1 Day Shy of 32 Weeks Gestational Age

Hi Everyone,

ATD has been one of the last babies seen on rounds lately which is a sign that he isn't as critical. This past week he has had more difficulty with breathing. Hearing the team talk specifically about his "lung disease" is quite hard to hear but there is a good chance he will grow out of it in a couple of years. They joked today that they rarely send kids to kindergarten with nasal CPAP. My response was: "at least we have a timeline."

He is still tolerating feeds very well so we are really thankful for that. His lung development and ability to grow new and healthy lung tissue is dependent on his nutrition. He now weighs 3 pounds, 10 ounces - up 5 ounces from birth. We've been able to hold him nearly every day and we have helped with baths. Here is a video from last night's bath:

One of his overnight nurses loves giving babies baths so she is the one who always gets a bath scheduled into his routine. She looks just like my good friend JT and she calls him "Mister" all the time (listen for it in the clip). She is one of our favorites.

He still has some bruising around his eyes. As JD said, he is preparing for football season.

Last Friday, KD came up to meet her brother. Here is some footage from that:

My cousin in Norway sent some statistics on the name Torbjorn that are really fun to read:

• It is an old name, over 1000 years, so in the Viking age. It is listed in the top 10 in old writings
• Tor was the Nordic God for thunder because he caused thunder with his hammer. Quite appropriate given that JD and I both have some loyalty to the NDSU Bison who's mascot is named "Thundar"
• Bjorn (actually Bjørn in Norway) means "Bear"
• The meaning is "the very strong one" or "the brave and strong one." As my cousin said, it suits our little fighter.
• In Norway today, 7360 males have Torbjorn as their first name but it is unknown how many have it as their middle name.

I will go back to work next week and work until ATD is ready to come home. I hope you all have a nice weekend and that you are enjoying the last few days of August.

A Lot of Progress in 10 Days of Life

ATD has been a busy little boy during his first 10 days of life and we are feeling incredibly thankful for how well he is doing. He is proving to be a strong and resilient little guy.

Here is an update on those issues we wrote about in the last post:

1) Premature lungs: We walked into ATD's room last Saturday afternoon to a team surrounding his isolette. We heard them say something about calling family members and then they turned around to see us walking in. It turned out to be really exciting news. They were taking out his ET tube and he was graduating to a nasal cannula CPAP device. We heard him cry for the 1st time since delivery. Since JD's research subjects are usually on CPAP, he was all over the terminology and talking business with the respiratory therapists in the room. The nasal prongs are very long; they are placed in the nostrils and then travel all the way down to the back of the throat. They had some difficulty getting them placed initially but after the 2nd try it worked. That felt like a huge milestone to us and he has done pretty well with breathing since then. One of the parameters they watch is something called the fraction of inspired oxygen (FiO2) which measures the percent of inhaled air that is oxygen. Room air is 21%. For the first few days after he was extubated, ATD would stay between 22 and 26% and we were all very pleased with that. On Tuesday morning when I got to his room, it was 43% so that was quite alarming. The nurse hadn't had him before so her response was that she didn't know what his baseline was. Because my emotions are hanging by a thread these days, I was immediately irrational and began to question her competence (in my head only, I promise I'm not that rude). The medical team came in to round on him and the attending physician used it as a teaching moment to explain that approximately 10-14 days after delivery, the honeymoon phase with the benefits of the steroids and surfactant begins to wear off and babies have to work a bit harder to breathe. At the same time this discussion was taking place, the nurse changed out his nasal prongs and the FiO2 was decreased all the way down to 23%, at which point the nurse instantly became my best friend. The fellow respectfully interrupted the attending physician, nodded to the screen and the differential diagnosis was that the cannula needed replacing (they are replaced 2-3 times a day). Today he is in the 30s again but at least this time I was prepared to see higher values knowing a bit more about the post-honeymoon phase. He will stay on the nasal CPAP until 32-34 weeks gestation, even if he does start consistently breathing fine on room air until then. The fellow described yesterday that there is no reason to pull it out and force his lungs to work any harder than they have to.

2) Infection: They are no longer monitoring ATD for infection so that is considered a stable issue. On Saturday night, the IV from his head was removed so with that gone and the ET tube out, we had a pretty good view of his little face. He lost 2 ounces from the removal of the tubing and the massive amounts of tape used to hold everything in place. The nurse even washed his hair a little on Saturday night which pleased JD immensely. He is closely monitoring to make sure that ATD's hair doesn't go past his ears. Clearly, ATD will have a hair cut before KD ever will.

