Luka's First Graduation!

 

Luka's last 'cares' in the Special Care Nursery in his
big boy bed

To mix things up a bit, Chris took the morning shift, leaving Susan to run a few errands.  These included picking up a bag of stuff from Dili that a willing 'mule' carried on the flight this morning, and also getting a printer and scanner to facilitate the bureaucratic part of birthing a dual-citizen in a third country (more on that later).  Imagine the shock when Susan returned to the nursery only to find the isolette (like an incubator) gone!  Instead of the familiar box with holes for the hands and arms, there was a regular nursing cot (looks like a clear plastic baby bath).  After containing my excitement, the nurse informed us that not only did Luka shed his isolette, but that he would in fact graduate from the 'Special Car Nursery' (one step down from the NICU) to the 'General Nursery' today.

View of the General Nursery

Of course this meant that he is now able to regulate his own body temperature (a big requirement around here), and that he is not only stable enough, but also progressing well on other fronts.  Funny thing is that news such as this is met with mixed emotions from parents.  While we are clearly proud of him for excelling and exceeding all expectations for a 30-weeker, now one week old - it is also accompanied by some reservations such as 'is he ready?', 'will he receive the same level of care?' and other questions.  Our Preemie book talks about this, and ensures all parents of preemies, that yes, they are ready to move on, and yes, they will receive the care that they need, which is understandably slightly less than another infant who still battles to hold feeds down and cannot yet maintain his body temperature.

Our new digs.

As if this was not good enough news for one day, we also received his SBR (jaundice test) numbers, and they have gone down by themselves since the last test, without the use of lights.  This indicates that his liver is functioning well enough to be flushing the last of this out of his system through all of those healthy bowel movements we get to clean between feeds.

Luka actively sucking his thumb
during diaper change this morning

We are incredibly grateful for this progress, but acutely aware that it is still a long 4-6 weeks that await us with Luka bound to the hospital until he is closer to his due date (end of May).

Day 8: Recalibrating milestones

One of the first things we have learned as parents of a preemie is that milestones in our lives are currently measured in milliliters, minutes and grams.  We are happy to report that Luka gained a whole 35grams (1.2oz), or four tablespoons of unsifted wholewheat flour, in weight between Sunday and Tuesday nights' weigh-in.  This puts him at 1,620g after his first series of losses that took him from 1,777g down to 1,585g.  Despite the fact that we are still at net loss as my dad pointed out, the important thing is that he has gained something, so hopefully this trend now continues.  His feeds are going well, though they are exhausting him.  He currently receives 30ml of fortified breastmilk (my expressed breastmilk with added calories, protein and calcium) every 3 hours.  The reason they fortify the milk is because apparently mothers have only a limited amount of 'pre-term milk' before it turns into 'term' milk, and the pre-term infant requires 'pre-term' milk for adequate growth and development.

The bigger feeds has Luka very satisfied, and it makes him too sleepy to breastfeed right now, which of course is disappointing to Susan since he was doing really well in the beginning when he was not fed as much as he thought he wanted - however we are assured that the first order of business is to get him fatter so that he can 'graduate' from the isolette to an open cot.  In order to do that however, he has to put on some weight, and be able to maintain his own body temperature.  The good news is that he is maintaining his temperature much better, his isolette has already been turned down from over 33C to 30.5C.

Luka's first infant massage, studies have shown the benefits
for growth and development, especially in pre-term infants

