuddle or holding. Mama has not been such a trooper, running on 1 hour intervals of sleep getting maybe 4-5 hours of sleep in 24 hour period, going back and forth with hospital personnels on the care of Liam and fighting traditional mentalities with modern preferences, while trying to "recover" from giving birth.

To recap and correct prior posts, Liam's bili went this way --> 7.1 --> 9.2 --> 15.3 --> 18.3 --> photo-therapy --> 15.3 --> 11.9 (yeh! below 12 means we get to come home!) Objective is to have a low number and/or a low delta gain the following day. So, from 7.1 to 9.2, delta gain is relatively low. But then it jumps from a 9 to a 15. Big delta change for a day's worth. And then from 15 to 18 in just a few hours. Not good. The numbers don't mean much, the concern is that 18.3 is very high and getting close to danger zone and other issues, so it was good that we did get re-admitted to the hospital to deal with this, even though it was very not fun.

We are now home, but not exactly out of the woods. The photo-therapy and increased in Liam's protein intake through formula supplement and me vigorously feeding him every three hours and additionally increasing milk through pumping after his feedings helped to bring the bili number back to a manageable level. Now the docs needs to see that Liam's liver can handle the bilirubins on their own, which we hope, and we will get an idea of that with another doc visit/blood draw tomorrow. So.. out of the woods, but not in the clearing yet.

Here's Ryan and Emilia paying Liam and I a visit:

Return of the Bilirubin, Part 2

This seems to be the way things go for us (we had a similar situation with Emilia). We found out that Liam's bilirubin level was too high again on Saturday so Connie had to take him back to the hospital. This time he went to the pediatric unit at Palomar Hospital. In retrospect, we may have been discharged too early from UCSD Hospital. I had the bilirubin levels wrong in my last post. His initial reading was correct at 7, but his second reading was just slightly higher (need to get the exact number when Connie gets back). It's a little obscure what is a good reading as it's more dependent on the trend. As long as the levels rise slightly or stay the same, things are good. But if they rise too rapidly, then alternative measures need to be taken. At UCSD, they must have thought that it was rising at an acceptable rate. But by Saturday, when we had him checked by our pediatrician, they had elevated to an unacceptable level. So that meant he had to receive phototherapy and supplemental formula until Connie's milk is fully in. He was retested this morning after receiving these treatments, and he is responding well. They expect that, if this trend continues, he should be able to come home tomorrow.

Welcome Home, Liam

We brought Liam home this afternoon after he was cleared of any bilirubin problems (He scored a 7 on his initial test which is borderline for requiring phototherapy. But he also tested Coombs negative which is good, and later tested at 14 for bilirubin so he was good to go). So this was the first opportunity for Emilia to meet him. (Sorry for the poor video - probably not enough light for the camera to focus properly.) She wasn't quite sure what to make of him (maybe he was too chill), but she later (off-camera) warmed up quite a bit and was even able to pronounce his name. She wants to help more than we can allow her so that gets frustrating for her. If she had her choice, she'd like to be able to carry him around. But for obvious reasons, we can't allow her to do that. The plus though is that I think she's going to be a big help down the road.



ps. It's way different having two babies at home - lots of juggling and shuffling.

Finally Home

The doctors cleared Emilia to be discharged from the hospital today.  Her bilirubin levels were finally on the decline, and there was no sign of infection in the 48 hr culture.  So in preparation for the trip home, she got her first bath and absolutely loved it.

Then she got bundled up and packed up in her carrier.

And finally lounging at home after experiencing birth, many needles, blue lights, and hospital food.

Emilia Update

Emilia's bilirubin level is still increasing, but at a much lower rate.  They feel that one more day in the blue light box should do the trick.  She'll be finishing her second day tomorrow at 10 am. They'll draw a blood sample at 4 am (for some reason, they think we're awake all the time) so we should know the results later that morning.

The first 24 hr test for infection came back negative.  We'll get the results for the 48 hr test tomorrow at 8 am.  She hasn't had a fever or any other signs of an infection so we're hopeful that it will be negative as well.

We've made some changes in her feeding regimen so she's getting a combination of breastmilk and formula.  This is just temporary until Connie's producing enough of the free stuff.  Emilia's weight so far has been good.  She lost about 6% of her birth weight in the first 24 hrs (this is suppose to be normal), and only lost an ounce (~1%) in the second 24 hrs.  She's been feeding well, and we don't anticipate any weight issues - yet.
 
So with any luck, we'll be able to head home sometime tomorrow.

Return of the Bilirubin

We thought the bilirubin was under control, however the levels today were elevated so they recommended that we start phototherapy.  Newborns generally have a susceptibility to high bilirubin levels since their liver is not fully developed, but Emilia also has a secondary factor.  Since Connie is Type O blood, I'm Type A and Emilia is Type A, she has a thing called ABO incompatibility.  Basically Connie's AB antibodies crossed the placenta, and are trying to take out the baby's Type A RBC's.  One of the by-products of this is bilirubin which builds up in the fatty tissue of the skin, and causes a yellow appearance (jaundice).  It sounds bad, but it's usually easily controlled by 1-2 days of phototherapy.  Basically, the baby is placed over blue UV lights, and the UV converts the bilirubin into a form that can be naturally removed by the body.

It's been a bit of a battle getting Emilia to accept being in the light box.  This is because it eliminates some of the soothing tricks we use, namely: tight swaddling and puttting her on her side.  But since she has no choice, she eventually accepts it.

We also still have the elevated WBC issue we're dealing with, but we should know tomorrow whether there is any infection that would require further treatment.  Hopefully not as that would mean another ~5 days in the hospital.

The good news today is that she passed her hearing test.

So This is a Newborn

In her first day of life on the outside, Emilia pooped 5 times and pee'd twice.  She's a food processing machine.

Her bilirubin levels are normal so her liver function looks good, and she won't need to be treated for jaundice.  However, they found that her WBC counts are a little high so they are going to administer some antibiotics, and monitor her for a few more days at the hospital.  Looks like she won't be home until Tue or Wed.