Sunday, May 31, 2009

5 days

Sorry for the late entry; it was a busy day in the Sonnek household. Christie and I went to visit this afternoon, and were pleasantly surprised by a heart-warming gift from Chloe and Bryce! The nurses put together two cards, one pink and one blue, with pictures, handprints and footprints from each of the babes. We were touched by their thoughtfulness.

Not much change in the kiddos' health status since yesterday. Bryce looks almost the same. Chloe had some unexplained bleeding into her ventilator tube and some fluid accumulation in her lungs, but the nurses said they could no longer hear a heart murmur, so they are hoping that her ductus arteriosus has closed.

We also learned that tomorrow is the day we've both been dreading. The twins are each going to receive brain ultrasounds to determine if the trauma of birth caused any bleeding in the brain. Christie and I have been agonizing over this test since the day they were born; if you've read the 'Intro to Extremely Premature Babies', you know how important the results are in determining the eventual outcome. They're also going to receive another ultrasound of the heart, which we're hoping will show that both twins' hearts are in good shape. Of course, we already know they have hearts of gold, right??! ;) If you have any positive energy to share, please send it Chloe and Bryce's way tomorrow morning!

Saturday, May 30, 2009

4 days

Our pint-sized progeny are holding their own. Bryce is still trying to show-up his sister: he's off the tanning lights, and his vitals have been consistently good. Earlier today he was desperately trying to open his eyes, but the doctors said they'll remain sealed for at least another week. Chloe is our problem child; her blood glucose has been high, so they've been giving her insulin, and she's still on the UV lights. However, the doctors said that both babies are doing extremely well, and that they have no serious concerns. Go, twinkies! :)

In other news, we're at home! We bid farewell to Fairview Riverside early this afternoon. Logan was ecstatic: he was running around the room packing up Christie's belongings as quickly as he could. Christie is resting comfortably, but it will probably be several more days before she'll be moving around with ease. It was extremely hard to leave the twins behind, but we know they're being well cared for, and we'll be counting down the days 'til our family is whole again.

Update: If you're like me, you probably find yourself wondering what life would be like for a baby born at 24 weeks. I've added a little list in the corner, called "Life as a Micro-preemie". The top link is a document distributed at another top hospital which describes the medical realities for our children simply and honestly. The bottom four are our inspiration: blogs from families of other micro-preemies (whose size at birth was close to that of Bryce and Chloe) who have beaten the odds and grown-up to be beautiful children. :)

Friday, May 29, 2009

3 days

One of the nurses told us on the first day that a typical week in the life of a micro-preemie consists of 2 good days, and 5 bad days. I'm not sure that we'd classify today as a "bad day", but we weren't very thrilled with it either.

The good news is that the twins' vitals remain unchanged -- no backtracking, and no new crises. However, both babies were given an echocardiogram this morning to check for "patent ductus arteriosus" (PDA). All fetuses have a special artery (called the ductus arteriosus) that is used to redirect blood away from the lungs. When a baby is born, blood begins flowing through the lungs, and this artery closes on its own. PDA is a condition in which the artery does not close, and it is common in premature babies. As a consequence, when the twins were born, they were put on medication to encourage the artery to close. Unfortunately, the echocardiogram showed that the artery has not closed yet in either baby. Bryce has a "small opening"; Chloe's exam wasn't finished when we visited, but given that the doctors could hear a murmur, we suspect she has a larger opening. A large opening means to0 much blood goes to the lungs, which can cause many problems.

PDA is not unusual in extremely premature babies, but we would have preferred to hear that it had closed on its own, because it means the twins will have to be put on another medication for 3 days, which will postpone their introduction to "real food" (mama's milk). Nevertheless, we are very grateful that the twins have made it through three days in relatively good health, and we're anxiously anticipating the one-week milestone.

Thursday, May 28, 2009

2 days

Bryce and Chloe had another good day. Both babies are maintaining a healthy blood pressure without medication, and neither has had any serious problems. During morning rounds (big group meetings of the medical staff that we're allowed to sit in on), our neonatologist said that they were "textbook" 24-week preemies, and that in this case, "normal is good, because we know how to deal with normal."