3) Feeding: This is the area with the most change over the past week. They started by increasing the volume of breast milk received every 3 hours from 2mL, to 4mL, and now he receives 23mL. We are so pleased that he is tolerating these feedings since they say that is usually the rate limiting step to going home. Yesterday they started to fortify the milk to 22 kcal/mL (milk is 20kcal/mL) and today they will increase to 24 kcal/mL. The plan is to monitor to see if he tolerates the higher caloric density and if so, shut off the IV TPN and try to increase total volume to a goal of 28 mL. He is fed through an oral gastric (OG) tube which goes from his mouth to his stomach. It will be great to have the IV discontinued and the little PICC line removed from his arm. Then he will only be connected by the CPAP, OG tube, EKG electrodes, and pulse oximeter. Last night we were here when they weighed him and he was 1515 grams or 3 lbs, 5 ounces so he officially reached his birth weight in less than 2 weeks which is usually the average time frame. This may fluctuate again with the discontinuation of the TPN but we were still excited. He never lost 10% of his birth weight, I am so impressed with the plan they have had in place for him to keep him well nourished. Tonight he started to spit up a little with the feedings so that has us a little anxious. The nurse explained that the CPAP delivers extra air to the stomach and the OG tube prevents the esophageal sphincter from closing completely so it is very common for those babies to spit up occasionally. We will be watching that closely.

4) Temperature regulation: A significant part of the update on ATD's temp regulation is due to changes in #5. ATD was outfitted in his first onesie on Monday. Since the bili lights are off, he no longer has to have the majority of his skin showing so clothing is now an option. They have preemie clothes here that former NICU families have donated. He has been able to wear sleepers the past few days and he actually fills them out pretty well, especially length-wise. He is also able to be swaddled which helps with temperature regulation and gentle containment to keep those arms and legs from using up too much energy. He no longer has the temperature probe on him and they are slowly decreasing the temperature in his isolate.

ATD Fully Clothed

5) Bilirubin: On Monday the bili lights were removed from ATD's room and they are no longer monitoring his bilirubin as aggressively. It is checked every 3-4 days now. Apparently he is old enough to handle a little higher bilirubin level and since he is now filling his diaper with both #1 and #2's, that is helping his body clear the excess. His facial bruising is so much better now, all that remains are two small black eyes. I'm hoping those are the last black eyes he will ever have in his lifetime but perhaps that is a lofty goal considering he is a boy and has two clumsy parents.

6) Hemorrhage: During Tuesday morning rounds, they discussed the brain hemorrhage risk again and said that a head ultrasound had been ordered for that morning. They promised to give results as soon as possible but told me that I wouldn't hear anything until later in the day. About 5 minutes later, the resident came back to say they had already done the scan before any of them came in that morning and everything looked normal. That was awesome news. They may decide to check again in a month but the fellow explained to me yesterday that they don't routinely do a second one.

7) Personal Hygiene: Last night we were able to help give ATD his first sponge bath. His umbilical cord is still healing so a full bath won't be an option for another week or so. Either way, it was pretty special to be able to help with that and he tolerated it pretty well from a temperature and oxygen standpoint. From a general satisfaction standpoint, not so much. He cried and squirmed quite a bit but quickly found some comfort with a tiny pacifier that they encourage preemies to suck on to start to build some endurance for sucking and swallowing. We quickly learned why there are "positioning" instructions for boys in their diapers. Before the bath, the nurse helped us get some footprints made.

All Inked Up

Tiny Foot

8) Therapy for Parents: On Sunday, I was allowed to do kangaroo care with ATD and hold him for the first time. This was an incredibly special time for me. We are allowed to do that once a day except on bath days so to limit too much excitement. I will usually feed him during k-care which means I hold a syringe and push 1 mL of milk every minute until it is all gone (see picture below). Last night after his bath, the nurse wrapped him up like a burrito and I got to hold him like that and feed him. Today is a rest day and he has stayed in his isolette all day since his oxygen requirement has gone up slightly.

Syringe Feeding and Cuddle Time (Thanks for the

homemade blanket, ie-Chacho 2, ACL)

Yesterday when the fellow came to visit, I tried to probe for some reassurance that ATD is on the right track. As I alluded to in earlier post, I prefer to have a slightly inflated progress report. All she could offer as a reassurance is that "he is doing as well as we would expect." Hmmph. Then, last night, my OB was on call so she came up to check in and she knew my language. She said he looks like he is doing "really great" and that we should be really happy with his progress so far. In addition, the attending on call this week is the same attending who was in the room when he was born and she seemed quite confident in saying that he is doing "very well" and that he is "following the textbook" in terms of meeting milestones. She cautioned me not to expect progress every day, however. Either way, that was very encouraging to hear.

