I was with Kelli again today, and she greeted me with a big, enthusiastic, "Hello!" when I walked in. She had the same two babies again with the addition of a third. The third baby was born at 36 weeks with a twin, but he had a few concerning respiratory issues while the other baby was ok, so he was the only one who had to go to the NICU. He is healthy and able to maintain his temperature well enough to stay in a crib as opposed to an isolette.
Kelli explained that babies have periodic breathing where their breathing slows down for a bit then gets quicker again. One of the babies had a spell when we were standing by the crib when his breathing slowed for too long and his heart rate started to drop. His breathing and heart rate eventually picked back up again, but it was an episode that was definitely noteworthy because the nurses have to make sure apnea (when breathing slows for too long) isn't a problematic and recurrent issue. This is when Kelli explained the triangle of breathing, heart rate, and oxygenation: if one drops off, the other two will follow, such as when the baby's breathing slowed and therefore his heart rate dropped too.
I got to see phototherapy for the first time today, which I learned is to treat jaundice, or a yellow color in the skin caused by too much bilirubin, a yellow-colored pigment of red blood cells. In the womb, babies need lots of these hematocrits and hemoglobin cells, but outside the womb in babies usually under 38 weeks, it causes yellow skin because the liver isn't mature enough to get rid of the bilirubin in the bloodstream.
Kelli let me listen to a heart murmur today, which sounds a lot like sand paper scratching back and forth as opposed to the normal "swish swish" of a normal heartbeat. Kelli explained that many drugs can be used for more than one purpose, including indomethacin, which is an anti-inflammatory drug used to close heart murmurs. Patent ductus arteriosus (PDA) is the blood vessel that connects the aorta and pulmonary artery in the heart, which remains open in babies inside the womb because their circulatory system is much different and they rely on the mother for gas exchange and circulation. Patent foramen ovale (PFO) is the hole between the left and right atria, which is another structure in the heart that doesn't close and can cause heart murmurs in premature babies. The murmur that I heard had both open PDA and PFO. The drug indomethacin, however, is the same as ibuprofen, which is an anti-inflammatory drug that we often use but for a different purpose. This is why pregnant moms aren't allowed to take ibuprofen because it would inadvertently close the PDA and PFO in the womb, which is obviously problematic.
Today I got to be more hands-on than I have the past two days! First, I got to change one of the 27-week baby's diapers. I got to stick my arms in the separate little arm holes in the isolette and change the tiniest diaper while my fingers got slippery from the humidity inside the isolette. Kelli then asked me if I wanted to change his patches because he kept ripping them off, so I worked to carefully plug the patch cords into the correct receptors and stick the patches in the right spots on his little body.
I also got to hold a preemie for the first time today! He was big and healthy enough, so I sat down in a big arm chair, and Kelli handed him to me. After a few minutes she comments, "You're just glowing!" How can I not when I'm holding the cutest little baby in my lap?!
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