Bryce was off the "vent" (ventilator) for close to 4 hours yesterday. I stood by his bedside for close to an hour and watched him breathe all by himself! Amazing to think that something the rest of us take for granted is a major accomplishment for my son. He started to get a little tired later in the day, so they put him back on the ventilator, and the doctor said that we'll try again when his lungs are a little more mature. However, the fact that a micro-preemie could breathe on his own showed that he had a lot of "spunk". :)

At this stage, the two biggest dangers facing the twins are infection and bleeding in the brain. Their 48-hour blood culture results came back today, and I'm happy to say that both Chloe and Bryce are infection free! Now we just have to work hard to keep it that way. As far as the bleeding is concerned, the babies are at highest risk during the first week, so they typically perform a brain scan after day 7. Intracranial bleeding is highly correlated with disability, so we'll be waiting with fingers crossed until next Tuesday.

And now, what you've all been waiting for: the first Sonnek Twin home movie! This is a one-minute clip of Chloe sleeping. It's hard to see her face because of the ventilator and the goggles over her eyes (to protect them from UV light they use to treat jaundice -- my daughter is 2 days old, and already tanning *sigh*), but she sure was active this morning. Enjoy! :)


video

Wednesday, May 27, 2009

1 day

Today, my chronicle of our pregnancy mishaps has drawn to a close. From this day forward "A Twin Story" will be just that -- the story of Bryce and Chloe's lives. It may be a short story, and it will certainly be a turbulent one, but we're holding out hope for an epic adventure with a fairy-tale ending. :)

Bryce and Chloe are almost one day old. As you can see from the pictures, they're currently supported by a daunting array of tubes and wires. Each baby has a ventilator, which enters through the mouth, to help them breathe. They also have a feeding tube in their mouths which will be used to supply them with Mom's milk as early as tomorrow! Several lines are attached through what used to be the umbilical cord (i.e., the belly button), one of which is currently providing the twins with IV nutrition. Finally, they have little sensors attached in various places which measure the babies' temperature, heart rate, blood pressure, and oxygen saturation.

The staff is constantly tweaking the amount of support the babies are provided with. The goal is to keep their vitals near healthy levels with the minimal amount of intervention necessary. Yesterday, both babies were receiving ventilator support, oxygen supplementation, and medication to maintain their blood pressure. They are also being kept under special lights to help with jaundice, which is common in premature babies due to their immature livers.

I'm happy to report that as of this morning, both babies are doing well. In fact, Bryce is doing exceptionally well. He is maintaining a healthy blood pressure without medication, is breathing room air, and they're going to try taking him off the ventilator later this morning! Instead, he'll just have the little nose tubes. Chloe is also doing well, but she has been struggling with low blood pressure and needs to remain on medication. This is very common in babies at this maturity level, and not a cause for immediate concern.

The doctors warned us, however, that the first 24 hours are commonly referred to as the "honeymoon period". The stress of delivery is actually beneficial for the babies, and when it wears off, they often exhibit more problems. The cliche "two steps forward, one step backward" is thrown around a lot in the NICU. We're encouraging Bryce and Chloe to really streeetch those little legs on the forward steps, and maybe slack off a bit on the others. :)

Tuesday, May 26, 2009

The Day (24 weeks)

I called Christie on my cell at 10AM this morning. I was just about to drop Logan off at daycare, and I needed to know what days he'd be attending next week. She was thrilled that we'd made it to the big 24, and said she was feeling great.

Five minutes later, I called her back to complain about daycare's billing practices. You can imagine my shock when Christie sobbed hysterically into the phone "You need to come now! The baby fell out!" and hung up on me (NB: the baby did NOT fall out). I tried calling back, but all the nurse would say is "you should come as quickly as you can."

So, I did just that. At 10:10, I was in northern Blaine. At 10:37, I was in scrubs outside the operating room. I'll spare you the details, but Christie had developed some rather serious complications, and they needed to deliver both babies by emergency C-section.

Bryce Thomas came into the world at 11:31. His sister Chloe Kathleen followed at 11:33. Both babies were stabilized in the operating room and did not need any resuscitation. Given their gestational age, everyone seemed very optimistic about the babies' conditions. Christie and I both got to say hello to our little miracles before they were whisked off to the NICU.