It has been really great to spend time with KD the past week since I've been home. She is so much fun right now and talking up a storm. Every time she wakes up from a nap or sleep, she takes roll call - "Mommy?, Daddy? Puppy?" as if she isn't quite sure who is actually in the house. On Sunday afternoon, the three of us went to the pool and she loved it. My mom left on Sunday also so we've been adjusting to having to remember to do things around the house like the laundry and general home maintenance.

Pool Time

We continue to feel so very fortunate for ATD's status. We still have a number of weeks before our family will be under one roof but we are fully aware that things could be so much worse than they are.

A Lot of Progress in 10 Days of Life

ATD has been a busy little boy during his first 10 days of life and we are feeling incredibly thankful for how well he is doing. He is proving to be a strong and resilient little guy.

Here is an update on those issues we wrote about in the last post:

1) Premature lungs: We walked into ATD's room last Saturday afternoon to a team surrounding his isolette. We heard them say something about calling family members and then they turned around to see us walking in. It turned out to be really exciting news. They were taking out his ET tube and he was graduating to a nasal cannula CPAP device. We heard him cry for the 1st time since delivery. Since JD's research subjects are usually on CPAP, he was all over the terminology and talking business with the respiratory therapists in the room. The nasal prongs are very long; they are placed in the nostrils and then travel all the way down to the back of the throat. They had some difficulty getting them placed initially but after the 2nd try it worked. That felt like a huge milestone to us and he has done pretty well with breathing since then. One of the parameters they watch is something called the fraction of inspired oxygen (FiO2) which measures the percent of inhaled air that is oxygen. Room air is 21%. For the first few days after he was extubated, ATD would stay between 22 and 26% and we were all very pleased with that. On Tuesday morning when I got to his room, it was 43% so that was quite alarming. The nurse hadn't had him before so her response was that she didn't know what his baseline was. Because my emotions are hanging by a thread these days, I was immediately irrational and began to question her competence (in my head only, I promise I'm not that rude). The medical team came in to round on him and the attending physician used it as a teaching moment to explain that approximately 10-14 days after delivery, the honeymoon phase with the benefits of the steroids and surfactant begins to wear off and babies have to work a bit harder to breathe. At the same time this discussion was taking place, the nurse changed out his nasal prongs and the FiO2 was decreased all the way down to 23%, at which point the nurse instantly became my best friend. The fellow respectfully interrupted the attending physician, nodded to the screen and the differential diagnosis was that the cannula needed replacing (they are replaced 2-3 times a day). Today he is in the 30s again but at least this time I was prepared to see higher values knowing a bit more about the post-honeymoon phase. He will stay on the nasal CPAP until 32-34 weeks gestation, even if he does start consistently breathing fine on room air until then. The fellow described yesterday that there is no reason to pull it out and force his lungs to work any harder than they have to.

2) Infection: They are no longer monitoring ATD for infection so that is considered a stable issue. On Saturday night, the IV from his head was removed so with that gone and the ET tube out, we had a pretty good view of his little face. He lost 2 ounces from the removal of the tubing and the massive amounts of tape used to hold everything in place. The nurse even washed his hair a little on Saturday night which pleased JD immensely. He is closely monitoring to make sure that ATD's hair doesn't go past his ears. Clearly, ATD will have a hair cut before KD ever will.

3) Feeding: This is the area with the most change over the past week. They started by increasing the volume of breast milk received every 3 hours from 2mL, to 4mL, and now he receives 23mL. We are so pleased that he is tolerating these feedings since they say that is usually the rate limiting step to going home. Yesterday they started to fortify the milk to 22 kcal/mL (milk is 20kcal/mL) and today they will increase to 24 kcal/mL. The plan is to monitor to see if he tolerates the higher caloric density and if so, shut off the IV TPN and try to increase total volume to a goal of 28 mL. He is fed through an oral gastric (OG) tube which goes from his mouth to his stomach. It will be great to have the IV discontinued and the little PICC line removed from his arm. Then he will only be connected by the CPAP, OG tube, EKG electrodes, and pulse oximeter. Last night we were here when they weighed him and he was 1515 grams or 3 lbs, 5 ounces so he officially reached his birth weight in less than 2 weeks which is usually the average time frame. This may fluctuate again with the discontinuation of the TPN but we were still excited. He never lost 10% of his birth weight, I am so impressed with the plan they have had in place for him to keep him well nourished. Tonight he started to spit up a little with the feedings so that has us a little anxious. The nurse explained that the CPAP delivers extra air to the stomach and the OG tube prevents the esophageal sphincter from closing completely so it is very common for those babies to spit up occasionally. We will be watching that closely.

