The $64,000 Question

Lily  11/2/08

Everyone keeps asking us, When is Lily coming home?  The short answer is: we have no idea.  The long answer is: when she meets all her criteria for being ready to go home.  The common misconception is that she has to reach a certain weight before being released,  but really, there are six main criteria Lily has to meet before she gets her hall pass:

1.  She has to be able to breathe on her own.  Done.  Since birth, Lily hasn't needed any oxygen or other breathing assistance.

2.  She has to be able to maintain her body temperature in an open crib.  Done.  Since 10/29 Lily has enjoyed freedom from the enclosure of her isolette, and has maintained her body temp the whole time.  

3.  She has to all take her feedings by bottle or breast for 24-48 hours.  This is her next big hurdle.  She's fed every three hours, and is currently taking bottle feedings three to four times a day.  When it's time for her to eat, we look at her for signs of being awake and alert, signs she is ready to suckle, and if she is we give her a bottle, or try to breast feed.  They also look at how long it takes her to take the whole bottle, as it shouldn't take more than 30 minutes.  The other day I was feeding her and she fell asleep about half way through with the bottle in her mouth.  Yesterday, Amanda was feeding her and she took a whole bottle in six minutes.  It's just a matter of maturity, and she is still considered just over 35 weeks gestational age, so she's doing great.

4.  Lily has a few wires attached to her at all times that measure her heart rate, her respiration, and her oxygen purity, and we can see all these on her monitor.  Whenever one of these goes out of range, the monitor beeps, and this is called a monitor event.  They are usually nothing to worry about, it's common for babies to stop breathing for a moment or two, and sometimes it can be caused by something as simple as a burp or a hiccup. In order to go home, though, Lily must go five days without any "significant" monitor events.

5.  Her final test is to be safe in a car seat or car bed (Yes, they make car beds for the little ones!).  When they think she's ready to go home, we'll have to bring in our seat or bed, with the base, and they'll put her in it for 90 minutes.  If she doesn't have any monitor events in the car seat, doesn't turn blue, and appears to be ok, she is ready.  Finally!

6.  I said there are six criteria, and she only has to meet five.  The last one is on us.  They won't let us take her home if they don't think we're ready to care for her.  That's why we've been doing most of her care here in the NICU.  We take her temperature, change her diapers, change her clothes, feed her, and wash her.  They'll send us home with nutritional information, a schedule of return appointments, and a litany of other helpful info, then it's Hello, Issaquah!  I hope she likes the rain.

As you know from reading Lily's Growth Chart, she has been gaining weight steadily.  The nutrition specialist was going over her grid with us today, and said in seven years of working with preemies, Lily is the first one she has ever seen meet all her growth goals from day one.  She is now "on the grid" at the 3rd percentile for her age.

Don't Forget To Breathe

Lily's Real Growth Grid

At birth she was below the 3rd percentile in weight