And so, the next chapter in our incredible journey begins. Each baby has its own team of doctors and nurses providing round-the-clock care. Once again, we have been very impressed with the quality of both the staff and the facilities. Our children are shockingly tiny: Bryce weighs 580 grams (1 lb, 4.5 oz) and Chloe weighs 555 grams (1 lb, 3.5 oz). I'll post some pictures later.

The doctors have warned us that the road ahead is long and fraught with peril; we still have no idea how this story will end. Chloe and Bryce will have to overcome countless challenges over the coming months, but they've cleared the first hurdle, and both are stable. In the best case, we'll bring home a healthy baby boy and girl in late-August or early-September.

Christie is doing great. We're both tired and frazzled, but very thankful that things worked out as well as they did. It is somewhat miraculous that we were able to hold out for two weeks, and we could not have asked for a better outcome under the circumstances. Thanks for all your support, and please keep Bryce and Chloe in your prayers.

UPDATE: Pictures!!

#1: The happy papa, after the delivery



#2: Bryce Thomas, age 1 hour (remember, the diaper is roughly the size of a playing card)



#3: Chloe Kathleen, age 1 hour (note how big the nurse's fingers look)



#4: Mama meeting Chloe for the first time

Monday, May 25, 2009

23 weeks, 6 days

If you're looking for drama, I'm afraid we're going to disappoint yet again. The twins had another ultrasound exam this morning, and they're both looking good.

I went on a tour of the NICU this afternoon, which was both scary and reassuring. They're currently caring for a few 24-week-old babies, and I was shocked by how tiny they are. Their diapers are about the size of a playing card, and the babies still had plenty of room to grow! The isolettes were an intimidating mass of monitors and wires, but it was somehow comforting to see the little gals (they were all girls) twitching in their sleep.

We're holding out for a few more weeks in the antepartum unit. :)

Sunday, May 24, 2009

23 weeks, 5 days

The battered and bruised glimmer of hope in our hearts is growing. If anything, I'd argue that Christie's symptoms have been diminishing. Enjoy your day -- you never know what tomorrow will bring. :)

Saturday, May 23, 2009

23 weeks, 4 days

Yesterday's most exciting event was either Baby A's hiccups or the hand massage Christie received from one of the hospital volunteers. Under the circumstances, boring is good. :) 24 weeks is just around the corner!

Update: I scanned the 4D-ultrasound pics of Baby A (the boy) and Baby B. The image on the ultrasound screen was much larger and in color; I'm not sure if anyone other than Christie and I will be able to make out their faces. The pic of Baby A is a sort of top-down profile, but if you look close you can see the right eye and nose. Baby B's pic is much better: you can see the right ear, right eye, nose and mouth.




Friday, May 22, 2009

23 weeks, 3 days

If you've been following along since day one, you may have noticed that we have a crisis roughly every fourth day. I'm pleased to report that the last 24 hours have been no exception to this rule. Things have been quiet, and we're hoping for a happy and peaceful Memorial Day weekend for everyone!

Thursday, May 21, 2009

23 weeks, 2 days

We had a scare last night. Christie had a monster contraction at around 8:30, which was accompanied by a minute amount of bleeding. Afterward, she started having regular contractions every 15-20 minutes. I rushed into the hospital in a panic, prepared for the worst, but neither the nurses nor the on-call resident were terribly concerned. After I'd talked Christie down, the contractions started to diminish in both strength and frequency, and she was asleep by 11:30.

The morning's news has been mixed. The bi-weekly ultrasound exam showed strong heartbeats and ample fluid levels for both babies. However, Christie has been having strong contractions about every 30 minutes this morning, and is struggling to remain positive. We're anxiously awaiting our morning visit from the doctor; I'll post an update later in the day.

Update: I harangued our medical team into giving Christie some medication to stop the contractions. The last few hours have been somewhat trying. Although I'm still convinced that we're in the best place possible for someone in this condition, our staff of perinatologists, residents, interns, and nurses has grown quite large, and everyone has a different opinion about what can and should be done. Even if the studies show it's typically ineffective, being on the medication eases Christie's mind (she's currently sleeping peacefully), so I think we made the right decision.