4) Temperature regulation: A significant part of the update on ATD's temp regulation is due to changes in #5. ATD was outfitted in his first onesie on Monday. Since the bili lights are off, he no longer has to have the majority of his skin showing so clothing is now an option. They have preemie clothes here that former NICU families have donated. He has been able to wear sleepers the past few days and he actually fills them out pretty well, especially length-wise. He is also able to be swaddled which helps with temperature regulation and gentle containment to keep those arms and legs from using up too much energy. He no longer has the temperature probe on him and they are slowly decreasing the temperature in his isolate.

ATD Fully Clothed

5) Bilirubin: On Monday the bili lights were removed from ATD's room and they are no longer monitoring his bilirubin as aggressively. It is checked every 3-4 days now. Apparently he is old enough to handle a little higher bilirubin level and since he is now filling his diaper with both #1 and #2's, that is helping his body clear the excess. His facial bruising is so much better now, all that remains are two small black eyes. I'm hoping those are the last black eyes he will ever have in his lifetime but perhaps that is a lofty goal considering he is a boy and has two clumsy parents.

6) Hemorrhage: During Tuesday morning rounds, they discussed the brain hemorrhage risk again and said that a head ultrasound had been ordered for that morning. They promised to give results as soon as possible but told me that I wouldn't hear anything until later in the day. About 5 minutes later, the resident came back to say they had already done the scan before any of them came in that morning and everything looked normal. That was awesome news. They may decide to check again in a month but the fellow explained to me yesterday that they don't routinely do a second one.

7) Personal Hygiene: Last night we were able to help give ATD his first sponge bath. His umbilical cord is still healing so a full bath won't be an option for another week or so. Either way, it was pretty special to be able to help with that and he tolerated it pretty well from a temperature and oxygen standpoint. From a general satisfaction standpoint, not so much. He cried and squirmed quite a bit but quickly found some comfort with a tiny pacifier that they encourage preemies to suck on to start to build some endurance for sucking and swallowing. We quickly learned why there are "positioning" instructions for boys in their diapers. Before the bath, the nurse helped us get some footprints made.

All Inked Up

Tiny Foot

8) Therapy for Parents: On Sunday, I was allowed to do kangaroo care with ATD and hold him for the first time. This was an incredibly special time for me. We are allowed to do that once a day except on bath days so to limit too much excitement. I will usually feed him during k-care which means I hold a syringe and push 1 mL of milk every minute until it is all gone (see picture below). Last night after his bath, the nurse wrapped him up like a burrito and I got to hold him like that and feed him. Today is a rest day and he has stayed in his isolette all day since his oxygen requirement has gone up slightly.

Syringe Feeding and Cuddle Time (Thanks for the

homemade blanket, ie-Chacho 2, ACL)

Yesterday when the fellow came to visit, I tried to probe for some reassurance that ATD is on the right track. As I alluded to in earlier post, I prefer to have a slightly inflated progress report. All she could offer as a reassurance is that "he is doing as well as we would expect." Hmmph. Then, last night, my OB was on call so she came up to check in and she knew my language. She said he looks like he is doing "really great" and that we should be really happy with his progress so far. In addition, the attending on call this week is the same attending who was in the room when he was born and she seemed quite confident in saying that he is doing "very well" and that he is "following the textbook" in terms of meeting milestones. She cautioned me not to expect progress every day, however. Either way, that was very encouraging to hear.

It has been really great to spend time with KD the past week since I've been home. She is so much fun right now and talking up a storm. Every time she wakes up from a nap or sleep, she takes roll call - "Mommy?, Daddy? Puppy?" as if she isn't quite sure who is actually in the house. On Sunday afternoon, the three of us went to the pool and she loved it. My mom left on Sunday also so we've been adjusting to having to remember to do things around the house like the laundry and general home maintenance.

Pool Time

We continue to feel so very fortunate for ATD's status. We still have a number of weeks before our family will be under one roof but we are fully aware that things could be so much worse than they are.

New Baby, Same Mission

So much has happened in the past week, I will try to summarize without making this too long.

