RT is at 24% oxygen!  The nurse on today is one of his primaries!  She tells us he had a poop earlier!  He had a good stable night, his temp has been fluctuating though.  Cranial ultrasound scheduled for today to check on his brain bleed and make sure no unknown issues are arising.

His ventilator settings have been weaned slightly,  NAVA level .2 lower.  (The amount the signal his brain is sending to his diaphragm is multiplied by, dictating how big of a breath he is taking) he is doing good with the change. 

He is super relaxed looking,  just sleeping!

Eventally he starts to stir he probably knows it’s about time for cares and is hungry.  His diaper only has pee. His hernia is about the same.  Ultrasound is supposed to show up, but doesnt, they must be busy.

Rescheduled for 1400. We can do skin to skin at 1700 if RT behaves.

He remains largely calm through cares! Just his normal wiggly self. He falls back into sleep quick after we wrap him up.

Lunch time. Then back up. Still on 23% oxygen! What a good boy! I feel like it really makes a difference to have his continuity of care with his primary nurses!

1400 cares,  just pee, cares go smooth,  swapped to nasal cannula, after cares,  the nurse starts his feed I give him his binky and dip it in a small cap with just a few drops of milk in it,  give him a treat to help associate getting full, the taste of milk and the shape of a binky. He loves it and relaxes quickly. I let him suckle 6-7 times then remove the binky and get another drop on it. He looks sleepy on the 3rd dip.  And suckles 3 times then stops. I remove the binky he looks content.

I close the door and slowly start putting his cover down over his incubator. I Glance up at the monitor his his heart rate starts to come down.  I open it back up and look at him.  He looks happy, heart rate now 110, then 100. Alarm sounds,  nurse is there quickly turns oxygen up to 40%.  90bpm, she suctions his mouth out,  not much,  stimulates him a little bit to bring his heart rate back up. Heart rate down to 60’s  I encourage him to get his heart rate up.he is slightly too relaxed. Nurse has the other nurse in the room call respiratory.   His spo2 is still in the 90’s. His heart rate slowly comes back up,  then his spo2 slowly dips to 79, then quickly back up to normal range.

He still needs to work on his whole suckling, and keeping his heart going!  One step at a time.

Ultrasound doesn’t show up.  Must be a busy day for them.  Maybe tomorrow then.

RT remains stable. Oxygen percent down to 27% then 23%

1700 cares,  just pee. Swapped to nasal mask. Skin to skin time!  Transition is smooth,  he relaxes immediately once we are settled into our chair.  We get some much needed cuddle time.  He is deep asleep. 24% oxygen.

1900 shift change,  new nurse tonight.  She knows of him, but has not had him yet.

2000, time to put him back,  transition is smooth. Diaper,  just pee. He almost pees everywhere as I’m wiping him,  but I’m quick and close the diaper before any escspes!  Back to nasal cannula. Swaddled he is comfy,  we give him some binky time,  no milk dipping though.

The respiratory therapist asks me if I think we will wean any settings on the ventilator, I say yes,  to me it looks like he has been averaging less or around 5 on the Edi so down on NAVA level. Respiratory therapist checks the graphs showing trends on what RT has been doing. He agrees. Yes probably down on the nava level again!

Night rounds,  Dr. comes by. Respiratory therapist tells him about the EDI signal average. Dr. Says to wean the NAVA level!

Time for dinner,  goodnight RT! Get some good rest! Keep strengthening those lungs buddy!

You get to see some of your grand parents again tomorrow!