Massaging Premature Babies Might Increase Weight Gain - What the Science Says

After our meeting with the pediatric physiatrist, her only recommendation to us, other than to enjoy our baby's company, was to integrate massages into our routine.

After looking around a little bit on the internet, I found this nice short and sweet video how to that I plan on trying out today. I think I'm going to stay away from the stroking around the mouth and nose area for the moment however, I suspect that all those nasogastric and orogastric tubes she had might make that area still uncomfortable to be massaged... just a thought. The other part that I think I will skip for now is the massaging of the back - sweet V. still does quite a bit of arching and her back muscles are quite overdeveloped, I do not want to over stimulate that area. Perhaps I'll try it when she is extra calm.

More searching found that there is some evidence that massage might be particularly beneficial to premature babies! I wish someone had told me about that when we were in the hospital. According to a Cochrane Review (Cochrane reviews basically look at the entire body of medical literature, every good study published on a subject and comes to an overall conclusion on how effective a treatment or a diagnositic tool is), it seems that there is some evidence to suggest that when comparing massage to light touch for premature babies, that massage may lead to a 5 more grams per day in weight gain, earlier hospital discharge and some improved neurodevelopmental testing. Amazing!! The best part really, is that although no study is perfect and perhaps the effects are somewhat overstated, they did not find any disadvantage to the massages. Read more about the details of the studies here.

My husband and I are now considering consulting an infant massage specialist.

Do you have any experience with infant massage? Do you think internet videos are sufficient or would a consultation with a specialist be preferable?

Inquiring minds want to know!

Xo
C

Hypoallergenic Diet For Reflux

Yesterday, the dietician responsible for following V's growth recommended I try a diet without any milk products to see if this might be the cause of what seems to be reflux. Apparently it is very difficult to distinguish reflux from bovine protein allergy in infants and in a few rare-ish cases, eliminating all dairy products from the mother's diet solves the problem completely! We should see a change in 48 hours.

So here I go on a non-dairy diet! To keep my calcium intake high, we got a super pack of soy milk (chocolate flavored!), so that won't be so bad. Turns out chocolate soy in coffee is kinda yummy. No cheese is going to be more difficult, but I am up for the challenge! What we wouldn't do for our bubs right?

Also, we have to skip the enrichment for the next 48 hours because it has some milk protein in it. Not that it will change her calorie intake that much, yesterday night she flat out refused the bottle... I'm really hoping the reason for this is the milk proteins, though I realize the chances are slim.

I have been researching diet changes and its effects on reflux, later this week I'll compile what I found and share it here!

For now, I have to go, time to breastfeed my hungry babe.

Wish me luck!

Xo

C

Reading in the NICU

To put this post in context, I first have to specify that my husband and I spend an inordinate amount of time at the hospital. My husband and I basically split the days in two, I would go in the morning to see our sweetheart, come home for supper, then we would both go in the evening and he would spend the night shift with her. I know this is an unusual set up, we just had a few scary nights at first when we were not there and my husband has a work schedule that allowed him quite a bit of flexibility during that time. We realize how very lucky we were in that respect! Living a 5 minute walk to the hospital was also extremely convenient because parking daily would have probably not been possible.

I spent from one to 4 hours in kangaroo care with my little bub everyday. I found after a while, that while she was sleeping, she did much better (from her O2 sats and heart rate monitoring at least) if I was otherwise distracted. When I had no distractions, I ended up spending all my time playing with her hair, or rubbing her back or stroking her arms... all things that I eventually found made her a little unstable.

We were not allowed to use our cell phones while we were in Kangaroo care at our hospital. As such, I could not distract myself with browsing the internet... I found that an even better solution was to read riveting novels. Immersing myself into another world kept my hands busy turning pages and my mind off the scary possibilities my sweetheart might be facing, it was win-win for both of us!

During our 77 days, I had time to read 2 books, both which were quite successful at keeping my mind off the NICU :

1) The Kite Runner

A great book that really transported away, the Kite Runner is about two boys who grow up in Kabul. I have to warn you there are a few difficult passages that are quite graphic about abuse (sexual and otherwise). Overall, it was very interesting to experience what it is like to have your seemingly quaint small town become completely disfigured by war.

2) A Cuckoo's Calling

 

J. K. Rowling's foray into adult litterature under a pseudonym. This book was great because it was a light read and a real whodunnit (aka great at keeping your mind off the many NICU unnecessary stressors). She keeps you guessing right until the end.

