Desaturation

Have A Preemie, It’s Such A Deal

/ bperica / 4 Comments

I am here to be honest with you. Having a preemie is such a deal both in cost and effort. Think of all the deals you have come across in your life. Think of the deals you expect to encounter in the future. Let your imagination run wild. I really doubt the deal you have in mind will come even close to being as good a deal as I am about to share with you.

1. Delivery is really fast. You don’t even have time to anticipate it. One night, you’ll be at home watching TV (in our case, I was trying to watch the latest episode of True Detective on HBO), and you will be truly concerned about everyday tasks, leaning over to your spouse and saying, “Oh gosh, we still have to clean the kitchen.” Then the pain will come. You’ll make a smart decision to go to the hospital to get some drugs or something and be sent home. So, still, having a baby won’t even be on your radar. But then the water breaks and well, you know something is going to happen. You’re not quite sure what. And then a few hours later you have a kid. Very little pain. Lots of drugs. A lot of very nice people working to help you deliver this baby as quickly and as painlessly as possible. And it is. The scar will heal up very nicely.

2. No third trimester. “Wow, killer deal!” You might say. Well, you are spot on. From what I hear, that third trimester is just a pain in the ass, or more like the lower back. Fatigue? Ha, you won’t even get to the worst of it. Frequent urination? You’re safe. A two pound baby does not make you urinate more. Heartburn? Okay, you might still get this if you have a preemie, but it’s not what you think. It’s just because you had tacos with the hot salsa on them, not because you are growing a human being. Swelling? Nope. You’ll be able to wear your wedding ring right up to delivery. Weight gain? Are you freaking kidding me? As soon as you develop the slightest baby bump you’ll be hours away from delivery, saved from the expand-a-pants, saved from the waddle, the stretch marks, and the need to have a whole different wardrobe for that third trimester.

3. Best babysitting in the world. As soon as your baby arrives, NICU nurses, will be with your baby 24/7 until the baby leaves the NICU. The earlier the baby, the more days you’ll get this amazing babysitting at a relatively low cost. You can still go out for dinner. You can go home to sleep. In addition to the nurses there are many other professionals checking in on your baby, making sure she is comfortable and developing as expected. You might be a little stressed about leaving your baby in the NICU at first, but, oddly, you get used to it. You still need to enjoy your free time before you have a baby at home. You weren’t expecting to have a baby this soon. You had three more months. Take them. The NICU team has you covered.

4. The lighter your baby the better. Truly, if you have a really small baby, you just qualified for all sorts of assistance regardless of your income. You will learn about supplemental security income. You’ll get a check from the Feds once a month that has to be used on baby things. Easy enough. And then for some reason you’ll get a little bonus check when your baby leaves the hospital. Sort of like the Feds just saying, “Hey, congratulations! And thanks for paying all your taxes all those years. This is how we roll. We actually do some good stuff with the money you give us. Here’s some back.” Then, if you’re lucky enough to live in Colorado, your little, teeny, tiny baby qualifies for at home physical therapy and occupational therapy visits. Three times a month, they come to you, assess your baby, tell you what the baby needs to do better, tell you where the baby might be a little ahead, and, this is all at no extra cost to you. This time it is like the state saying, “Thanks for paying your taxes. You struck gold with this little girl and now we are going to pay people to help you with her development.”

5. People give in emergencies. The more traumatic the experience, the more people you will hear from, the more flowers you will receive, the more food will show up at your doorstep, the more aid in your mailbox, the more touching notes you will receive from people you’ve met once or have never met before, the more baby clothes you will receive, and the more diaper cakes you’ll be gifted. People will feel for you. They’ll fork over some really excellent gifts and meals. Truly, what a steal.

6. Having a preemie could very well be cheaper than having a full-term baby. When you have a preemie, she needs a place to stay. These places are called neonatal intensive care units or NICUs. A night at our NICU costs as much as the Peninsula Suite at the Peninsula, Chicago, or almost $9,000 a night. Multiplied by 109. No one is going to stick you with that bill. Trust me. In fact, when your bill arrives you could end up paying less than 1% of your total stay. I mean, if you have very solid insurance, you might just pay .007% of your total hospital bill. Double-O-Seven.