Today we also gave Luka his first infant massage.  As part of our ongoing research and reading on the matter of premature babies, we have often come across research showing the benefits of infant massage for growth and other development.  One comprehensive research study has shown that massaging a pre-term infant (even those weighing less than 1,500g) three times a day for 15minutes, increases weight gain by up to 50%.  While we are still researching the matter and will get a book on it as soon as we can find a bookstore in Darwin that sells more than BBQ and fishing books, our initial approach follows that which is outlined in Preemies: The Essential Guide to Parents of Premature Babies.  Don't worry, this is not exactly a deep-tissue massage we're talking about.  Starting off with the infant on his front with his legs tucked underneath, we apply a firm stroke from his head, over the neck and shoulders, all the way down to his tail for five minutes.  The child is then placed on his back and his limbs are 'flexed' for 10 seconds each alternating, finishing with five more minutes of stroking on the back.  The reason massage is so important, is because touch is the first sense to develop in a baby.  While the premature child cannot yet focus his eyes properly, and gets overstimulated very easily (i.e., by being held, stroked and spoken to simultaneously), touch is highly developed and the skin provides the larges surface area for targeted stimulation at this time. It is important not to 'stroke' lightly as premature babies cannot differentiate between pain and tickling.  Luka seemed to enjoy the massage yesterday, though we watch him very closely and obtained the permission from his doctors before attempting this.  They agreed that he was stable and that it certainly could not harm him.  Thanks also to my old high school friend from Pretoria, now living in Germany, for providing this research on the benefits of infant massage for preemies.

And in other news, as if an emergency evacuation was not enough excitement for our little man, it appears that there might be a cyclone looming off the coast of Darwin.  Fortunately for Luka, by the looks of it, he is currently in the only building that survived the 1974 cyclone that wiped Darwin off the map - the house we are staying in on the other hand, looks pretty new.

Day 4-5 Update message to family

This is the last installment of the letters sent to family in the first few days after Luka was born, hope you enjoy the pictures.

Luka gets his drip out!

Dear friends and family, it is 23:15, and I have to be up at 03:00 to express breakfast for Luka, so this will be brief.

We had a very good day at the hospital today, apart from a bit of jaundice that the little man is still struggling with, he had his drip removed completely (since he is eating so well and does not require the glucose supplements anymore) which not only makes for a much healthier-looking baby, but also a lot easier to maneuver!  He is up to 18ml feedings of breastmilk through the tube every 2 hours, another 2ml per feed and he will have reached what is considered a 'full feed' for his size.  He had a marvelous attempt at the breast this morning, and stayed on for at least 5 minutes - we are sure he will start at full throttle as soon as he has a bit more energy.  The light for the jaundice treatment also seems to be exhausting to him.

'Kangaroo Care' - proven to enhance development
of any newborn, but of preemies specifically.

Doctors and nurses continue to be amazed at his progress, and Chris and I still sit with him for the majority of each day providing skin-on-skin care to ensure his healthy and happy development.  Each of these moments are very precious.  Attached 3 quick photos - I will try and work on a more accessible means of relaying news about Luka tomorrow and updateeveryone soon but I know I will be in big trouble if there is not an update in my little sisters' inbox when she wakes up!

Lots of love and thank you for the continued love and support.

Chris, Susan and Luka

While under the lights for jaundice, I caught Luka pulling
this funny face that looks like the cutest grin in the world.

Luka's 1-week Birthday

Susan on forced R&R away from the nursery

As part of our elaborate birthing plans, we had intended to bake a cake for our baby on his or her actual birthing day.  The idea had been suggested to us by a dear friend and mother of three adorable boys in Dili who had done this for all of them.  Our plans were somewhat disrupted since the maternity ward at the Royal Darwin Hospital, does not come equipped with its own kitchen.  As such, and given the stress of the last seven days, we decided to celebrate Luka's first week in true Chris & Susan style.

The family one-week into this adventure

After spending an average of 10+ hours a day in the Special Care Nursery, we were finally in a frame of mind to take a few hours to ourselves.  Where did we go?  To the food store of course - leaving with a trolley full of fresh goodies, good cheeses, and baking supplies. This afternoon was spent in the kitchen of our rental home, baking cupcakes for Luka's first "birth"-day party.

For anyone interested in baking, these might actually have been the best chocolate cupcakes ever.  For the recipe, please visit here.  Not being fans of frosting, we simply melted good quality dark chocolate to spread as a topping before decorating.  We passed the cupcakes around the Special Care Nursery and the Birthing Suite where we birthed Luka a week ago - they were enjoyed by nurses, midwives and new mommies alike.