Although just from personal experience, I believe reading kept me in a calmer mindset, therefore less likely to fidget which could only have been beneficial to my sweetheart!

Xo

C

More on Breastfeeding my Preemie

"Each latch took an average of 20 minutes to achieve. I've never worked so hard in my life!"

These sentences really resonated with me! I read them on birthing and breastfeeding, where an amazing mom shows us that breastfeeding is possible even in the face of seemingly insurmountable difficulties! I really encourage you to go read her story, it is really touching, and her sweetheart, born with arhinia, is so darn cute!

I used to tell my lactation consultant that breastfeeding Miss. V felt like a wrestling match! How very far we have come from those early hospital days!

After 22 days of tube feeding and lots and lots of kangaroo time, she finally had her first introduction to breastfeeding at 32 weeks. It would mostly consist of opening and closing her mouth haphazardly and not much else! The following days would bring a few suckles, but nothing that could be considered nutritive. It was hard to believe that her teeny tiny mouth would even fit over my nipple, let alone be nourished by it!

One month later at 36 weeks, miss V would finally have a full meal at the breast. Its funny, because when she had started being put at the breast, she was so great at rooting and starting using the pacifier at such a young age, I thought fir sure she would be breastfeeding before what all the nurses predicted (34-38weeks). The progress at the time seemed painful slow at the time. Looking back now I see she actually progressed relatively quickly!

Currently, while there remain the occasional chocking episodes (my darn breastmilk flow is still too high), overall, we have lovely, peaceful and quite nutritive nursing sessions! Miss V's weight is still a bit of an issue, so we are supplementing once a day with enriched breastmilk, but otherwise I really can't complain. In fact, there is no way I would have believed when I first started trying to breastfeed her that we would one day get to a point where it can be relaxing!

Just look at how far she has come:

So preemie moms who are just starting the great breastfeeding wrestling tournament, take solace in knowing that sometimes, even when it feels unlikely, you too can be successful!

Xo
C

Physio - The Third Meeting

I am relieved to say that this meeting went much better than the first two!

See the second physio meeting wrap up here.

The physio immediately noted that Miss V's arms were held lower and more in front of her, her hands continue to become more and more open and she is one very chatty, smiley baby! As the assessment continued, she found that she reaches forward towards a ball, tries to grab at objects and is finally pushing up with her arms during tummy time!

Our mission for the next few weeks consists of:

1) Continuing the tummytime, trying to get her to reach far forward for objects (we can alternate with tummytime on the ball).

2) Playing with her on her back, trying to get her to reach for/grab a small ball.

3) Play sidelying trying to get her to reach for her toys and grab them (they should be large enough that her hand remains mostly open).

4) Generally hold her in an almost fetal position, while stimulating her pects do that she keep her arms forward. As she improves with this, we are to try to get her to use both hands to hold larger objects.

5) Try to get her to grab at her feet, by generally tapping them together, bringing her hands to her ankles, etc. This exercise is my favorite; she giggles so much when she sees her toes!!

Now that I have these exercises noted, I'll see back in two weeks how they have progressed.

All those exercises were hard work! Here is my sweety taking a much needed recovery nap!

Hihi, she looks like she is up to no good!

Xo

C

Choosing Grandparent Nicknames

I am an only child, so having a baby meant my parents became grandparents for the first time. As my husband and I mulled over potential baby names, my parents began considering what they wanted our baby-to-be to call them! The process uncovered a few nicknames I had never heard of and a sweet story!

For my dad, it was quite easy, he had always wanted to be called "grand-papa" just like his father had. Grand-papa is the french version of Grandfather.

My mom on the otherhand had a bit more difficulty choosing. Her mother calls herself Nana, which my mom really likes. However, she was worried that our baby would get confused if there were two Nanas. Grand-maman (the french version of grandmother) was already being used by my mother-in-law. 

She looked to her sister for some help. My aunt became a grandma a few years ago and did quite a bit of research to find an original nickname that she thought would suit her. At first she considered nagymami (which is Hungarian), but no one in my family is Hungarian so we all found it too difficult to pronounce. She finally decided to be called Yaya, from the Greek word for Grandma, which has been super easy for her granddaughter to learn to say! None of those seemed to fit for my mom.

She ended up calling herself Mina. This is part of our heritage : it is Corsican (that beautiful island off the coast of France). Grandma's there are usually called either Mina, Minnà or Minana. I think its adorable!

