Oh, Maria.

This morning Maria is still at 2lb 15oz, but she did gain 10 grams over the last 24 hours. Dr. Balsan is not happy about her slow rate of growth, thus the reason her feedings are at 24 calories. Overnight she had some fairly large residuals from the caloric density of her feeds. However, Dr. Balsan does not want to reduce the calories...he wants her to grow.

This issue with her feedings is a classic example of the "wait and see" game we play daily in the NICU. Maria is on caffeine to help reduce her A's and B's (apnea and bradycardia). The caffeine cause a higher metabolic rate which makes calorie retention difficult. But in order for her to reduce her alarms from A's and B's, she needs to grow and mature, so in the meantime she needs the caffeine to help reduce the alarms til she can grow...see where I'm going with this???

Her 10am and 1pm feedings were good. She had no residuals then, so maybe she just takes a while to acclimate to the higher calories. I hope she is indeed tolerating it, because I feel like forcing calories is a bit like stuffing a pig.

On Thursday Maria will receive another brain ultrasound to check for bleeding and cycts. Her first scan was at 1 week old, and the results found none of either. Thursday is Maria's one month birthday (30 days). With all of her recent alarming, I get nervous about oxygen saturation, particularly in her brain, so we'll see how she does. Dr. Balsan did tell us about a recent study that showed that the single greatest factor in the development of a preemie was the educational level of the mother (or primary care giver). So my monthly student loan payments feel a bit less painful!

Maria's blood cell count this morning was 36.8 (much better than her pre-transfusion 25). She's dropped a bit from her 40.5 level post- transfusion, but Dr. Balsan will supplement with iron before he would transfuse her again.