What Did Eliza Miss By Not Having a Third Trimester?

In a few recent discussions with other parents of preemies, the subject of what our babies missed by not having a third trimester, or even part of the second trimester, has come up. It makes for interesting reading.

Here are just a few highlights of the things our babies missed out on which I have gathered from a couple of different websites:

Week 26: Eyes remain closed. Although your baby's eyes are fully developed, they may not open for another two weeks.

Week 27: Second trimester ends. Your baby's lungs, liver and immune system are continuing to mature.

Week 28: Baby's eyes open. Your baby's eyes are beginning to open and close. The color has been established. Your baby is now sleeping for about 20 to 30 minutes at a time.

Week 29: Movement is more forceful. Your baby's bones are fully developed, but they're still soft and pliable. This week, your baby begins storing iron, calcium and phosphorus.

Week 30: Baby packs on pounds. Your baby weighs about 3 pounds and will gain about 1/2 pound a week until week 37. Your baby may practice breathing by moving his or her diaphragm in a repeating rhythm.

Week 31: Reproductive development continues. Your baby's lungs are more developed, but they're not fully mature. If your baby is born this week, he or she will probably need a ventilator to assist breathing. Complications such as bleeding in the brain are less likely than they were even a few weeks ago.

Week 32: Downy hair falls off. The layer of soft, downy hair that has covered your baby's skin for the past few months — known as lanugo — starts to fall off this week.

Week 33: Baby detects light. Your baby's pupils now constrict, dilate and detect light.

Week 34: Protective coating gets thicker. The pasty white coating that protects your baby's skin — called vernix — gets thicker this week.

Week 35: Rapid growth continues. Your baby continues to pack on the pounds and store fat all over his or her body.

Week 36: Baby can suck. Recent fat deposits have rounded out your baby's face, and your baby's powerful sucking muscles are ready for action. To prepare for birth, your baby may descend into the head-down position.

Week 37: Baby is full-term. As fat continues to accumulate, your baby's body will slowly become rounder.

Week 38: Organ function continues to improve. His or her brain and nervous system are working better every day. This developmental process will continue through childhood and adolescence.

Week 39: Placenta provides antibodies. Your baby has enough fat under the skin to maintain body temperature as long as there's a little help from you. The placenta continues to supply your baby with antibodies that will help fight infection the first six months after birth.

Not only did our children miss out on these crucial steps in development but their underdeveloped eyes were assaulted by too much light, their ears (which had no cartilage and were mere flaps of skin) were subjected to too much sound, their skin had no protective coating but instead was subjected to the pressure of the isolette, the touch of the sheets, blankets and tiny diapers, their imnmune systems which were so far from being formed were subjected to a thousand germs, despite everyone's best efforts to protect them, their nervous system was forced to endure the pain of PICC lines, umbilical lines, endotracheal tubes and feeding tubes and their bodies subjected to dozens of medications, all of which you as their mother were told to avoid during pregnancy.

I think that the next time someone suggests that preemies just need to put a little meat on their bones and get a little bigger, I'll just hand them this list rather than try to explain the effects of prematurity.

Hunger Strike Again

It seems Eliza is yet again on another hunger strike. No particular rhyme or reason for this. She is not sick, not teething, not constipated. None of the usual reasons for a decrease in her appetite. This all started earlier in the week, but really if I think about it, the weekend was not that good on the eating front so I should have known something was up. She is now down to an average of 600 calories a day instead of the recommended 1200 (1000 calories a day is "OK" but not optimal). Frankly Eliza's caloric intake would be a lot less if she wasn't on the 1.5 kcal formula and tolerating Benecalorie even in the little yogurt she has eaten because her volume of intake is abysmal. She is down to 8 to 12 ounces of formula and 2 ounces of yogurt for the entire day.

The decline in Eliza's behavior seems to be related to this hunger strike. Today at the sensory gym I almost just left with her since she could not focus on a single task for more than 30 to 60 seconds, was scratching the therapist, screaming, throwing things, throwing herself on the floor, etc. Just awful. Feeding therapy was primarily filled with her throwing food, plates and bowls, yet oddly at the end of her morning session she suddenly stuffed about 4 veggie stix in her mouth, which of course she spits out since she cannot chew or swallow them. Go figure. Her sleep has been a bit worse than usual, up every three hours instead of five hours. I figure another month of this and one of us is going to have a nervous breakdown.

This week was also Eliza's semi-annual EI reviews. Never a pleasant experience. Although I am painfully aware that Eliza is not eating or speaking anywhere on the level of a 19 month old (her adjusted age) or a 22 month old (her actual age), reading in black and white that she is her speech is on the level of a twelve month old and her feeding is even worse is just a bit disheartening.

On a positive note, she has perfected her ballerina twirl.