The absolute cutest grandma nickname in our family has to go to my husband's fraternal grandma. When my husband was little, his (~4 year old) brother listened in on a phone conversation between his grandparents. His grandfather called his grandmother "darling". Hearing this, my husband's brother assumed Darling was actually his grandma's real name! Ever since, the two boys called her Darling. I know its early (wayyy to early in fact), but I'm thinking that could be a pretty cute name for me one day!

What will you or your parents be called?

Xo

C

Three Months Old!! (Corrected Age)

Current nicknames : 

Tite cocotte, princess pie, little lady

Weight :

4.99 kg (almost 11lbs!)

Height :

About 57cm

Medical Issues :

I think this is my favorite category this month:

Our pediatrician could hardly believe you were (?are) a preemie because you hit the 25 percentile of weight. 

Your respirologist who had previously demoted you from the BPD clinic to his general respirology clinic told us you no longer needed respirology follow-up! Your chest xray looked perfect, although he did warn us that you still have underlying mild to moderate BPD (downgraded, or should I say upgraded, from moderate) and you remain at risk of severe complications if you were to get a respiratory infection. Still a win in my books though!

A pediatric physiatrist essentially told us you are developping well and have no clear motor delays to date. While there are no guarantees, this news has certainly put some of our worries to rest.

Lastly, you started taking Zantac twice a day for reflux. You are not a fan! It tastes quite strongly of mint, we'll have to see what you eventually think of toothpaste, I predict more difficult times ahead!

Sleep:

You regularly sleep 6-7 hours at night. The days are still a bit all over the place, but in general I'd say you have three longer naps.

Clothes/Diapers:

You are starting to grow out of your 0-3 month clothing. I'm excited for you to start wearing your pretty 6 month sized summer outfits! Here you are in our current favorite outfit (a little dress with black leggings):

Hanging out with Mina <3

Diet:

Still exclusive breastmilk, with the occasionnal enriched bottle.

Baby Gear Love:

Your favorite toy is "Rodrigo" or "Eduardo" a lamaze toy.  

You adore hanging out in your sweet vibrating rocker. 

You are not super into books yet, but I'm sure that will come!

Milestones/Firsts

This past month you have really mastered holding your head up while sitting or being held.

A few weeks ago you clearly imitated us for the first time : you blow us kisses (smack your lips)

Your coos have definitely transformed into babbles. I swear you said mama two days ago, but your dad was there too and he is skeptical. I think he just hasn't mastered babyeese yet! 

Things I don't want to forget:

You LOVE it, often breaking into smile or cooing, when we talk while sticking our tongue out. You seem to find it sooooo silly! Eg. when we say : Lalalalalalove.

You have such a sweet little personality, we are so very lucky that you are our daughter and we get to hang out with you everyday! I can't wait to learn more and more about you!

So much lalalalove!

Mamamamama

Finally Mastering Infant Medication Delivery

Since her days at the NICU, miss V. Has been exhibiting some signs of reflux. She would grimace and gag a little when her bed was flat post feed and sometimes have an associated brady. Later, she would be fussy at the breast and sometimes arch her back. Of late, her weight gain has dropped off slightly, bringing her to the third percentile for corrected age. With the stagnating weight being the last straw, our respirologist recommended we start giving her Ranitidine (also known as Zantac).

Well, miss V. is not a fan! Giving it to her twice per day has proven to be very difficult. When the entire amount of medication is spit right out, you start to question the usefulness of what you are doing. We tried mixing with breastmilk, feeding it to her when she is particularly hungry, sneaking it in when she is sucking on her pacifier or during breastfeeding with a syringe (without the needle, obviously) and feeding it to her via a dropper. The only time some amount seemed to be swallowed was once when she was half asleep... Not something I could count on, since it needs to be given quite rigourously every 12 hours in our case. 

We had a rough time until last evening when we had a eureka! moment. You see, the best results (albeit quite mediocre) we had were when we used a syringe to sneak the Zantac in. The problem seemed to be that the 1mL suringe could not be subtly introduced: it inevitably interrupted her breastfeeding or pacifying flow. The solution : we used a plastic catheter usually employed intravenously! NOT the needle part, obviously, we just the plastic sterile part. Its great because I get to control the amount of medication I administer and it is small enough not to interrupt the suction on the pacifier or the breast. Its so great! Here are some pictures:

See, we just use the plastic part. No needles here! Those go in our nifty sharps container.

Here's Miss V. Happy as a clam, sucking on the plastic bit and swallowing all her medication for once, without tears!

Has anyone else tried something like this before?

What tricks do you have to get your sweetie to take their medication?

