Brad and Amanda Garrett Family

Alexis, Jackson, Matthew, Noah, Amanda and Brad

Week in Review

July16

As many of you requested updates on Baby Matthew, Amanda and I decided that it would be easier on both of us to update you (and you are many) through a website. Thus, we created this weblog to share his progress with you and to keep a journal of his development for ourselves.

My mom kept detailed notes of most everything that occurred over the past week. Using her notes, I will try to summarize the highlights of this past week, particularly as they relate to the baby’s delivery and developmental concerns and milestones.

Monday July 9, 2007

On Monday, ironically during our Family Home Evening lesson on Noah and The Flood, Amanda felt a small gush of fluid between her legs. At first she thought that it may have been a potty-training-type incident, common among pregnant women. However, Amanda and I quickly realized that the fluid was from her amniotic sac. We left a message for the on-call doctor and also began making arrangements for a sitter.

Realizing that Amanda was losing amniotic fluid was very difficult for Amanda and me. We were concerned that we either lost or were losing the baby. But, at 27 and 1/2 weeks I knew that the baby was old enough to survive and told Amanda not to give up. We were able to get a sitter for Ali and Jackson and then we rushed to the hospital.

The hospital admitted us at Labor and Delivery but we were unable to confirm a heartbeat for about an hour because of the admittance process. After hearing what seemed like a healthy, strong heartbeat through the monitor, our nurses arranged for a more detailed evaluation by ultrasound. Through it we learned Amanda retained a considerable amount of fluid, despite the rupture, and that the medical objective would be for Amanda to avoid labor for as long as possible. The baby also measured about a week larger than his gestation.

The ultrasound doctor (Dr. Albert) said the probability of survival for a 27 week old baby is approximately 90%. He also informed us the probability would increase to 95% by week 34 and that we should try to avoid labor for as long as possible. Notwithstanding the benefits of avoiding labor, the risks associated with certain preventative measures (e.g., magnesium) were too great so the doctor chose not administer them.

In order to help the baby’s premature body, particularly the lungs, Dr. Albert ordered steroids, noting that the medication would likely not have an effect unless we could avoid labor for at least 12 hours. He also ordered 2 types of antibiotics for Amanda and the baby to fight any infection in or presented to either of their systems. Finally, he ordered medication to help Amanda’s body to relax and avoid contractions (The nurse described the medication as having the same effect as a few margaritas. Amanda laughed at this comparison as she has never had a margarita and said it should work well as a result). The nurses measured Amanda at 3 cm and partially effaced.

Late Monday evening (around mid-night), the nurse administered Amanda’s medication. Amanda’s body quickly relaxed and the contractions stopped almost immediately. She slept for an hour or two before awaking from a pain associated with one of the IV antibiotics she received. Because the “margarita” medication was still in her system, she was very animated about the pain, commenting at one point that her arm was being “ripped open.” For the remainder of the night/morning the nurse and I watched her, helping her with her pillows, trips to the bathroom and the pain associated with the antibiotics.

Tuesday July 10, 2007

By 7:00 am Amanda and I were both awake. We learned Amanda’s doctor would arrive within the hour and that, based on the activity of the previous night, he believed she would deliver in 6-12 hours. At this point, I was able to give Amanda a priesthood blessing to help her and the baby through the coming day. I felt it was particularly important for Amanda to receive a blessing and appreciated the brief pause from the whirlwind of events that allowed her to receive it.

Dr. Herzog, Amanda’s OB/Gyn, arrived and checked her status. She measured 4cm and was approximately 50 percent effaced. Thinking delivery would not occur for a few hours, I hurried home to gather Amanda’s things and to check on the kids. After just an hour and one-half Amanda’s doctor called to tell me I should return as soon as possible. Again I sped to the hospital and arrived to find Amanda laboring and also learned the NICU team had been in the room, ready for the delivery. The doctor returned, checked Amanda and discovered the baby was face-up with his head back and mouth open. Dr. Herzog was uncomfortable with the idea of rotating the baby (as was I), and he ordered an immediate C-Section. Within seconds the room began to clear and I was told to wait for someone to return and bring me into the operating room. By myself, I had a chance to think about what had occurred over the past 15 hours. First, Amanda and I thought we may have lost the baby. We then learned the baby was ok but that we should try to prevent labor as long as possible. We took steps to prevent labor, but contractions continued regardless of our efforts so we tried to delivery the baby normally. When a regular delivery failed, we had no other option but to try to safely take the baby by C-section. It seemed like everything we tried failed.

