Days 52 - 54: 4 Pound Club & Extubation!

So much has been happening folks.  I don't want to jinx the progress, so I'll just get right into it:

Last Tuesday the boys had their second eye exams.  Jackson's eyes are fine, progressing as expected for his age/corrected gestational age.  Aiden's however are showing signs of maturity.  You are probably thinking this is a good thing - the eyes considered mature, especially with them being born so premature.  Not so.  All preemies are at risk for Retinopathy of Prematurity, which has to do with the eyes maturing.  It would be better if I had a white board to draw this for you, but I don't, so I will do my best with words and a URL that should give you a better description.  As the eyes mature blood vessels grow outward away from either the retina or optic nerve, I can't remember which, they should grow straight out.  When they show signs of maturity too early, the vessels grow out but not straight - they grow circular.  If it continues to progress, and RoP advances to stage 3+ you run the risk of the retina detaching from the eye, resulting in blindness.  Not to scare you (yet), Aiden's is Stage 1, and will be closely monitored weekly going forward to monitor its progress.  Typically Stage 1 resolves itself, so we will wait and see.  If intervention is necessary, it is a relatively simple laser procedure that is not invasive.  Having had Lasik surgery on my eyes, it doesn't scare me as much, since I've been through it. 
Try this link for more info on RoP:  http://emedicine.medscape.com/article/1225022-overview

Jackson has been making significant progress sprinting on the high flow nasal cannula.  As of today, he is now up to 15 hrs per day, split between a 9 and 6 hour intervals.  If you haven't done the math yet, that leaves only 9 hrs per day on the CPAP!  The intervals will continue increasing, leaning more toward the cannula until he is completely off of CPAP.  When on the high flow cannula, he is on 3 liters of O2 right now, and once down to 1 liter, it will be considered low flow cannula.  He is rocking his feeds and leaving the nurses and mom and dad some pretty nasty diapers.  All of the nurses "have heard" about how smelly the boys' diapers are, so they already have a reputation.  Jackson still has a handful of apnea spells each day - where he forgets to breathe, some resulting in bradycardia - where his heart rate slows to below 100 beats.  As I mentioned a few posts ago, he will grow out of these by week 37.  As of 10:30pm today, Jackson is 4 lbs. 3oz.!!  At this point, this should be gaining at least one ounce of weight per day, sometimes more.  The pictures really show the weight.

Aiden had a huge day today.  Not only was he extubated and placed on CPAP, but he also got a big boy isolette like his brother, and he joined the 4 Pound Club!!  He's had a busy day, and I'm sure he's fast asleep right now.  If you've been following, for a while now, we've been waiting for the days that he continued to deliver some solid blood gases.  He did just that the past couple of days, but in addition, he outgrew his ET tube, and instead of replacing it with the next size up, they put him on CPAP.  He has been adjusting pretty well with the exception of missing his neo-bar (the bar that held his vent tube in his mouth).  If you look back at all the pictures, you'll see Aiden's hand always holding onto the neo-bar, and now that it's gone, he is not happy.  The funny part about it was watching him look for it and trying to grab something.  So, after realizing what he was looking for, I stuck my finger in the neo-bar location, and he latched right on, and calmed right now.  It was truly amazing.  He also got his crib upgraded to the big boy isolette.  The nurses went to a lot of trouble to make sure they set it up so that he faced Jackson.  Funny part is, as soon as they layed him down facing his brother, he immediately turned his head.  No lie.  They can turn their heads still because they have not gotten as big as full term babies' heads are.  Eventually, they will not be able to move them.  Aiden received a round of Lasixs (check the spelling on that) this morning to get rid of some excess fluid.  A strategy to lessen the additional strain he would endure while adjusting to CPAP.  10:30pm update is that he is doing well, and lost 2-3 ounces from last night, and is now just over 4 lbs!

Get ready for a ton of pictures!

Above:  All Jackson

Above:  All Aiden

Now for some videos:

Above:  Aiden sucking on pacifier while kanagrooing with dad.

Above:  Alert Aiden!

Above:  Jackson is ALERT!!