Xo

C

Our Very First Easter

A short note to mention how adorable my husband is. He snuck around the house while everyone was sleeping and hid Easter eggs. Since I've known him, I've told him that when we have a daughter, I hope the Easter bunny leaves a little trail of chocolate covered almonds to the chocolate stashes (as a girl, I always figured they were Easter bunny poop... Is that weird? Maybe thats weird... Too bad, I think its cute!) What do I see when I get up? A couple chocolate covered almonds near the coffee machine with a Reese egg in the sugar bowl, a little trail on the bathroom counter leading to the half open drawer, one on the play swing, and a whole bunch in sweeties room! A dream come true! Man have I got a keeper! 

Oh, and we've found the perfect way to get our little lady to take her Zantac! More on that later!

Xo

C

Fetal Cardiac Ultrasound

Fetal ultrasounds have not been the happiest appointments for our family. Due to a prior pregnancy with a major genetic abnormality, Miss V. underwent a bunch of ultrasounds.

The 13 week nuchal thickness showed short limbs, a soft sign for downs syndrome. Week 16 and 18 ultrasounds showed marginal cord insertion on two hematomas. Then week 20, we were told she had a cardiac malformation called a persistant left superior vena cava, what a mouthful!

To understand PLSVC, you first have to know a little bit about normal cardiac anatomy. There is a great breakdown of what it is here. Usually, we have two vena cavas, a superior right and an inferior right. Everyone develops a superior left vena cava at some point during their fetal development, however, usually it is resorbed (kind of like how we all have webbed fingers at one point, but then they get resorbed).

In miss. V's case, the blood from her arms, instead of draining into her superior right vena cava, it went through her PLSVC, which in turn drained into her coronary sinus. All this simply means that it was a variant of normal.

The worry in her case was that there seemed to be a bit less flow going through the aorta because of a compression for the enlarged coronary sinus (it was enlarged because it was receiving extra blood from the PLSVC). When the aorta has lower pressure pulsing through it during development, it sometimes remains a smaller diameter. In certain cases, that can lead to a coarctation of the aorta.

The aorta is the blood vessel that allows all the blood in the heart to be distributed to the rest of the body. A coarctation of the aorta is just a fancy way of saying that it has a smaller diameter. Imagine two pipes: one has a big opening and one is narrower. You can imagine that less fluid can go through the smaller one. You wouldn't want a tiny pipe draining your sink, just like you wouldn't want a tiny aorta draining your heart. It can cause extra stress on the heart trying to push all the blood through the tiny opening and it means not a lot of blood reaches the legs, the kidneys and a bunch of other organs. 

The key with the coartation is that if you have a patent ductus arteriosis (PDA), the blood can get carried to the rest of the body that way, through the PDA. So while most babies want to have their PDA closed, when you are worried about a coarctation, you want the PDA to stay open! 

Luckily our little princess' PDA remained open for a while. She was followed with weekly ultrasounds until they figured her aorta was big enough that they were no longer worried about a coarctation (fiou!) and then gave her some ibuprofen to close up the PDA. We were some of the lucky ones whose preemie closed up their PDA without the need for surgery and she did not get any of the icky side effects from ibuprofen. 

So at the end of the day, our scary cardiac fetal ultrasound just showed a PLSVC, which is a variant of normal and miss V is not considered to have any sort of cardiac problem! It just goes to show that fetal cardiac ultrasounds are far from perfect, so there is a bit of hope if your child had a not so sterling echo if it is regarding coarctation.

Xo

C

100 Happy Days #30 - Great Doctor's Appointment!

We had a much awaited appointment with a pediatric physiatry (also known as physical medicine and rehabilitation) specialist today. After some not so great meetings with the physio and neonatologist, who told us that many of miss V's movement were abnormal (without settling on a diagnosis), we were bracing ourselves for the worse. Boy were we wrong! 

The doctor was so sweet and reassuring! She basically said that because miss V has good head control, good contact and has been cooing up a storm that the bit of stiffness in her arms is not worriesome. Plus, she reminded us that from a neurological perspective, it is miss V's performance at her best that counts (she opens her hands and brings her arms forward, even reaching for objects when she is relaxed at home, but is quite stiff and stressed during her medical visits).

We are to encourage arm usage by playing with her on her side (gravity helps her reach for objects) and generally try to keep her in positions that help her relax. They even suggested learning baby massage techniques! That sounds like so much more fun than fighting with her during tummytime!

Although of course nothing is guaranteed in life, it sure felt nice to be reassured that our sweetie is doing well! I know two parents who will be sleeping soundly tonight!

