Day 9 & 10: Weight gain, infant massage and important lessons for my parents

Finally! Getting some clothes on.

As we put our first full day in the 'General Nursery' behind us, we are eternally grateful for the progress and gains that Luka has made over the course of his first 10 days.  My mother asked the good question yesterday 'if Luka is doing so well, why does he still have to stay in hospital that long?'  The answer to that is that while he is doing 'well', he is still dependent on machines to monitor his heart rate, breathing rate and oxygen saturation for Apnea and Bradycardia, very common in preemies.

Luka swaddled up (see feeding tube)

In addition to that, he is also completely dependent on a feeding tube for his nourishment, and while he is putting in a valiant effort at the breast, would not currently survive on these acts of bravery.  We were assured that infants are not able to suck at the breast until at least 34 weeks because they are not yet able to coordinate sucking, breathing and swallowing at the same time. So despite Luka having figured it out by 30 weeks + 6 days, he still has a long way to go.  The two main milestones we are currently working on are (a) weight gain, and (b) self-feeding - i.e., from the breast or bottle.  At the moment, he is still being fed through the tube 100%, anything he gets from our attempts are just a bonus, and important for developing his sucking reflex.  We are therefore likely still bound to the hospital for another 4-6 weeks until he can 'demand feed' from me.  This will mean that once he is actually feeding from me, I will be spending even more hours at the hospital to be there when he needs to be fed, and eventually moving back to the hospital for night feeds, followed by him rooming-in with me so that we can practice demand feeding at night.

Feeds:  Luka currently receives 33ml of fortified breastmilk every 3 hours, and likes to have a go at the source about twice a day depending on how wakeful he is.  He is also on a baby vitamin now that provides him with the critical Vitamin D he needs to absorb the added Calcium.

A foot massage from mommy!

Massage: As previously mentioned, we are practicing infant massage on him, currently about twice a day.  The important thing is to watch him very closely and go off his cues that could indicate possible over-stimulation (which is what we don't want).  We had two successful sessions yesterday, both of which he seemed to really enjoy.  Thank you for all the resources that people have sent our way, keep them coming.  A note to new parents - little tiny babies can make a biiiiig mess - so beware of any kind of stimulation that lets the bowels go...we have learned yesterday that Mr. Luka no longer qualifies for 'naked massages'.

Other cares: Since he is now in the General Nursery it means we can finally dress him - a feat slightly more complicated than one would think.  First of all, there is a very limited supply of preemie clothes in Darwin (for the South Africans, think Brits 1980s, for the Californians, Bakersfield), and even the ones we can find are too big - so for the time being we are making due with what the hospital has on hand, since we are obviously holding out for when the little chomper packs on the pounds.

Weight: Speaking of pounds, we are up a whole 65g again - putting him at 1685g, about 100g less than his birth weight.

Folding Luka into a tank top twice
his size

Mom and Dad:  We are doing well, tired, but optimistic.  We had to move to the fourth place in ten days yesterday as the lovely house we were renting near the hospital had a prior booking from 1-10 April, we will move back there though for the duration of our stay.  And to continue the trend of Baking for the Baby, which was a favorite past-time of Susan's during pregnancy - we made delicious and easy jam muffins to celebrate his graduation from Special Care to General Nursery - nurse bribery is totally acceptable, no?

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.