After about 10 minutes, a nurse escorted me into the operating room where Doctors Herzog and Kaye were already operating on Amanda and 2-3 other doctors from the NICU were standing by to receive the baby. At 11:39 the baby was born and I was able to take just a few pictures before the NICU team took the baby to his pod (The NICU is configured to hold up to 52 babies and is divided into different “pods”, which each hold about 6 babies at a time). He weighed about 1200 grams (2 lbs, 10 ozs) and was about 13″ long.

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As we left the operating room a nurse said the NICU team would contact us with an update on the baby and to discuss what to expect over the next few days. Unfortunately we did not hear from the NICU for 3-4 hours, causing us to wonder whether everything was ok. We later called to request an update from the NICU and received a visit from Dr. Santiago, the NICU doctor. We learned his vitals (blood pressure, pulse, sugar, etc.) were healthy and that he would likely remain in the NICU until his due date (4 Oct). We also learned that they tried to replace the umbilical cord with a central IV line. However, his vessels were so small that the doctor could not correctly set the line.

Premature babies generally have problems breathing on their own due to underdeveloped lungs. As a result, most need breathing assistance, which may be provided through a few of the following methods. The ventilator is the most invasive/aggressive method. It assists breathing by pumping the lungs through a tube that runs from the ventilator directly into the lungs. If the baby does not require a ventilator but needs some assistance, he generally receives a Continuous Positive Airway Pressure (“CPAP”). The CPAP is a mask (similar looking to what a fighter pilot might wear) that provides supplemental oxygen and maintains constant pressure on the lungs to keep them inflated. Finally, if the baby does not require a CPAP but may need some assistance (or oxygen), then he generally receives a nasal canula, a tube that runs to a baby’s nose, supplying additional oxygen, when necessary.
Room air generally contains about 21% oxygen. Upon arrival to the NICU, the baby required about 29% oxygen from the ventilator. Shortly thereafter, the doctor reduced the ventilator oxygen to 26%.

Later that evening I, and then Amanda and her mother, had the opportunity to spend some time with the baby. I was shocked by his size and amazed at the technology that assisted him to survive. He had a respirator tube into his lungs, a feeding tube into his stomach, an IV line into his scalp and various sensors on his body that measured vital statistics such as respiratory rate, pulse, blood pressure, temperature and the quality and amount of oxygen he breathed. I was also so grateful for the technology that so closely monitored every minute change in his body.

I was surprised at the level of security in the NICU. Its doors are always locked and may only be opened by nurses at the NICU desk. Only relatives on the “family tree” and up to two guests (during visiting hours) are allowed at bedside (there can never be more than 4 people at bedside at any given time). No child under the age of 3 may enter the NICU, and all children over the age of 3 must provide proof of immunization before being cleared to enter. Thus, Ali and Jackson were not allowed to see the baby until the following morning when we provided their immunization records. Sunday is family day at the NICU and the entire family may visit the patient.

Additionally, all who enter the NICU must first thoroughly wash their hands with soap and water and then with antibacterial sanitizer. Because many of the babies in the NICU have underdeveloped immune systems, the introduction of even the most simple of bacteria can cause problems.

Wednesday July 11, 2007

Grandma Gant spent the night with Amanda, and I spent the night at home with Ali and Jackson. We returned around 10 am to discover Amanda showered, dressed and working on her hair and makeup. I quickly chided Amanda for not taking it easier and learned the epidural was still in her system, which explained her feeling of well being.

When we returned to the NICU we were overwhelmed to learn that the doctor took the baby off of the ventilator and transitioned him to the CPAP machine. We felt that it was such a tremendous blessing to know he progressed so much during the first day that he would be able to have the ventilator removed.