Xo

C

100 Happy Days - Imitation

Yesterday I was just beaming!! Little miss V. started imitating our lip smaking. Up until now, her "imitations" seemed more random luck and not repeatable. I'm such a proud mama!! I cannot find any information online about whether this is a proper milestone, so I'm guessing it isn't... I'm certainly counting it as one though!

Miss V by month

At birth:

One month:

Two months:

Three months:

Four months:

Five months:

6 months:

100 Happy Days - Chocolate Truffle Making

As a little distraction and a very cautious first step out into the world post great Lockdown, I went to a chocolate truffle making class. It was small enough that only my friends were present (no strangers), so I could be sure that they were all healthy! All thanks to a great Livingsocial deal - I'm going to keep an eye out for more fun outings offered. We went home with over 40 truffles!

Yum yum!

Xo

C

Happy Lungs

When Miss V was hospitalized, although she never needed to be intubated, there was a time when it seemed that she might be coming home on some oxygen. At the very last second, she passed her oximetry and was able to go home tube free so to speak.

She has a diagnosis of moderate bronchopulmonary dysplasia which will likely continue to follow her for a few years yet. The great lock down will happen again next fall and winter, we will continue to dust twice weekly and run our HEPA filter, she can never EVER (!!!) smoke and may yet develop asthma... But today we received good news:

Miss V's chest xray is normal and we no longer have to be followed in the respiratory clinic. So excuse me while I go ahead and savour that for a bit :)

Xo

C

Physio - the second meeting

After a really great visit at Miss V's pediatrician's last week where we were told she was hitting her expected milestones for 2 1/2 months, we braced for her second physio appointment this week.

Her last physio and neurodevelopmental meeting had been tough. At 10 weeks corrected, we had though she was doing great: smiling, laughing, her eyes tracking toys left and right and even lifting her head up in prone (during tummytime). Boy did it feel like we were wrong... 

"Look at her hyperextension... she is favoring her left side... she doesn't have a stepping reflex... asymmetrical Gallant reflex... incomplete Moro..."

Ugh. Not words a mommy wants to hear on the first neurodevelopment evaluation! I was actually relieved to be told generally preemies require 5 times to amount of homework help time than term babies. All I could think was, "you mean she will be able to attend school?"

Lots of tummy time, positioning, holding in fetal position and hand integration later we braced ourselves for the second physio meeting. We were CAUTIOUSLY optimistic after the pediatrician's comments. We should have know better!

Yesterday's physio meeting sucked. We had for the last month insisted on doing 25-45 minutes of tummytime per day. There had been so many tears in the name of tough love. Turns out we were just encouraging Miss. V. to strenghthen her back extensors. It felt terrible to think those tears were not only in vain, but actually contributed to the problem. She is unexpectedly tight in her arms. We shouldn't expect to see any improvement anytime soon... Yet no one can comment at 2 1/2 months if there is an underlying pathology or if its just a little snag in preemie development that will resolve itself. Good points : she is opening her fists more and no longer seems to be favoring the left side.

Is it just me, or is a big gym full of noise and bright lights not the best environment to evaluate a sweet little preemie?

I was instructed not to read online. So of course I could not help myself... Of course the best study review I find says :

"Early signs of spastic quadriplegia include marked flexor hypertonia of the upper extremities with pronounced scapular elevation and retraction and increased extensor tonus of the lower extremities."

Double ugh. Did I mention I found this study at 4am. Needless to say, mommy slept very little last night.

All we can do now is to worry and wait while we're being told to enjoy the moment... Oh and exercise, exercise, exercise... Tummy time on a large ball, sitting arm integration and lots of hand stimulation. We managed to get another physio session in 2 weeks time instead of 4, you  know, just in case we somehow start stimulating the extensor tone again.

Here's hoping our third physio meeting will be better than the last two.

xo
C

100 Happy Days - Painting

I just love the feeling of accomplishment associated with completing a painting. It is so much more satisfying than the never ending chores list! Here is my latest watercolour:

18x24 inches, Birch Forest

Professional Photography of Preemies

We just received a bunch of pictures back from our photography session back in early March when miss V was about 5 weeks corrected age. Isn't she adorable? She was pretty awake for most of the session. I wondered if doing the session closer to the 10-14 day mark, but Miss V. had been pretty awake since about 38 weeks. Anyone else have any earlier experiences? Big thanks to Angela Chin who was amazing, check out her and her husband's beautiful photography blog.

Xo

C