Wednesday, May 20, 2009

23 weeks, 1 day

Another day has come and gone, and I'm pleased to say our world looks about the same. No fever, no infection, and babies' vitals are strong. So strong, in fact, that I can now see little Baby A and Baby B taking out their aggression on Mommy's tummy! I can't imagine what it feels like to be kicked from the inside, but it is fun to watch. ;)

Several people have asked if they can send flowers or visit Christie. The doctors are currently discouraging visitors because of the danger of infection. If Christie's temperature exceeds 100.4 degrees, they will deliver the babies immediately, because they have no way of knowing if the fever is symptomatic of a cold or a more serious infection. Logan has been keeping in touch with Mama through Skype; if you have a computer with a video camera (most new laptops have them built in), Christie says she'd be happy to video chat. Flowers would definitely be greatly appreciated, although we might ask that you send them as a group or space them out in time; there's a limited amount of available surface area in the room. :)

Tuesday, May 19, 2009

23 weeks (!!)

Today is a very special day for us. From this day forward, if the twins are born prematurely, the NICU doctors will typically provide the babies with intensive care, as opposed to hospice care. I cannot express in words what a tremendous relief it is to know that whatever happens next, there is a chance that our future children will get to experience the joy of life. More importantly, that "chance" is increasing at a tremendous rate over the next two weeks. Every hour counts, and I'm happy to report that as of today, we have no reason to believe that delivery is imminent.

Monday, May 18, 2009

22 weeks, 6 days

Christie and I are feeling jubilant after a steep ascent on the emotional rollercoaster. The ultrasound tech came in this morning to check on the babies, and Baby A's fluid levels are the same as those of a normal baby! Also, Baby B's sac appears to be intact. The tech printed out a 3D-ultrasound picture of each baby's face, and Christie has been gushing about how cute they are all morning. ;)

Babies and mama are healthy; one more day and we cross over that magic "viability" threshold. Thanks for all your thoughts and prayers.

Update: The doctor stopped by later this morning to say that he was (pleasantly) surprised by the results of the ultrasound exam. He explained that it was possible that either Baby A's sac has a very slow leak, or even that it hasn't ruptured at all! It's hard not to get your hopes up with news like this! :)

Sunday, May 17, 2009

22 weeks, 5 days

No news is good news, and so far nothing has changed. Mama and babies are healthy.

Saturday, May 16, 2009

22 weeks, 4 days

Disclaimer: There is a very real possibility that this is going to become a heartbreaking story.

Baby A's amniotic sac ruptured at about 9AM this morning. Christie is not in labor yet, so there is still a chance that we can stretch this out for a week or two, but the risks are much greater now. Christie and I are both struggling to cope with this turn of events.

The doctor says it is possible for Christie to continue on as is. The body is constantly producing more fluids, so the fact that she is slowly losing it does not necessarily mean all hope is lost for Baby A. However, the fluid is especially critical for lung development at this stage. Even if Christie does manage to stave off labor and infection for a few weeks, it is uncertain whether the baby can thrive in this environment.

The "good" news is that it is quite likely that Baby B's sac is still intact. If Christie does go into labor, they will try to deliver the first baby, while preventing the delivery of the second. The doctor said that this scenario is not uncommon, and that women can often carry the second baby for several more weeks. Christie's nurse was especially reassuring; she said it is "very rare" for them to lose both twins.

However, in her current state, Christie is at significant risk of infection, which could be life threatening. If Christie develops a fever, the doctors will induce labor and deliver both babies, no matter what. As a precaution, we need to avoid anyone who's sick, so I'm afraid we'll be limiting visitors.

Hopefully I won't have any more news to share until Monday, when they'll do another ultrasound to confirm the current state of things. We'll be here, desperately wishing the hands on the clock would move a little faster. Keep praying for the twins.

Friday, May 15, 2009

22 weeks, 3 days

Today was a milestone for us. Dr. Y ordered another ultrasound examination this morning, and nothing has changed since Tuesday (yay!). The babies are healthy and kicking, and things are holding steady.

It has been 72 hours since Christie was admitted to the hospital. Since she has not gone in to labor yet, it is much less likely that her current condition is going to precipitate it. Dr. Y seemed quite optimistic that we could maintain the status quo for the next few weeks. Christie and I were elated.

