Luka Lessons: How to hold me properly

As we continue to learn more each day not only about parenthood, but about preemie-parenthood specifically, we are relieved that it does appear every once in a while we figure something out.  It might be due in part to the combined 2,000 pages in Preemie reading we have amassed since joining the land of nursery-care two weeks ago, but to some extend, gratefully, logic also sets in occasionally.  As such, by carefully watching and listening to Luka's signals, we have learned that it is much preferable not to handle him while on his back, as much as possible.  Obviously this is not possible when, for instance, changing his diaper - but it is when lifting him.

Turns out babies have two highly developed instincts, one is a startle reflex usually triggered by a loud noise, and the other is a fear of falling.  Full term babies spend much of the last trimester in a tight 'flexed' position in the womb, as their size increases and they have less room to stretch out in.  When a baby is born prematurely, he misses out on much of this 'flex' time, and therefore his 'extensor' muscles become over-developed.  Therefore, it is important to ensure a preemie gets ample stimulation of their 'flexor' muscles, generally by simply relaxing the extensor muscles.  Preemies are also less able to flex their own muslces, i..e, bring their legs up or arms in, and need a little assistance in doing this.  Notably, whenever they are in distress, they will immediately kick their legs straight out, flail their arms above their head and arch their neck and back.  The easiest way to calm them, is to pull the knees up to the belly, tuck the arms, and firmly hold them in this position, recreating a contained womb-like environment (the hand womb).

We have noticed that whenever we move Luka from the bed to the chest or vice versa, and he is on his back, that he goes into the strongly extended position - so we started thinking, perhaps we should flip him over, and move him on his side or belly.  Well, turns out, even the book agrees!  Apparently the effects of gravity on a premature baby who is moved in the vulnerable supine position, causes them a lot of stress, which can be avoided by rolling them onto their belly and lifting them up face down.  This position allows the abdominal and shoulder muscles to flex, and removes the sensation that he is falling.  We started experimenting with this yesterday with much success (see photograph).

Known in Australia as the 'Rugby Hold' - we hope Chris handles
Luka better than he did a rugby ball...but hey, give him a break, he
is only a prop!

 

Day 13 - Grams 'n Growth

On Sunday evening's weigh-in, our little man gained a whole 72grams, putting him at 1755g total, and inching his way closer to his birth weight.  He continues to feed well, and we try breastfeeding between 2-3 times a day with some success.  He is still far from feeding himself that way, and is mostly dependent on the tube for 'cavage feeding' but we are hoping that with increased size, comes increased strength and wakeful time to keep practicing on the breast.  He is still under 33 weeks gestation, so not really expected feed yet - but seems to be giving it a go nonetheless.

In other news, we have to move again, so we're packing up the apartment at the Botanical Gardens tonight - a fun fact for the fans of our kitchen - yes, we do in fact have more types of flour in our mobile Darwin pantry, than we have pairs of shoes here (combined).

And in other news - we are pretty sure Susan got a speeding ticket on the way home from the hospital last night - boo silly Australian speed trap cameras!

Holding Luka's head to sooth him during Kangaroo Care

A tiny Top 'n Tail

Cleaning a baby is no easy feat under any circumstances.  Cleaning one that weighs less than a bag of flour, while contained in a box too low for your height, with nothing but two small hand holes to operate through, is not for the faint hearted.  To date, Luka has not yet received a real big-boy bath.  Instead, we (or the nurse at night) clean him every six hours using the following procedure:

Supplies drawer

1. Prep all cleaning supplies from his dedicated drawer - this includes: fill small bowl with warm water, pour a hand-full of cotton balls in. Place at foot of isolette (the dirty end).  Place sterile pad gently on top of isolette (these boxes are extremely loud when things are placed on top, so one has to be very careful).  Take a packet of sterile cotton balls (in a sealed plastic packet) remove 3.  Add 2 sealed cotton swabs, a tube of saline water, and a tube of sterile water. Place a few more sterile towels at the 'dirty end', and one (or two) under the little guy's backside.  Place a brown paper bag for 'trash' at the foot of his bed, and make sure you have a fresh diaper handy.

Saline and Purified water tubes

Sterile cotton balls

2.  Wash your hands
3.  Sterilize your hands using the bottle of sterilizer attached to each bed
4.  Warm up your hands by rubbing them together
5.  Open the isolette doors

Calming and ask permission

6.  Place your hand(s) gently over the baby's body without startling him.  Make sure he is calm and not stressed.  Ask permission to change him, then continue to tell him what you are doing throughout the process.
7.  Start from the top to the tail.  First of all, the eyes:  Open the saline solution, pour generously over two sterile cotton balls.  Holding his head  gently with one hand, wipe one cotton ball once only over one eye from the inside out, repeat on the other eye with the second cotton ball.

