Monday- Weight Issues

Now that Ryan has nearly fully recovered from his respiratory issues, what is holding us back from being discharged from the NICU is helping him to figure out eating and getting him on an uptrending pattern of weight gain. His nurse last night weighed him, and I asked her what the change in weight had been from the previous night. I was glad when she said that he had gained 2 ounces, even though I figured that a lot of that was due to the additional supplement of breastmilk that Ryan is receiving via his N-G tube with every feeding. I was surprised this morning though when the nurse practitioner came to examine him and said that she was very concerned about and needed to stop his continued weight loss and that he had lost 2 1/2 ounces since the previous day. I told her that I acknowledge that I am a bit sleep-deprived, but I distinctly remember his nurse telling me that he had gained 2 ounces. She said that was not what had been documented in his chart. So, I was confused and worried about if he really had lost that much in a day even with supplementation. During rounds (about an hour later), the discussion was primarily about substantially increasing the supplementation amounts for Ryan and possibly adding fortifiers too. That was really discouraging to me, because adding even more supplement meant that we were heading in the wrong direction as far as getting to the point where Ryan could just nurse normally. I brought up the weight discrepancy again during rounds, and I was glad that our day nurse was present as well because she vouched for what I had said about his weight. When his night nurse had transitioned Ryan's care to our day nurse, she had told our day nurse that Ryan had gained 2 ounces. Since there were two of us now claiming that the documented weight was inaccurate, they decided to weigh him again. Sure enough, he had gained 2 ounces! I'm glad that I said something again before his team of caregivers decided to take a more aggressive approach to supplementing him which (in my opinion) would have been detrimental to him ultimately learning to eat well on his own.

A lactation consultant had come to Ryan's room when I was first attempting to nurse him, and she had not been helpful at all. She said that my positioning of Ryan and his latch were correct and proceeded to get angry with Ryan for not sucking. She kept saying things like, "You have this all right, but he just won't suck" and "What's wrong with him? Come on, suck!" I couldn't believe that she was actually getting upset with a tiny newborn who had just been through several traumatic respiratory issues and was trying to nurse for the first time! I asked Ryan's nurse the next day to see if a different lactation consultant were available to come help, but unfortunately the same crazy lady who shouts at NICU newborns was on call. Thankfully today a lactation consultant who has much more experience with NICU babies was working, and she came to observe a feeding just after rounds were done. She was very encouraging and confirmed that his position and latch were correct, and he proceeded to eat well for about 10 minutes. The lactation consultant also provided me with some tips on keeping him awake as well as some general breastfeeding information. She was so pleased with this feeding that she talked with the neonatologist and convinced her not to supplement Ryan too aggressively. She's going to bring a very sensitive scale to a feeding tomorrow and do a pre- and post- feeding weight comparison for Ryan to get a better idea of how much milk he's taking in. Hopefully that will go well!

Last Friday the neonatologist said that Ryan was healthy enough for his circumcision to be scheduled, and a nurse had called our OB's office that day to let them know, but no one returned the call. I asked about it today since we're back into weekdays now, and the nurse told me that the OB was not going to schedule it until Ryan was closer to being released and that they'd probably do it the day before he was discharged. Since they won't schedule it yet, this made me wonder when on earth are we ever going to get out of here???