7. After hours visiting at the hospital. You know, typically when you show up at our hospital after 8 you have to sign in and say who you are going to visit. They give you a sticker that you immediately throw in the trash. What a waste. It’s a real hassle. You don’t want to stop and talk with anyone, you’re going to see your baby for crying out loud. Worry not. You’ll live at the hospital. After you’re stopped once or twice, you’ll just look over at the security desk when you next enter the hospital after hours and you’ll get in with the head nod you always see guys giving each other.

8. You get to write about it and people will read. And maybe, after you’ve gone through all this and cried a thousand times for your child’s life and watched her vital signs plummet to numbers that you just associate with death, you’ll be able to find some humor in the whole experience and put a spin on it like I just did.

NICU Noises

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As we settled into the NICU routine we started to accustom ourselves to the environment there. The NICU is a far cry from a nursery (pun intended), but one thing we noticed right away were the noises. They came from everywhere. Every preemie is on a monitor and every monitor has the potential to make some very loud, annoying beeps. The NICU we were in can hold somewhere around 50 babies. Combined with the beeps from the monitors, the cries, the noises from the staff and the visiting families, there really is no quiet time in the NICU.

London’s monitor alone made four different noises. Right away, you learn to fear and hate the beep for a brady (short for bradycardia) when the baby’s heart slows and blood flow decreases, followed by dropping oxygenation levels. The noise itself leaves no room for peace. I suppose that is the goal. It gets everyone’s attention and makes you want to hit all the monitors in the place with a golf club. Good thing I am not a NICU nurse. It took a while to get used to the bradys. They sound like a horrible thing, and they can be, believe me, but bradys are quite common for preemies. London bradied quite a bit. Occasionally we had to rub her on the back a little bit to get her to snap out of it, but most of the time she climbed right back up into a normal range without any stimulation. There were days when London barely bradied at all, but then there were the horrible days where every baby in our corner of the NICU seemed to have made a pact to all brady at the same time or take turns. Like I said, a parent gets used to it, but you don’t quite realize how normal the bradys can become until you have visitors and your baby bradys while they are there. The visitors looked way more concerned than we did after a while, especially if they are in healthcare and are used to taking care of adults.

The noise for when the baby goes apneic, or stops breathing temporarily, is slightly different than the brady noise. Don’t worry though, when you hear it you will still want to jump out of your seat and break the monitor over your knee while simultaneously appreciating the notification that your daughter is not breathing. London did not have many apneic episodes and, when she did, they were mostly false alarms. The monitor would tell me London’s breathing at 2 breaths per minute, but her oxygenation was at 99. Note: just get clarification from your nurses about the quirkiness of the particular monitor your child is hooked up to.

_BKP2265The most common noise we heard from our monitor is for desaturation, aka desat, meaning there is a low blood oxygen concentration. London struggled with chronic lung disease throughout her NICU stay, so she desated a lot. Some days the alarm seemed like it was always on and the nurse would have to come into our pod every five to ten minutes to silence the alarm or tweak London’s ventilator settings. Not as alarming as the brady beep, but the desat beep had a way to bore itself into my brain. I would here it in a song on the drive back home from the NICU. I would hear it in my sleep. I would hear it come from the TV. It sends a strong message that your child is not oxygenating like she should be. It does not let you forget and it never leaves your head as long as you have a baby in the NICU.

The last noise is really the only happy noise your baby’s monitor makes. It’s a gentle beep that notifies those around your child that she is oxygenating very well, with levels around 98-100. If this is the case, then the oxygen can be titrated down to see if your baby continues to oxygenate well on a lower flow. For us, this noise was the rarest, but toward the end of London’s NICU stay we did start to hear it a little more often.

The main takeaway from this post: the NICU monitors are always making noise. Some are deeply alarming and others you shrug off after a few weeks. How do I know this? Because after a while the only alarm that could wake me up out of a little nap in London’s pod was the brady beep. In fact, the other noises can lull you into a little nap when you are stretched out in the recliner next to your baby’s pod. And then, BAM, a brady alarm makes sure you don’t get too comfortable.