Saturday night, 8/6/11

- Contractions started out of the blue

- Betamethasone booster was given almost immediately

- IV was placed and magnesium sulfate infusion was started

- Transferred down to floor 5, the Labor & Delivery unit for continuous monitoring

Sunday, 8/7/11

- MgSO4 dose was increased from 2 grams/hour to 2.5 grams/hour because of increased contractions

- Stayed in Mag fog until 10 pm when it was discontinued and a second shot of betamethasone was given

- Contractions slowed down to every 8-10 minutes throughout the night

Monday, 8/8/11

- Considered stable and moved from Labor&Delivery back up to the regular floor to a single room that I hadn't stayed in before

- Mentally prepared for things to settle back into a routine

- 11:15 am, contractions started increasing in pain and frequency

- 1:00 pm, moved back to Labor&Delivery except onto the brand new remodeled floor 4 which had just opened at 8am that morning.

- First expected delivery in that room meant that our nurse had to go on a scavenger hunt for supplies

- Mid-afternoon, RH, our friend and duola arrived

- 5:30 pm, JD came from work

- 8:45 pm, parents from both sides came to give us best wishes

- 9:08 pm, ATD arrived after 4 pushes in a 10 minute period

For weeks, my OB was discussing the plan that was implemented on Saturday night. There is evidence that shows that giving another round of steroid shots might provide additional benefit for lung development, especially since it had been more than 5 weeks since the first round. The goal was to buy at least 24 hours by slowing down contractions with MgSO4 so that the steroids would have time to reach ATD. In addition, recent evidence has shown that giving at least 12 hours of MgSO4 for babies born before 32 weeks may provide neuroprotective benefits. We were very comfortable with this plan and just hoped that we would have enough time to carry it through. Aside from more time (i.e. weeks) in the womb, we felt comfort in everything we were able to do before ATD's arrival. My OB felt that if my body suddenly started contracting, there was a reason for it and we should let it happen instead of trying to buy another day or two with prolonged MgSO4. As we've mentioned in these posts, the biggest concern with ruptured membranes is exposing the baby to infection so if that was the case, buying more time would have been worse for ATD.

Another plan that had been decided on weeks ahead of time was based on an anesthesia consult for my little breathing problem (subglottic stenosis). They were very worked up about that and what plan should be in place in a worst case scenario, such as intubation. We were impressed with their thorough review but it was another choice that was taken away from us. They all felt very strongly that I should be given an epidural to reduce labored breathing and prevent any additional damage to the airway. One of the anesthesiologists has the same condition and she insisted on this plan as did my ENT surgeon. The epidural was placed after JD got there and it definitely helped with the speedy delivery - I can't take much credit for anything that happened that day.

Now for the much more interesting part...an update on ATD. Not only did he come out head first, he came out face first. His whole face was purple when he arrived which was quite shocking and a bit scary because the first thing you think is that he isn't getting enough oxygen. My dad said that he looked like one of those California Raisin toys which is a pretty accurate description. We felt quite a bit of reassurance because the neonatologist was joking around while they assessed him and she even brought him over for me to give him a kiss before taking him up to the NICU. I missed out on this part but JD was there watching them place an endotracheal (ET) tube, an IV in his head, and probes all to monitor temperature, his heart rhythm and rate, and his oxygenation. The neonatologist had the residents and fellow place bets on his size and they were all guessing in the 1200 grams (2 lbs, 10 ounces) range. They were all shocked when he was 1510 grams (3 lbs, 5 ounces). I guess one thing that might lessen the sting of me having such weak and unreliable membranes is that our babies tend to be on the bigger range. Medical staff have even referred to him as being huge.

A medical team rounds on ATD every morning and it is quite the scene. About 10 of them file into his room. There is an attending physician, a fellow, 2-3 residents, a medical student, a dietitian, a pharmacist, a respiratory therapist, some other tag alongs, and three computer stations. I appreciate listening to the rounds not only for a medical review of his overall condition but to hear the tone in their voices. We've found comfort in the lack of urgency or desperation in their discussions. Since then, they've been monitoring the following issues:

1) Premature lungs: Premature white boys tend to do the worst with breathing so we were prepared for that (they refer to them as wimpy white boys). Since then he has been diagnosed with respiratory distress syndrome (RDS) which is largely due to his inability to make enough surfactant. They gave him two rounds of extraneous surfactant and he responded well to that. They do a chest Xray every day to watch to see if his lungs become more dense in appearance rather than dusky. For a while this week they thought it might be possible that the dusky appearance was due to pneumonia but after presenting him as a case during their grand rounds on Thursday, all the neonatologists agreed that it was a case of RDS. We were quite pleased to have so many experts evaluating what is best for our son. His breathing is our biggest concern but during the evening rounds just now, they said the ET tube might be coming out in the near future. In fact, they said that if he happened to yank it out on his own that they would do a trial with the nasal cannula and not re-intubate him unless totally necessary.

