Gaining Weight Again
CURRENT WEIGHT: 2 LBS, 9 OUNCES
After two consecutive days of weight loss this week, Truman has now had two days of weight gain. The medical staff would like to see a faster weight gain, so the doctors and nutritionists are working on ways to tweak his feeds to get just the right amount of calories at just the right volume -- so that he gets enough extra calories to grow, but not too much for his still very small tummy to process.
As of today, his feeds have increased to 22 CCs per feed, which is 5.5 ounces of 24-calorie milk per day. Breast milk is about 20 calories per kilo (kilo of what I don't know). They have added four calories of human milk fortifier and two calories of oil (yes, clear oil) to his feeds to reach a total 26 calories. Dr. Nama has discussed adding another four calories of fortifier and some protein powders and vitamins if necessary.
Respiration is still going well. He stays on room air almost all of the time and has a back-up rate on the C-PAP of 10 breaths per minute. He still has some slight desats into the 70-percent oxygen range, but he recovers on his own generally. And, the de-sats are almost always prompted by anger or fidgeting, rather than lung issues.
To explain what a de-sat is, taking air into the lungs is not what breathing is about. It's about taking that air and then transferring the oxygen from the air into the bloodstream to have proper oxygenation of the body. Truman has a monitor that measures the oxygen exchange in his blood. The goal is to have anywhere from 82 percent to 95 percent oxygenation. Less, the body is not getting enough oxygen throughout. More (unless he is set on room air), he is getting too much oxygen through the machine, which can have negative side effects to the eyes and brain. When we say that he "high sats," it means that he was set to receive room air and still managed to have oxygenation above the 95 percent mark. If he is on room air, high-satting is a good thing.
In fun non-medical Truman talk, he is developing quite the temper and quite the scream. He doesn't fuss too much about being taken out of his isolette for holding, but he can get VERY anger upon being put back. He really loves touch. He soothes fairly well with a pacifier or having his hair lightly stroked, but sometimes he just needs to scream a little. He also starts to wake and get a bit fidgety and fussy about an hour before feeding time and can get downright angry about 10 or 15 minutes before.
He also likes to put his fingers, knuckles, hand -- whatever he can fit and aim -- into his mouth. Sometimes he only gets close enough to lick, but he tries anyway. He also like to puts his hands on the side of his head or up near his face and can really do some serious sucking with his pacifier or feeding tube. In fact, when the breast milk starts hitting his tummy from the feeding tube, it often prompts him to suck on the tube (or whatever is available). One of his nutritionists said these are all good signs for when he starts learning to bottle feed in a week or so because they are signs that he will not have some of the oral aversion issues that preemies have from being intubated so long.