Thursday, May 14, 2009

22 weeks, 2 days

Some good news today. Christie has had so few contractions since she arrived that Dr. Y has decided to remove some of the monitors. Also, they're allowing her to get out of bed a few times per day to use the bathroom. Christie was thrilled. :)

Wednesday, May 13, 2009

22 weeks, 1 day

After a sleepless night spent scouring the Internet to learn everything I could about Christie's condition (I recommend against this, btw), we were greeted by Dr. Y and team for our 8 AM ultrasound. Once again, the babies were doing wonderfully. Unfortunately, Dr. Y confirmed what Christie's doctor had seen in her exam: Christie's cervix is dilated 2cm, she is 100% effaced, and Baby-A's membranes (the amniotic sac) are protruding about 1cm outside the womb. For those of you unfamiliar with the terminology, this basically means that while the chickens have made no attempt to escape the coop yet, someone has left the door wide open.

At this point, we had two less than ideal options. Option 1 was to use a stitch (called a "cerclage") to close things up. While this is often quite successful in singleton pregnancies, recent studies have shown that it causes preterm labor more often than it prevents it in multiples pregnancies. Dr. Y said that she would perform the procedure if we wanted it, but that she wasn't recommending it. I've read the medical studies myself, and Christie and I both agree that the risks are too high.

So, we arrive at Option 2: more waiting. Basically, the plan is to keep Christie on strict hospital bedrest and do everything possible to prevent things from progressing any further. She is on several medications designed to keep her body as relaxed as possible, and they have been closely monitoring her for labor symptoms (contractions).

When asked how long she could hold out like this, Dr. Y said "hours, days, weeks, ... maybe months". She also warned us that if the babies were born at 22 weeks, they would be too young to survive, and that they would not try to save them. Needless to say, it was a very emotional morning for us.

On Wednesday afternoon, one of the NICU (Neonatal Intensive Care Unit) doctors came down to talk to us about the birth and life of premature babies. Once again, we were thoroughly impressed, and we both felt much more optimistic after he left. He told us that "if Christie was in labor today, the outlook would be dismal. Survival rates are less than 10%, and disability rates are over 90%." However, he also emphasized the fact that this is not the situtation we're in, and that "every day, every hour, every minute" at this stage is very important. At 23 weeks, they will try to save the babies; at this age, survival rates are only ~25%, but they're increasing by 3-4% per day! At 24 weeks, survival rates are 50-60%, and at 25 weeks, 80-85%. Furthermore, disability rates decrease at roughly the same rate, so by 25 weeks, about 65% of babies grow up to be healthy and disability-free. By 27-28 weeks, premature babies are nearly as healthy as full-term babies. Based on this advice, Christie and I have decided to do everything we can to fight to save the twins.

So, we wait, we hope, we pray, and we count down the seconds until next Tuesday.

Tuesday, May 12 (22 weeks)

I went with Christie to her regular 22-week checkup last Tuesday. Other than some back pain when she walked for long distances, Christie was feeling better than she had at any time during the pregnancy. We even went a little early to do a tour of the birthing center. Neither of us had any clue that Christie would be admitted to that very same place in less than an hour.

Christie's doctor performed the regular ultrasound exam, and both the babies were healthy and merrily kicking each other. Though it is unusual to do so at 22 weeks, Christie's doctor decided to check her cervix as well. The next few minutes were a blur of tears and activity. The doctor said that Christie had developed serious complications, and that her care would be immediately transferred to a specialist in Minneapolis.

Christie was rushed to the University of Minnesota Medical Center Children's Hospital (a.k.a. Fairview Riverside) by ambulance (with lights and sirens!). I followed behind in our vehicle, and narrowly avoided at least three accidents. After madly dashing through a maze of corridors, I burst into Christie's room and..... the waiting began.

We met Christie's new perinatologist, Dr. Y, a couple hours later. She was accompanied by an entourage of residents and interns, and we were both impressed. She exudes confidence and competence, and so far we couldn't be happier with our care. Dr. Y ordered Christie on strict hospital bed rest, and said that she would wait until Wednesday morning to examine Christie to avoid exacerbating any irritation caused by Tuesday's exam.