Just after learning of his progress, we received a visit from Travis and Janet Woods, neighbors and friends from church. During the previous afternoon and that morning I also thought about the baby’s need to receive a blessing and wanted to make sure he received one as soon as possible. Travis came at just the right time and we administered a blessing.

As the baby is expected to remain in the hospital for many weeks, a regular IV line would be impractical and difficult to re-insert into such small vessels on periodic basis. Thus, it is common for a baby expected to remain in the hospital for an extended period of time to receive a peripherally inserted central catheter (or “PIC line”). This line would replace the current IV in his scalp and would facilitate the administration of nourishment (proteins, and lipids), medication (antibiotics, caffeine), or other fluids (e.g., blood).

During the afternoon, doctors inserted a PIC line into his arm and successfully delivered the line to the vena cava, just outside the heart.

We also learned about the baby’s development in the NICU. The NICU teams keep all babies on a strict schedule, and we are only allowed to interact with the baby during “touch times.” Keeping the baby in an environment similar to the womb is critical for its development. In the womb, babies sleep deeply and, as a result, grow. If a premature baby is not sleeping, then he or she generally burns precious extra calories required for growth. Our baby’s touch times are at 3, 6, 9 and 12 am and pm.

Even at this age, certain sensory perception and development is very acute. For a 27-week old baby, the sense of smell and hearing is the most developed. As a result, we are not allowed to wear scented deodorant, cologne/perfume, or scented lotions. The nurses also requested that we speak softly while on the unit.

One of the greatest things Amanda can continue to do to nurture the baby outside of the womb is to have “Kangaroo time” with him. Just as a Kangaroo nestles its newborn closely in its pouch, a preemie mother can also spend close, quiet time with her baby. Each day Amanda will spend 2-3 hours with the baby on her chest. The skin-to-skin contact, mother’s scent and heartbeat are comforting to the baby and not only help him relax and sleep, but also it helps him to feel comfort and a bond that similarly exists between a breastfeeding mother and her baby. The nurses also feed during Kangaroo time so that the baby learns to associate mom with feeding. Dads may also kangaroo. I do not yet feel comfortable holding such a little baby, but I am excited about my kangaroo time with him. We also comfort the baby while we are away by leaving a small cuddle toy (actually a baby-shaped cloth) with the baby. Amanda wears it in her shirt while at the hospital and refreshes it during feedings. When we leave, the cloth goes back into the isolet (i.e., incubator) over the baby’s eyes.

On Wednesday evening we had visits from Bishop Johnson and some of Amanda’s friends. Then, after taking the kids to the house for bed and returning to the hospital, we finally, after 3 days, had time with each other to talk about a name. We decided on Matthew Dean Garrett. We both liked Matthew and the middle name, Dean, is a family name from both sides of our families. While looking up names on the internet, I noted the meaning of Matthew is “a gift from God.” We certainly feel that we received many gifts from Him over the past few days.

After deciding on the name, I went back to the NICU around midnight to spend some time with the baby. While I was there, the nurse told me that Matthew had some air in his stomach, which can be dangerous in certain circumstances. Matthew was on his tummy and the doctor and nurses hoped that the air could be pushed through the system rather than out into the body cavity through the stomach wall.

Things in the NICU were generally good, but for an episode of sleep apnea that he had. The episodes, when the baby gets into such a deep sleep that his heart and respiratory rates fall to an unhealthy level, quickly reminded me how delicate Matthew’s situation was (and continues to be). I left that night fairly unsettled and slept from about 1:30 to 4:30 am.

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Thursday July 12, 2007

I returned to the NICU early Thursday morning (5am) and the nurse informed me that she was no longer concerned about the air in Matthew’s stomach. Thus, they would continue feeding him the regular dosage (2 cc’s) of mothers milk. He also had a wet diaper.

The nurse spoke with us about a heart murmur that they detected through the stethoscope arising from the ductus arteriosis failing to close between the aorta and pulmonary arteries. While this is a common issue for premature babies, it should be closed as quickly possible to avoid putting an undue strain upon the heart and increase blood pressure in the lung arteries.
Matthew opened his eyes some, but he should not be able to see for about 5 more weeks.
Matthew also has some bruising and jaundice (like our other two kids), and as a result will receive treatment from a specialized light until his bilirubin counts improve. In order to protect the eyes from the bright bilirubin light, Matthew wears foam sunglasses. When he is relaxed on his back with arms and legs extended and wearing the sunglasses, Matthew looks like he is sunbathing.