To scale.

Happy 1-week 'birth'-day Luka.

Update on Luka:

Today was a good day for us.  His second cranial ultrasound came back negative for hemorrhaging, after the first test came back inconclusive.  The volume of his feeds continues to be increased, he is now actually at 'full feeds' for his weight, and we are hoping he will now be growing fast.  Despite his initial weight loss from 1.777kg to 1.585kg in the first week, our boy has already grown 1.5cm.  His SBR numbers (jaundice-talk) continue to be slightly below the level requiring photo treatment, which allows us many more hours of cuddling instead of watching poor Luka bake under the light like a little chicken.           

Day 3 Update: Daddy's first diaper change

Dear family, 

Daddy's first diaper change. Ever.

A little later than yesterday, but here is a brief update on Luka's third day (25 March 2011).

We continue to do 'Kangaroo Care' for approximately 10 hours every day, meaning bare skin-to-skin contact for Luka with either Susan or Chris.  

Feeding: Yesterday the little man had another great attempt at the breast, and managed to latch long enough to get a good couple of suckles in.  The most promising progress is his current trend of digesting food well enough to receive continuously increased amounts (considering we started with 0.5ml of colostrum on a cotton swap a mere 4 days ago, to now being able to tolerate 10ml of breast milk every 2 hours via the tube to his tummy - what he gets from mommy is a bonus)

Breathing and other vitals: Remains strong, still no need for oxygen and other assistance - though we had to recalibrate our own attention to the alarms yesterday when Luka got a little 'too comfy' on a chest and his breathing slowed - it was nothing to be concerned about, he corrects this himself, just his jumpy parents with alarms that don't mix well right now.  The good thing is that he does correct it, and then the alarm resets - but upsetting to rookies nonetheless.

Jaundice: His jaundice was low enough yesterday to be removed from under the light, but it is expected that it might return again for a bit more treatment before he rids his body of all the hemoglobin (increased feeding will help);

Medication: After clean blood screens, he was taken off all medication including antibiotics, and presently only receives some glucose through a drip to augment the feeds, again, as feeds are increasing, this is decreasing so we are hopeful to 'graduate' from another pipe soon (this one makes changing and snuggling particularly difficult)

First family portrait

Luka continues to amaze us every day, considering he was born somewhere between 30-31 weeks, and most nurses and doctors don't expect a baby to have the ability to coordinate breathing, sucking and swallowing necessary for feeding until around 34 weeks.  We are eternally grateful for his progress, and are slowly settling into that unmistakable bond that one can only ever imagine if you have lived through it.  For now, Luka has short 'awake' spells when we try and put him on the breast, or we change him.  Chris did a magnificent job of his first diaper change yesterday ever.  He simply walked in and said 'I'm determined to change my first diaper today' and then did an excellent job, despite his hands being far bigger than Luka's entire backside.  

Susan continues to do well, emotionally still a little rough around the edges, but Days 3-5 are apparently rough with the hormones all over the place.  Chris remains ready with snacks, chocolates and tissues pretty much on demand for which Susan is very grateful.

Camping out in the Special Care Nursery (SCN)

Good news is that we have secured a house to rent close to the hospital which will make our living situation a lot easier than being in a TravelLodge 20 mins away.  

Attached are some photos from yesterday.  Once again, thank you to each and every text message, email message and phone call we have received.  We appreciate your love and support.  Also, we have not yet managed to send out the wider distribution email to our friends around the world but we intend to do so tonight - you will also be on that list - once that is out, the 'Facebook ban' is lifted.  As always, we really appreciate your understanding.

