Weight on the board 1820 grams!  4lb .1 oz! Just over 4 lbs! That’s amazing!
He is on 21% oxygen! But then I look at his PEEP setting, it’s up to 10, from 9….. why did they have to raise the constant pressure the ventilator is giving him? Did they have a bad event last night and not call us?  I look at the log from last night, it looks like two events… in the comments it says periodic breathing… That would not require more pressures… Did they get an xray that showed derecruiting of his lungs? If so then he would require more oxygen probably. Is his leak out of his mouth causing the need for higher pressures because only some pressure makes it to his lungs?

The nurse comes over after assisting with cares from another baby. She tells us he had a good night,  except for the two events where he forgot to breathe for a little. He has been good for her all morning.

The nurse today had RT back in the first couple weeks. So she is somewhat familiar with him.

I cock my head to one side confused and look from the nurse to my wife,  to the ventilator showing a peep of 10… the wife nicely asks what necessitated the change of peep to 10. The nurse has a puzzled look too.

She says she doesn’t think it was at 10, maybe a change the respiratory therapist made?  She immediately pages the respiratory therapist and checks to see if there was an order in to raise it that she missed.  No order,  the respiratory therapist investigates, some point around shift charge it somehow got turned up.

PEEP is turned down to 9 again! All our fears are cleared,  just an accident, the knob to adjust the peep is next to the oxygen percent knob,  maybe it was accidentally turned. Thankfully his lungs can handle a high peep and the excess pressure can escape out his mouth. They apologize and thank us for catching the error. One of the doctors was talking about using a Peep of 10 originally when extubating so we arent worried that it was too far off.

It’s good mom and I have learned as much as we have about all his systems or it could have been a while before it was caught.

We ask of any plans to wean his NAVA level down at all.  No plans yet.

He is super tired and goes into back up mode. SPO2 Starts to Desat I’m betting he was more awake with the pressure coming out of his mouth and now can finally fall asleep because it’s nor anoying him.

He is really out,  I open his incubator and put my finger in his hand and unwrap his feet from his swaddle he is unresponsive and doesn’t move, the nurse comes over and gives him a couple rubs to stimulate him and remember he has to breathe. He wakes up and his legs shoot up into the air and stretches,  like he is pretending he wasn’t asleep. He wiggles his little fingers and does a big Big yawn.

23% oxygen.

He falls back asleep and we decide to let him sleep to the next care because he is so comfy looking. He is remembering to breathe now, not quite as deep a sleep.

Lunch time,

Nava level weaned to 2.3!

It has to be between 2.0 and 1.5 to switch to CPAP (the next step towards less ventilation support)

Back up to NICU. He is still asleep. Back to 21% oxygen though!

Cares,  just pee. Swap to nasal mask from prongs.  Skin to skin Time! My turn.  Smooth transition,  he is leaking out of his mouth and alarming occassionally because the machine detects a large leak.  Pretty standard for RT. The respiratory therapist wants to try ram canula, it is nose prongs on a loop that go around his head,  she swaps it onto him. She wants to do this It alarms less for his leak for some reason and the alarm can bug RT, it’s tbought full.  But it also wants to pop out of his nose with every tiny move he makes.  She tapes it to his head, it helps ever so slightly.  But still pops out every time he shifts. After a few desats when they pop out  and increased oxygen needs to 33% from 25% for cares we swap him back to nose mask.  It is much less stressful for me.  He can wiggle more without it coming off.

The rest of skin to skin goes well! I get to go an extra 30 minutes.

1730, put him back, cares. Temp 36.7. Just pee.

Dinner.

Back up to NICU new nurse tonight that has never had him.

2000 We do cares a slightly different order, mom takes temp then the nurse and respiratory therapist do their thing. Then I change his diaper just pee,  wash my hands and head back over. Often one of us would then help contain and talk to him as they finish swaping to the next nasal prong or mask depending on what he has been on. They seem more hands on and don’t let one of us get back in there to help.  RT seems angrier this care. After they are done,  mom points out one of the nose prong isn’t actually in his nose.  We are told this one isn’t supposed to be all the way inside his nostril….

It looks wrong it is missing his nostril, and he doesn’t calm down.  We try and calm him down, containment, hand hugs and binky things that normally work. He is still angry. I would be too if I was being poked in my nose wrong.

He has not been this mad since the first day extubated trying the wrong size nose prongs.

We ask again and the respiraroty tech this time adjusts it. He doesn’t immediately calm down (5-10) seconds so she holds his head while I contain his feet and then he calms down after another 10 secoonds.

She says oh see he just wanted me to hold him.

(I’m pretty sure all he needed was a little bit to realize his nose was ok. )

While he does like human touch and being social it doesn’t fix everything.

I wonder if she really thinks the nose prong was not upsetting him.

That’s OK, I’m glad she positioned him comfortably and was gentle with him, and now he is ok.

(because we have to sleep) hopefully the next care that I’m not there for, the nose prongs are in the correct spot, and she is able to keep him happy.

Back when we were weaning off of his pain medication we wrote a note on the board that says please call my dad if I’m irritated, won’t calm down or can’t sleep day or night.

If they call I can go and help calm him down or help figure out why he is upset.

I will be upset if I don’t get a call but later hear he was upset or angry for a long time and not sleeping. Being upset uses up his energy that he should be using to grow and recover. Sleeping is when baby brains develope the most. I would rather stay up all night and hold a binky in his mouth when he needs it than have him be angry for extended amounts of time. We need him to keep growing.

We hand hug him, reswaddle him, talk to him and tell him how much we love him. He gives mom a big smile. Binky time, sleepy eyes. We close up the incubator and cover it with the blanket.

It’s always hard to leave the NICU especially after RT has been crying. We give it a while, and he remains a calm. Time to go try and get some rest before we do it all again tomorrow!

Sleep tight and stay strong!

Padding we put under the straps to help protect his cheeks.

Skin to skin!

A brief moment while he was not on the ventilator swapping between mask and nasal prongs.