2) Infection: Because he was exposed to ruptured membranes for so long, they started him on IV antibiotics for 48 hours until cultures come back. Fortunately all cultures have been negative and they discontinued the antibiotics. Exposing him to a low AFI has been a huge source of guilt for me and if he would have been infected because of me, that would have pushed me over the edge.

3) Feeding: Babies don't have the coordination to nurse until about 35 or 36 weeks gestational age so nursing is out of the question right now. Also, their guts aren't mature enough to digest food so ATD has received his nutrition from a TPN that optimizes his electrolytes, carbohydrates, fats, and protein. I always hated calculating TPN orders in pharmacy school but the pharmacist in the unit has years and years of experience with this and the whole medical team defers to her to get just the right mix for ATD. They placed a PICC line (peripherally inserted central catheter) so that the fluids can be delivered right into his superior vena cava and directly into his circulation rather than using the IV in his head which is in a smaller vein and may not have the capacitance to handle such high volumes of fluids. On Wednesday, they started to give him small amounts of breast milk (2 mL every 3 hours) and starting this evening, they will increase this to 8 mL and start to count that as his total fluid volume. The hospital provides a higher grade breast pump and supplies to all families in the NICU so we have a set of things here at the hospital and at home. The primary goal is for him to receive the good nutrition and antibodies that breast milk provides and a secondary goal is that nursing might still be an option when he matures a bit more. We are really encouraged that he is tolerating these feeds so far. They weigh him every night at midnight and so far he hasn't quite lost 10% of his birth weight which is usually the case with every baby. Last night he weighed 1395 grams (3 lbs, 1 ounce).

4) Temperature regulation: ATD is in an isolette so his temperature can be monitored and maintained. He can't wear any clothes so you can imagine they keep it pretty warm in there (it is set at 36.2 C / 97 F right now).

5) Bilirubin: There aren't specified normal bilirubin ranges for premature babies so they base decisions on rate of change from the baseline. ATD's bilirubin rose pretty quickly in the first two days after birth so they have him under a bili light therapy. This means he has to wear little goggles while the lights are on. Since he can't eat much milk, he doesn't have bowel movements and this is normally how bilirubin is cleared from the body. Also, the bruises on his face contributes to the high values as well. The bili light has been working and his levels have come down some.

6) Hemorrhage: Premature babies are also at a risk of a hemorrhage in their brains. I am too afraid to ask details about this since the attending said that there isn't anything they can do to prevent or treat it. They will do a brain scan early next week to determine if they see anything alarming.

So if you are wondering what specific things to pray about or send positive thoughts on, those are 6 things that are on our minds constantly these days. Now, here are some fun facts about our little boy:

1) He looks more and more like his daddy every day. Today, the position in which he is laying is exactly like his dad sleeps. One arm up and under the pillow.

2) His apgar score was 6 initially and then 8 at 5 minutes. KD was 7 and then 8 so very comparable.

3) Any concerns I had about him developing contraction due to low fluid volume are gone. He is completely stretched out and his arms and legs are moving all the time (almost too much that they try to strap him down and contain him).

4) The nurses say that he has a bit of a temper. He gets upset with cares (assessments and diaper changes every 3-4 hours).

5) He has a surprising amount of hair. We aren't sure what color it is since he hasn't had a bath but it looks darker than KD's did.

6) His middle name of Torbjorn is after very special family in Norway.

7) On rounds this morning, the team stated that probably the most important therapy decision they make is to have a bit more patience. Sounds like that is a prescription for this whole family.

I want to apologize if I haven't directly responded to your emails. I promise that I will. These past few weeks have been very difficult emotionally and keeping up with email was the first thing that dropped off the priority list. We so appreciate all your continued support. His physicians feel it is best to limit visitors at this time. ATD is basically completing the third trimester in that incubator and extra stimulation and exposure needs to be kept to a minimum. We will be excited to introduce ATD to the world in a few months.

Short Update

Aaron Torbjorn was born on 8/8/11 at 9:08 pm. He weighs 3 lbs, 5 ounces and is 15.5 inches long. Baby and Mom are doing well. More details to come.