Cleaning inside the mouth

8.  Open the sterile water - pour generously over the third cotton ball.  Still cradling his head, gently, but firmly, wipe the cotton ball over his mouth.  Pour some of the water on the cotton swabs and wipe the inside of his lips and gums.

Cleaning the bottom

9.  Making sure he is still calm, move down to the diaper.  Gently undo the diaper tabs.  Folding the diaper in half underneath him (to catch unexpected surprises), take two cotton balls from the bowl of warm water, squeeze excess water out, gently wipe down the affected area. Repeat until clean, without lifting his legs too high in the air to avoid a spike in blood pressure.
10.  Remove the diaper from underneath him, discard all used items into the brown paper trash bag at the foot of his bed.

Dry thoroughly

11. Dry bottom thoroughly using sterile towels, apply bum cream
12. Attach new diaper.
13. Undo and remove sensor from one foot, move and reattach to the other foot to avoid burns from the light on the sensor.
14. Hold baby once more, thank him for being so good and cooperative.

Almost done!

15. Wash hands, bowl and restock drawer.

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?

Benefits of Kangaroo Care

The following article appeared in the Sydney Morning Herald - thanks to a friend in Dili for sharing.

A Short(s) Story

"Mom....there is something I need to tell you..."

"Oops, hang on...something coming through now..."

"One second...."

"Well, I think it kind of speaks for itself now doesn't it..."

"Aaaaaah....so good...."

"Now where were we...ah right, I think I need a new diaper please"

Some of the best responses to our birth announcement...

From Afghanistan, Iraq, Mongolia, Nepal, Cambodia, Egypt, Germany, England, South Africa, Sudan, West Bank, Switzerland, and everywhere else - thank you to all of the over 150 email responses we received to our birth announcement last week.  Some of these had us in tears, others were incredibly humbling, and others yet, had us in stitches.  We have decided to share a few of our favorite letters with you here:

From Susan's Oxford Professor:

Project Evaluation Report (Interim) University of OxfordMarch 2011
The Evaluation team is pleased to acknowledge receipt of the report from the implementing partners. We note with approval the successful and speedy completion of stage one of the project. We take this opportunity to extend our congratulations. We look forward to regular reports on the implementation of the further stages. We need to mention that the current report is missing an environmental impact statement or an itemized plan for progressive realisation. No doubt these will come in due course. The particular issues involved in the delivery of this project also are noted and we compliment the project staff on the practical steps and attitude with which they attended to these matters.
Yrs faithfully,THE EVALUATION TEAMOur ref: Serjak1/22.3.11/prospective applicant

From Chris' best friend and best man at our wedding:

We are so happy for the three of you.  A new chapter of your lives has just begun and your child could not be luckier.  I sincerely believe a baby would be hard pressed to find parents more able to provide a rich and diverse life.  I know Luka is quite possibly one of the luckiest babies in the world simply because he has you as parents.  I guess what I am saying is that I would like it greatly if you would consider adopting me.  I know this is a lot of pressure right now seeing as how you just had a biological child, but I do come potty trained and can accomplish most domestic chores with little to no prompting (just add beer).  Just putting that out there...

From Susan's Father: 

Seems to me we have another overachieving hypercompetitive little f*&#@ in the family. I am very glad for you and I hope it is only uphill (in the best sense of the word and as the complete opposite of downhill as in "things are going downhill"!) from now on.

From a good friends in Kabul/Cairo:

Dear Project Implementers, I'm very encouraged by the partnership that has been developed to enhance the population of population-deprived areas of the South Pacific Region. It is important that this work continue, given the fact that those regions currently have the lowest enhancement rate for non-indigenous population that I am aware of. The importance of this work cannot be overstated and we all must do what we can to improve these unfortunate statistics.
Congratulations to all who have participated in the “Luka Martin Serjak” (great name!) Program for making great strides to improve the non-indigenous population of this region that is so in need of enhancement. On behalf of all who will benefit from this knowledge, I'd like to thank the Susan Marx and Chris Serjak Foundation for Non-Indigenous Population Enhancement for making such valuable work possible. Sincerely yours,PrincipalsWar Zone Vasectomy Project