Day 3 (GA: 28 Weeks 3 Days)

Yesterday went pretty well for both babies.  Thank you to all who prayed and fasted for our little guys.

Ezekiel was intubated and put back on the ventilator for about 6 hours in the morning, but quickly came off it and is on a SiPAP, which is similar to the CPAP but also help regulate breathing by adding some breaths between his own.  He is still breathing 21% oxygen (room air).  Breast milk is being fed to him, about 2.5mL every 3 hours.  He has lost weight and is less than 950 grams (2lbs 2 oz).  I say less than, because they measure with a diaper on and some stuff on his head.  During his rounds, where the doctor, nurse practitioner, and pharmicist pow wow over his treatment and progress, I sat in and heard some more positive news:  his nucleated red blood cell (NRBC) count is increasing.  NRBCs are little RBCs that still have their nucleus; mature RBCs lose their nucleus.  This means that Zeke's bone marrow has kicked in and is making new blood cells.  Overall, Zeke is doing very well.

Gabriel continues to be very sick, but he has made small but positive improvements, which is the right direction.  His care was mostly to wait and see how his body responds.  By the end of the day his blood pressure was getting higher (good thing) and his main blood pressure medicine (Dopamine) was reduced.  His blood oxygen levels remained high with a 40% concentration going in (it had been 80% most of the day).  They are closely monitoring his sodium, potassium, and calcium levels.  His potassium was trending high so they treated him with insulin.  Insulin is the drug used by diabetics to reduce the glucose in their blood.  Insulin turns out also to induce potassium going into cells.  But since it draws sugar out, they have to increase his blood sugar prior to administering the insulin.  He continues to have pulmonary hypertension and patent ductus arteriosus (PDA).  Today he will get an ultrasound of his heart again to look at the PDA.  He (and Zeke) will also get a head ultrasound, where they look for bleeding in the brain, called intraventricular hemorrhaging (IVH).  This is the main cause of cerebral palsy (grade 4) and neurological development issues (grades 2 and 3).  There have been some positive signs that Gabe has not had any bleeding:  his hematocrit has stayed steady.  When there is bleeding is the brain, the hematocrit takes a sharp decrease.  So his constant hematocrit is a good indicator.  We will know more tomorrow, after the head ultrasound is read by the doctors.  And the best news for last:  He had not urinated since he was born and this was a huge concern to his care providers.  But by midnight he had made about 5mL.  He has retained a lot of water and he has gained a bit of weight.  His is now roughly 1650 grams (3 lbs 5 oz).  He looks like the Stay Puff baby compared to the baby Gollum that Zeke is.  It is quite the contrast.