A Not So Pretty Week

I figure we were about due for a week from hell, things had been just a little too quiet lately. The beginning of the week started out quietly enough, then the nanny left at about 7 pm on Tuesday and by, oh say, 7:03 pm Eliza projectile vomited all over the living room (thankfully missing the area rug, but nicely filling in the little gaps in the floorboards). This continued non-stop (and I really do pretty well mean non-stop) for about four hours. My solution, since it is darn near impossible to clean the floor and hold Eliza at the same time, was to cover the entire exposed floor area with towels ... with every towel I own (the poor planning here revealed itself in the morning when it was time to shower for work). The towel method worked fairly well and by 1 am or so, having gotten about 4 ounces of pedialyte to stay in Eliza, she managed to pass out, so to speak, and slept until 4 am for a bottle. This being Manhattan, a washer/dryer is unheard of in an apartment so the laundry man got an extra good tip this week, bless his heart.

So after a night of non-stop vomiting, puking, refluxing, whatever you would like to call it, Eliza ate close to nothing for two days. Not a surprising development, pretty much her M.O. after a bad night like we had.

The hunger strike came to an end Friday, but Friday was not the happy day I was hoping for. Once again the nanny left at about 7 pm and at about 7:03 pm Eliza decided to climb on the chair, then on the table, then attempt to slide off the table, landing flat on her back with the table cracking her right across her forehead. Having had an average of three hours sleep at a stretch all week, I decided this was the time to become a blithering idiot.

So Eliza is screaming, bleeding a bit and has an egg on her forehead that would make Faberge himself proud and I can't figure out what to do. Then it dawns on me, call the NCCU! Now for those of you who think it is strange that I would call the NCCU 18 months after Eliza's discharge, I would point out that (a) Eliza's pedi works there (b) we visit them each month because the nurses like their Starbucks and cookies and (c) they really are the best folks going. Nurse Janice answers and after a tearful description of the incident and hearing Eliza screeching in the background, she suggests the ER. So I start to pack a bag, get my shoes, etc. while trying to hold Eliza. This is not working so I put Eliza in the living room and put a Backyardigans DVD on. I go to the bedroom to get my shoes and realize I no longer hear screaming from the living room. Of course I assume Eliza has keeled over from the blow to her head. But no! She is doing her ballerina twirl (with her arms in a nice third position for you ballet folks) to the theme song. So I say, huh, maybe I don't need to go to the ER? For good measure I call my sister-in-law (well former SIL, but who's counting) who is a pediatric ER nurse. She assures me that if Eliza can do her ballerina twirl then there is no closed head injury. To confirm this diagnosis I call the NCCU again and speak to Nurse Monica who confirms that ballerina twirling is in fact a known diagnostic test to rule out head injuries. The night ends with a much needed glass of wine for me and a bottle of Resource JFK for Eliza.

Saturday brings us to my parent's where I spend an inordinate amount of time explaining the Faberge egg on Eliza's head to my mother, who thankfully was not judgmental. We visited with my Dad who thought I was his sister June, but we a nice conversation about my husband "Bob" (June's husband) and my (their) farm. Dad is happy that all is well on the farm.

On Sunday I was inspired by my 20% off coupon for potty chairs to end this week from hell with the purchase of a potty chair for Eliza's future use. I mean really how hard can this potty training be? So I purchased not one, but three potty chairs. One for my mom's, one for the apartment and one for the house on Saba.

Eliza was very enthusiastic about the potty chair.

As you can see below Eliza is so very excited to be using her new potty chair ... as a giant cup from which to drink while in the tub. Oye. This week has got to be better.

A New Milestone ... 20 pounds!

Yesterday Eliza had a morning check up with her GI and an afternoon visit with her pediatrician. I think it is safe to say she was officially 20 pounds! At the GI she weighed 19 pounds 15.5 ounces (could they not have rounded up?) and at the pediatrician three hours later she weighed 20 pounds 2 ounces. I have decided to split the difference and call it 20 pounds. Also it's good to know their scales are pretty close. The GI was really please with Eliza's progress in the past month. Never in her life has she gained a pound in a month (a half pound used to thrill me) and I think we were both shocked to see that she had gained a bit over a pound and a half this past month.

It was also kind of nice to hear the GI say I was doing a good job. The past few weeks I have run across an inordinate number of people who have told me I should "get over it" or, my personal favorite, that I have a "chip on my shoulder" because Eliza was a micropreemie. Is it something in the air these days? I know a few other moms in the micropreemie boat who have had to tolerate such ridiculous comments by people who have no earthly idea what it is like to spend months on end in the NCCU while your child struggles just to survive or to raise a baby who requires substantially more care than the average infant or toddler.

When I embarked on this adventure of single motherhood, I somehow thought that other women who had chosen to be single mothers would be more supportive than my married friends and acquaintances. Interestingly this has not been the case. There is a handful of single moms I have met who are just wonderful. The larger group however has really acted as if extreme prematurity is somehow "catching" or that it should never be the topic of conversation since it not "relevant" to their discussions. I find this attitude quite interesting since the majority of the single women who have told me that I should "get over this" are well into their forties and planning their first or second babies. Given that demographic they are at a fairly high risk to end up in the preemie boat, which would be pretty ironic. So I have decided that I, and the little "chip" on my shoulder known as Eliza will pal around with our friends, mostly married and some single, who bring compassion, empathy and a bit of humor to the table and leave the judgmental, narrow minded and mean spirited folks to wallow in their own muck.