Amanda’s milk is also beginning to come. This is a great blessing because, although Matthew could receive donor milk, it is generally not as effective as the mother’s milk because donor milk is pasteurized. We also learned that at 34 weeks the feeding tube will go through his nose (rather than through his mouth as it currently does) so that he can begin to learn how to suck, breathe and swallow. In its current state, the body is unable to process these various activities at the same time.

Amanda seemed to do better in the NICU than I did during the first couple of days. It was hard for me to be there watching him struggle, but the optimism of the doctor and nurses helped me to gradually feel better and better about his situation.

Jackson coughed during the night and I was unsure whether he had a cold or allergies. Thus, I only took Ali in to see the baby. Ali talks often about being a baby doctor, so it was fun for her to wash and wear a mask like a doctor. She was so happy to see Matthew. The nurse gave Ali one of Matthew’s diapers, which she promptly took home and put on her doll, Abby.

By Thursday the CPAP was also turned down to 21%, the equivalent of room air.

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Friday July 13, 2007

On Friday I felt like Jackson was not sick, but that he had allergies. So we decided to let Jackson meet the baby. Although rambunctious in the waiting area, he behaved so well in the NICU and was so sweet with his brother. He had a big smile when he saw the baby Kangarooing and immediately reached out and gently rubbed the baby’s back.

Before each feeding, a nurse empties the contents of Matthew’s stomach to measure any “residual” milk. Until Friday, the nurses generally have retrieved some residual milk (or amniotic fluid) from the stomach as they prime it for digestion. However, as of Friday Matthew generally had digested all of the contents of his stomach. The doctor increased his feedings to 3 cc’s.

Saturday July 14, 2007

Saturday morning the doctor said he was still concerned about Matthew’s heart murmur. He asked for our consent to give a blood transfusion to the baby, and we agreed. The doctor said that in order to help the open heart duct to close, there were a few things they would try. In addition to extra blood (which would take strain off of the heart), they would also give him some medication that would prevent the duct from trying to remain open and also reduce fluids. To offset the reduction of fluid intake, they turned up the incubator humidity to a balmy 77% . The nurses and doctors all laughed that the conditions in the incubator (humidity, temperature and bilirubin light) were just like Miami.

Matthew received 12 cc’s of blood from 3pm-6pm. When we returned at 6pm we noticed how much better the color in his skin was. He received the remaining 12 cc’s over the 3 hour period following the time we spent with him. The transfusion must occur very slowly to avoid potential issues with the digestive system that sometimes arises from a transfusion. I roughly estimated 24 cc’s of blood to be approximately 5 teaspoons.

Matthew also came off of the CPAP before we arrived on Saturday morning. It was not only nice to know he was capable of breathing entirely on his own, but also it was nice to see the uncomfortable plastic CPAP removed from his nose (which had become red and irritated).

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Sunday July 15, 2007

Amanda and I spent Sunday with Matthew while Ali and Jackson attended church with their grandmother. When we arrived at the hospital our nurse let us know that she did not detect a heart murmur. We were so relieved to hear this news and we were again grateful for the miracle of his development. We have been overwhelmed with support, love, well-wishes and prayers from many people at every step along the way. We can confirm that these prayers are heard and answered as we see such great progress in such a short period of time.

Matthew also continues to digest well and the nurse doubled his feedings to 6 cc’s.

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posted under Family
One Comment to

“Week in Review”

  1. On July 17th, 2007 at 5:52 pm Linsey Says:

    I am so happy you set this website up!!! I have been waiting on my Mom to forward updates on to me from your mom and was getting tired of waiting to hear! :)
    I have been thinking about you guys all week and how difficult it all would be. I admire your strength and faith. You two are so great. I love you guys and we will continue to send prayers your way!
    And, he is so beautiful. I see so much of Ali and Jackson!!!

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