James landed a ticket to the NICU about 5 minutes after birth when the pediatric nurse noticed he was grunting a little with each breath (a sign of distress in newborns) - turns out he had "transient tachypnea of the newborn," where the baby essentially has trouble transitioning from a fluid-filled environment to an air-filled one, resulting in too much fluid staying in the lungs. The baby naturally tries to "breathe off" that extra fluid by increasing their respiratory rate. However, that can land you in a dangerous situation, because tiny babies don't have a lot of reserve and can wear themselves out rather quickly doing this. So, he ended up on continuous monitoring while his little lungs struggled to make that fluid-to-air transition.
At first, the NICU team wouldn't let us try breast feeding, since eating is like a workout for newborns, and breathing has medical priority over nutrition. Of course I understood this, but it made me so sad, especially when they had to start an IV with dextrose about hour 4 of life to keep his blood sugar from dropping too low (since they were afraid for him to try eating and then go downhill respiratory-wise).
Sometime Wednesday night (the day he was born), I was holding James in the NICU and he was very fussy (also bad for a baby with respiratory issues - crying takes a lot of energy and can deplete oxygen reserves in baby's blood, increasing his respiratory distress since he wasn't breathing very efficiently already). He was also showing LOTS of hunger signs (rooting, sucking on hands, etc.) so the nurse and I decided to try putting him to the breast just for some soothe-sucking, and guess what! His respirations and oxygen levels looked BETTER on the monitor, not worse! Of course my milk was not in yet, but over the next day or so, he was able to breast feed as it started to come in and his blood sugar leveled out and they stopped the IV fluids.
Having that extra hydration the first day had given him tons of wet diapers in the first 24 hours (usually they only have 1 or 2). When they stopped the IV fluids, he didn't have a wet diaper for 12 hours and then they started freaking out about him getting dehydrated (this was on Friday night/Saturday morning) - also he had a few other factors that set him up for risk of dehydration, like breathing too rapidly over a few days, as you lose fluid by evaporation from your mucus membranes through breathing, and this can happen pretty quickly in little babies.
Meanwhile, his respiratory issues were continuing to resolve (which is what you expect with transient tachypnea - it just resolves), but they were concerned about hydration now (Stu & I think it was significantly related to a rebound from being on IV fluids). Anyways, so the NICU team started running a bunch of labs every couple hours to watch his hydration status & I was breast feeding like crazy to try and re-hydrate (praise God he didn't have to go back on the IV, bc I think it would have just perpetuated this cycle).
Saturday morning during rounds, the docs noted that his sodium levels were a little high (an objective measure of hydration) and they would just recheck it that night and see how he was the next morning. Thankfully, Stuart was there and told them that we were ready to go home and didn't want to wait another 24 hours to see how this would play out. So they agreed to check the lab again a little sooner that afternoon, and started to get everything else checked off for discharge (hearing test, Hep B vaccine, setting up the first pediatrician appt, etc.). They told us since he was doing so well that IF the sodium level came back looking better that afternoon, and since we were in healthcare and knew exactly what kinds of things for watch for in terms of hydration and respiratory risks/changes, and since we had our first pediatrician appointment on Monday (very soon after discharge), then we could take him home Saturday. So we prayed all day for the sodium level to come back normal, and were assured that everything else was taken care of for discharge. The first lab they sent ended up not being enough blood to get an accurate level, so 2 hours later they stuck him again and sent a second sample. The result from that sample actually looked WORSE than it had on his morning labs! But the docs said this didn't make sense because he was very much improving in all the other signs/symptoms of hydration, so they didn't trust that lab result. So, they sent a THIRD sample and we waited for it to come back. By the time we got that result, it was 9pm on Saturday, but it came back improved and they said we could go home WOO!
We got everything packed up, and at 9:45pm I was feeding him one last time before our car ride home, and they nurse says "Oh, we have to do the car seat test... it's 90 minutes long." And we just lost it. The car seat test is where the baby has to sit in the car seat for 90 minutes to prove they won't die or something, and in NC any premature baby or any baby that is in the NICU for a respiratory problem has to do this test. However, the attending physician earlier in the day said that James did NOT have to do this test since his respiratory issue had resolved, and he wasn't a premie. But, all the nurse knew to do was protocol (which I completely understand) because that doctor had not documented anywhere that James didn't have to do the test. So, I sat in the floor of the NICU sobbing, with James screaming in his car seat for about 30 minutes, while Stuart went out looking for the doctors on call that night in the NICU.
After about half an hour, Stuart came back and said that we could go - the night doctor had talked to the day doctor and clarified that James did NOT have to do the test (although he had done 30 minutes already - twice the time it takes us to get home) and that we were leaving. The nurse confirmed all of this, and made sure it was documented in our discharge summary this time :)
James was already in his car seat, so I didn't even take him out to put on his going-home outfit, and just carried his car seat out in my hand since I had already been discharged. We finally went down and got in the car about 10:30pm and got home around 11:00pm.
So, that's our fairy-tale story of how we brought our first baby home from the hospital. No going-home outfit, no riding out in a wheelchair carrying my baby. Just running as fast as we could to escape! It was SO good to be home. And the next morning was just bliss - sitting by our Christmas tree drinking hazelnut coffee and listening to Christmas music with our perfect, hydrated, breathing baby :) That's the story of James' first four days of life, and as much as parts of it sucked, I know I wouldn't change a thing about our first adventure with our sweet new babe.
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