Old Year's Night

New Year's Eve, or Old Year's Night as it is called on Saba, was spent with some good friends nearby. Eliza got to wear her new party dress and try out her new rocker, which is now her seat of choice. She was quite the party girl, playing with the older girls and stayed up until we left a little after 10 p.m. Of course Eliza decided to end 2007 the way it started, by projectile vomiting all over herself, the car seat and pretty much the entire backseat of the car on the way home.

2007 was a mixed bag for Eliza Grace. Here is brief rundown of the ups and downs of 2007:

Motor Skills: Eliza Grace has progressed wonderfully with her physical skills, both her fine and gross motor functions. She can pick pocket a wallet from a purse and turn the pages of People magazine like a pro. She can climb over the old fashioned tension gates and can balance standing on her rocker while reaching for her toys (not something I encourage).

Occupational and Sensory Issues: Eliza's sensory issues are also improving, but slowly. Sounds that previously caused her to have a meltdown no longer do. She can now tolerate touching sand, rice and grainy textures with her hands, but cannot tolerate these textures on her feet. She is still averse to having her hands "dirty" with any type of sticky or wet textures (a/k/a food) but is slowly improving.

Feeding: Eliza's feeding has not improved and considering that she is a year older, her feeding has technically worsened. At Eliza's age her primary source of nutrition should be solids. Instead, Eliza's nutrition is 70% to 80% formula and 20% to 30% yogurt (not quite a "solid"). This is virtually unchanged since early 2007. Her repertoire of foods has not increased, and in fact has decreased since she no longer will eat any purees, whether store bought baby foods or home made. Other than a brief two week period in December when she tried nibbling on some crunchy foods and pizza, she once again only eats yogurt and only drinks her formula. I am thankful that with the calorie supplement and the high calorie formula I am usually able to get about 1000 calories in her a day. If I couldn't supplement her calories this way she would be at about 600 to 700 calories a day. Her weight is monitored monthly, or more frequently when there is a weight loss so we can determine if a g-tube would be necessary. Given Eliza's behavior toward anything "unusual" (nebulizer, aerochamber, cannula, IV, hell, even her diaper sometimes) the doctor and I do not believe that she would tolerate having a g-tube at this point, and that it may be more detrimental than helpful. She is too old not to notice it and too young to understand it. Of course if her development is at risk there would be no choice and we would figure out a way to cope with it.

Weight/Length: At the beginning of 2007 Eliza weighed almost 14 pounds and closed out 2007 at 18 pounds, or a gain of about 2000 grams, for our metric friends. She gained 3 inches in length. The weight gain over the course of a year is not particularly stellar (yes, yes I am well aware she was one pound four ounces and "has come a long way", so please don't repeat that mantra to me). Her growth in stature is again slowing down, likely due to the difficulty in maintaining her caloric intake at the desired level of 1200 calories.

Speech: Eliza's speech is improving. She has an eclectic selection of words such as Mama, Nana, Papa, turtle, fish, frog, Boz (Bosley our cat), K-D (my niece Katie), da (down or done, depending upon the sign she makes), arf (dog), moo (cow), baby (the name she calls herself in the mirror), night-night, bye-bye and hi-hi. The usual single syllable words all the baby books insist a toddler should say seem to elude us.

Sleep: Eliza still maintains her record at 14 nights of continuous sleep since coming home from the NCCU. Since she cannot take in sufficient calories throughout the day, she wakes up at least once, mostly twice, at night for a bottle. "Ferberizing" does not work since (a) if she doesn't get the one or two four ounce bottles in the night she will not have made the minimum caloric intake of 1000 for the 24 hour period (b) she is hungry (or at least as hungry as Eliza ever acts) and (c) if I let her "cry it out" she generally vomits on everything.

General Health: This past year Eliza's health was fairly poor in the first six months, with projectile vomiting 8 and 9 times a day for weeks on end, pneumonia, bronchiolitis on more than one occasion and a week long hospital stay with rota virus. The second half of 2007 was a bit better. The vomiting seems to be more controlled and episodes only occur 3 to 4 times a week. She has had a couple of chest colds which required only ER visits, mostly because of the dehydration that accompanies her inability to bottle feed when she is congested. She underwent an endoscopy with biopsies like a pro, and was back to her usual self within a couple of hours after being vented for the procedure.

Which brings us to 2008.

This coming March, Eliza, my mother and I will travel to Saba for a three week vacation. Since Saba is a five square mile island with limited resources, each of our vacations there seems to require the planning of the Normandy Invasion, so I have already started to ship boxes of Eliza's formula, calorie supplement and every conceivable medication she may need while there. Eliza will celebrate her second birthday on Saba with her very, very large extended family and her ever growing list of little cousins. Maybe she will eat some birthday cake, maybe she won't, but either way I am sure she will enjoy the sun and sea as she has in the past.

I hope that 2008 will be the year that Eliza decides food is not so bad. If it isn't, they'll be some disappointment, but it won't be the end of the world.