Much, much love

Chris, Susan and Luka

Day 2 Update

Dear family,

First cuddle with Daddy - 23 March

Our roller coaster ride of sudden parenthood continues.  Luka had a splendid day on the 24th of March, his first full second day.  This is something for which we are grateful although also awfully aware will not always be the case. 
 Briefly:

1. He was still being treated for jaundice (normal levels for someone of his and even older gestational age), but the last test last night showed him below the levels needing radiation, so perhaps if that is sustained in this morning's test, the blue light and silly sunglasses can come off;
2. He is definitely his daddy's boy - being HUNGRY all the time, which is good.  Most of the preemies in the room with him are many weeks ahead of him and still struggling with milk.  Luka has an extraordinarily strong sucking reflex, so much so that we have decided, against earlier intentions, to give him a pacifier to stimulate that reflex - he has been informed that it isonly because he is so early that he is getting away with that... more importantly, his tummy seems to be tolerating food well enough that he has already been fed exclusively on my expressed breast milk as of less than 24-hours.  Yesterday morning while Chris was holding him, he decided that the tube down his throat was no longer needed, and yanked it out right from his stomach.  Unfortunately for him, he still needs the tube to feed, but it is now in his nose, leaving his mouth free to suckle and try the breast. Remember, our milestones now come in minutes and mililiters, we we started out with 2ml every 6 hours, then 4 hours, and as of last night, 2 hourly.  The most amazing feat for us yesterday however was when the little guy got a great latch on the breast and even suckled a few times - which most of the staff could not believe a 31-weeker would do, so we will continue to try him on the breast first, and then 'top-up' with expressed milk.  He was weighed last night and will likely have dropped a few grams, which again is not uncommon for any baby, but more so for preemies - we are positive that his little appetite will put the grams back on quickly.  
3. Breathing and heart rate remains strong, and more importantly, constant.  While he was on the CPAP machine his HR was a little low, so we figured he was trying to beat his grandma Julie the marathon runner...but now that he has no respiratory assistance whatsoever, his HR is in normal range. 
4. We continue to spend about 10+ hours at the hospital, and provide as much skin-to-skin care (kangaroo care) as possible with alternating between my and Chris' bare chest - I told Chris the amazing thing is now that he gets to help 'grow' Luka for us, and boy oh boy does the little guy love that furry chest....(see photo of the day attached).
5. Luka's brain ultrasound came back negative for bleeding - this is a test they do at a few days, then a week and then 3 weeks to make sure there is no bleeding on the brain - so far so good.
6. He is definitely more alert, opening his eyes from time to time, and you can see the concentration as he tries to focus them - we will discuss with the doctors when an appropriate time would be to start introducing charts/pictures for him to focus on

Chris and I continue to process what has happened, I do struggle from time to time with emotions and going to the shopping center yesterday looking for nursing bras might have been a bit much after 48 hours.  My physical condition is great, no complications or concerns so far, my milk came in Day 2, so I am expressing everything Luka needs.  Now I can focus on getting Luka healthy.

Chris has been a rock throughout, he found us a lovely house to rent extremely near the hospital that will make our lives a lot better than living in the Travel Lodge, or one of the dingy 'hostels' frequented by hospital staff.  We believe this will give us time to heal and bond and process the whole thing, while being so close to the hospital.  The hardest part of course is leaving Luka behind every night, but we know he is in much more capable hands at the moment than even we can provide him.

Thank you for your continued support and understanding - and thank you also to everyone for being so sensitive to our request for privacy, it is amazing how we have almost entirely kept the news within our small family circle for now.  We just activated an Internet 3G device that will allow us more regular communications from the hospital during the day, and will start spreading the news a bit wider today.  

Please keep Luka in your prayers, and than you for your love and understanding and support.

Love

Chris, Susan and Luka

Luka's First Photos

The following few posts are letters written to family immediately following the arrival of our dear Luka. 


March 24, 2011
Dear Family,

My first photo in the Isolette

As promised, here are the first photos of our precious little Luka.  As you all know by now, he decided that he wanted to be his daddy's surprise birthday present, so rather unexpectedly made his appearance at exactly 15:00 on 22 March 2011, in the Royal Darwin Hospital, Australia.  Not exactly how we had it planned, but seems he is already trending to being as unpredictable as his parents.  

