Wednesday, July 16th - A Day of Many 1sts!

When we arrived this morning around 11:00 am we went straight to Kinley's crib to say hi, but she was not there. It took us a second to realize that she was in a bouncer seat! This is the first time Kinley has ever been out of her crib without being held by someone. Ashley, Kinly's nurse today, told us that the OT (occupational therapist) stopped by to see Kinley this morning and said it would be good to get Kinley out of bed and into a chair so that she could work on head control. Ashley also told us that the OT planned to come back a little later to work with Kinley while we were here so we can learn some exercises to do with Kinley on our own.

Ashley also got us caught up on the events we missed from last night and earlier this morning. She told us that Kinley had not pooped or thrown up since yesterday and that we haven't missed rounds yet. Delores, Kinley's neonatal nurse practitioner, did stop by to briefly see Kinley and she wrote a few orders while she was there. Delores increased Kinley's feedings to 15 cc/hr and decreased the amount of nutrition that Kinley is getting through her IVs. Now Kinley is getting more nutrition from her feedings than through her IV, so that is pretty good.

With Kinley's methadone and ativan doses being moved back to every 6 hours last night we were hoping that her withdrawal symptoms would reside. Kinley threw up again, for the second time in 24 hours, around 11:30 am while she was still in her bouncer. Ashley is guessing that it was about 10 ccs again (the same amount as last night). Ashley moves Kinley back into her bed where she is able to get Kinley out of her dirty outfit and, unfortunately for Kinley, she also has to remove her NG tube. After Ashley gives Kinley a quick diaper change (no poop) and gets her cleaned up she heads over to take care of the other baby she is responsible for today. Ashley returns almost immediately when Kinley emits a very loud noise from her crib that sounds like she is throwing up again. We are all happy to find that she has not thrown up, but she does have diarrhea. Kinley had exploded in her diaper. This is another sign of going through withdrawals. Poor Kinley, for having diarrhea and vomiting. And poor Ashley, for having to clean up after Kinley. After Ashley has changed Kinley's diaper, put her in a new outfit and given her a new NG tube she calls Delores (nurse practitioner)and gives her the update. Delores wants to keep everything the same until they can come by during rounds.

Nancy, the occupational therapist, returns around 1:00 pm to help work on Kinley's head control, examine her muscle tone and work on some oral stimulation to try and get her ready to take a bottle. The muscle tone in Kinley's legs is very good, but her arms appear to be a little lacking. They are not horrible, simply not as well toned as her legs. She will just have to work on getting her arms into better shape. One sure fire way to do that, and more importantly to build muscle control in Kinley's neck, is "tummy time." Today was Kinley's first time to lay completely on her belly. Laying on her belly forces her to work on lifting and turning her head. It will also encourage her to use her arms to push herself up. Nancy is very pleased with the amount of head movement Kinley can do on her own. Now it is time to move on to oral stimulation. Kathy and I know that Kinley loves her binky (pacifier), but she needs to show Nancy in order to move towards having a bottle. Nancy gives Kinley her binky and once again, she is very pleased with what she sees. Nancy will plan to come back later today or tomorrow and have Kinley try her first bottle feed.

Lucky us! It is 3:00 pm and Nancy is back to attempt giving Kinley her first bottle feeding ever. Before starting, Nancy lays Kinley on her side because it will help Kinley be more comfortable with swallowing. Laying on her side will let the milk pool in her cheek and allow her to swallow when she is comfortable. That way the milk does not go straight from the bottle nipple to her throat and possibly cause her to choke. Nancy's goal is to get Kinley to take 5 to 8 ccs from the bottle. It is not a fast feeding because Nancy wants to make sure that Kinley does not choke on or aspirate her milk. Aspirating is when a liquid is inhaled into the lungs. Kinley is a good girl and ends up taking all 8 ccs without any issues. Nancy will return tomorrow to attempt a second bottle feeding.