Mommy's first visit

Briefly: Luka Martin Serjak (the name was chosen to reflect his paternal grandfather's initials, L.M. Serjak, as well as his given first name (Martin) that is also his great grandfather's middle name).  "Luka" was chosen for its Slavic roots to match the Serjak name, and yes - was just 'us'.  Luka was born at an estimated 30 weeks and 5 days, measured 40.5cm (16.2inches) long, weighed 1,777kg (3lbs14oz) and came out screaming.  He was delivered naturally by two midwives (and a whole lot of doctors hiding behind a curtain) - more on the whole process later.

My first cuddle

Here are some of his first photos.  Most importantly, he breathed on his own from the start, and never required ventilation.  The pipe you see in his nose is called a CPAP - Continuous Positive Airway Pressure , which simply helps a little guy like him keep his lungs open and clear to allow his brave breaths in.  Good news is that he was completely removed from the CPAP within 24 hours and is doing fantastic on his own.  Further good news is that he seemed to have come with his dad's appetite as all he wants to do is suck on something, which we understand is a very positive sign for this gestational age. Susan has been expressing milk, and Luka received his first taste of the liquid gold administered by his daddy on a swab early on the 2nd day.  By 11pm on the 23rd, the nurse believed it was time to try our first breastfeed.  Not sure who has the most to learn, but pretty sure it is I.  We are not quite there yet, as a little preemie of 31 weeks is not yet able to coordinate breathing, sucking and swallowing at the same time - but he is giving it his best and we will try again this morning.

Soothed with a 'hand womb'

Attached a few photos, they are small files to allow me to do this quickly, will make an online album soon.  Request that you please continue to respect our privacy at this time with no Facebook posts or other types of public announcements as we have not even begun to think of where to start announcing this - but my work for instance does not even know yet.

As from mom and dad, we are doing great.  Susan spent only one night in hospital after the birth to watch for bleeding, and has been up and around since 30 minutes after the birth.  We had a nice steak dinner last night, and slept in a hotel, until we settle into more permanent accommodation for the next weeks.  We anticipate to be here at least 5-6 weeks, as the requirement is to be at 'Term' and 2.5kg before Luka can go home.  We still intend to travel to South Africa as soon as feasible, and will keep you posted more regularly.

First taste of breast milk on a swab

For now, please enjoy some of the photos, remember, he is a little guy, but we have already watched him improve by leaps and bounds in under 48-hours.

Lots of love, and our sincere apologies for making you all worry during this time.  Our numbers in Aus are:

+61-424-325-491 (Susan) and +61-424-084-315.  We ask that you please check the time zone carefully and not send texts or call during the night, as we have to keep our phones on at all times.  Note the differences for South Africa is +7hours and for CA is +17 hours. 

Thank you for your prayers and support, please keep them coming, this is only the beginning of our journey.

Being treated for jaundice, but already interested in sucking

Love

Susan, Chris and Luka

Let the Legend begin...

Luka Day 4

Ever since we learned that we were pregnant somewhere between seven and eight months ago, Chris and I have endured the endless reminders that our lives will forever be ruled by whoever I was baking in my belly.  As most expecting parents do I suppose, we calmly obliged and thanked the observer for their kind reminder and went about our business. Little did we know exactly how powerful a force a new baby can be...particularly if he decides to make his appearance 10 weeks early, which is exactly what happened to us one unsuspecting Monday when we were medically evacuated from Dili, Timor-Leste to the nearest port with healthcare facilities, Darwin, Australia.

More on the whole transfer and adventure of that day later, for now, allow us to briefly introduce you to our latest blog Loving Luka.  Dedicated entirely to the indescribable, unbelievable, emotionally charged, lump in your throat, rule your world love that you can experience for 1.7kg of mostly skin and bone, and so much heart.

The past week has been a profound experience in every single way.  We are humbled, honored and blessed by this most beautiful little person that has come into our lives and we will endeavor to share some of our experiences with you here.  This blog will follow our love and acquaintance with Luka, as well as the inevitable trials and tribulations of learning to care for a preemie bound to a high care nursery unit.

Please visit here often, post your comments, and feel free to share with friends and family.