32 Weeks Gestation

The triplets are 32 weeks gestation today or almost 7 weeks old. 32 weeks is the average gestational age that triplets are born at, so this is around the time when we were actually expecting our triplets to be born. Obviously, God had other plans for our little ones.

Since our last blog, we have been unable to visit or even see our triplets in the NICU. This is because on Wednesday morning, Jodi came down with the flu and is still fighting it. Nathan was staying out of the NICU as well to be safe, and he recently came down with the flu as well. Once we are symptom-free, we will still have to wait a full 48 hours to be able to go into the NICU. It is so difficult to not be able to see our little miracles. Every day that passes makes us more anxious and frustrated and upset... especially since Nathan has some time off of work for the holidays. We miss our babies so badly! However, we know that it would be very serious if one of our triplets were to get the flu, and so we take comfort knowing that we are still being "good parents" by staying away. We have been calling the NICU often to get updates on our babies and some nurses have been sending us pictures as well.

Liam:
In our last blog about a week ago, Liam was just getting over an infection and the doctors were watching him so that once he was well enough he could go for heart surgery. Liam was kept on an antibiotic to fight a potential yeast infection since his tests for an infection had all come back negative. He had been doing much better except for some mucous in his stools. A sample was sent off for testing a few days ago and a few tests still need to come back. However, the test for the flu came back negative, for which we are very thankful.
Since Liam had this one symptom, the doctors were holding off with talk of surgery until they knew he was not sick. Just this morning, however, Liam's standard blood work came back with infection markers yet again. Once again, all of the tests are being sent off to try to determine the type of infection he has. The nurses have been speculating that this infection is not new but something that he has been fighting for awhile. This is because Liam has been on weeks and weeks of antibiotics and just keeps getting sick. We hope and pray that the source can be determined and our little man can be fully healed and well enough for surgery. When Liam gets sick, he needs more breathing support and the impact of the open duct (PDA) is very evident. Today, the nurses noticed that his lungs are very wet (one of the effects of the open PDA), and that Liam is retaining a lot of water. They have given him lasix to help him get rid of some of the excess fluid. The boys have been on lasix more than once in the past already, so this is not very new. Liam also received yet another blood transfusion this morning.
Today was also the day that our triplets were signed up for eye exams. When babies are born very early as ours were, the risk of eye complications is high. The exams today gave the eye doctors a baseline from which they will continue to monitor every week or so for the next few months. We are told that eye disease usually manifests around the weeks 34-36 and especially in babies who have been on higher amounts of oxygen support. This means our boys are at higher risk than Taylor, who has been on much lower breathing support than her brothers.

Taylor:
Last Wednesday, the healthcare team tried to extubate our little girl and get her back on CPAP. This was unsuccessful since Taylor did not tolerate it well and still needed the extra support. She also had some swelling in her throat and vocal chords from the tube. The team put her tube back in and gave her a few days to rest and recover. On Friday, they tried again since Taylor's breathing settings and oxygen requirements were very low (which is a good thing). This time, they gave her steroids to help with the settings. Taylor tolerated this very well and remains on CPAP again. As of today, she is doing very well. She is not having any bradychardias or spells where she forgets to breathe. Most of the time, she is able to breathe room air at 21% oxygen, without needing extra oxygen. This doesn't mean that the CPAP machine is not supporting her, since she is still receiving pressures and volumes to help inflate her lungs and given a set number of breaths. Last week, Taylor's echocardiogram showed that her PDA has closed significantly. While the PDA was not impacting Taylor a lot, it still needed to be closed eventually and so we are very happy with this bit of news!
As for her sickness, Taylor seems to be over whatever type of infection or sickness that she had. She is still not at 3 pounds, but is slowly but surely continuing to grow.

Malachi:
Last week, Malachi had vomited a few times and been tested for an infection. Since then, he has been doing well and has not had any more vomiting or symptoms. Today, he came off of his general antibiotics and so had his IV taken out. Because he was a bit sick, he had been taken off of his food but this has been slowly increased again. Malachi is not having full feeds still, however, because his sodium levels have been too low. Thus, he has been kept on a lower amount of breast milk so that his sodium levels can catch up (with the help of supplements).
In terms of breathing support, Malachi has remained at roughly the same amounts of support, which is relatively high. He needs to keep growing and getting stronger, which he has been doing quite well at. Yesterday, the nurse weighed him to be 1500 grams, which is well over 3 pounds! Another great bit of news came from Malachi's echocardiogram last week which showed that his PDA has also closed significantly. This takes heart surgery off the table for Malachi. This is very good news, yet the PDA does have the potential to open again for Taylor or Malachi in the future if they were to get a significant infection or sickness.

Although we have been mostly sick during the holiday season, we have been witnessing some of the generosity of the people at McMaster Hospital and at the Ronald McDonald House. There have been so many people donating so much to make the holidays enjoyable for sick children and their families. Between the food, well-wishes, events, and presents, we have been feeling quite blessed. We are also so thankful for the NICU team who has been very understanding and helpful to us while we are unable to be with our babies. We desperately hope and pray that now that we have had colds and the flu that we will be healthy and sick-free for a long time in order to care for our little miracles!

42 Days

We had a very hectic weekend here at the NICU, but things have been starting to settle down for a bit. 

Liam Josiah:

Since last Wednesday night (when our little sweetheart became very sick), Liam has been responding well to his antibiotics. The doctors told us that they had been very worried about him, and it really sunk in emotionally a few days later- especially when the other two triplets started having issues as well. The blood cultures never showed what the infection exactly was so Liam was prescribed a week of general antibiotics which seemed to have done the trick. The reason why the blood cultures and tests were inconclusive may have been because he was already on a different type of antibiotic for his last infection and meningitis. We were very thankful that his lumbar puncture came back negative. On Sunday night, Liam needed a blood transfusion to bring up his hemoglobin and we again noticed an improvement in his physical appearance.

As for the PDA heart surgery, Liam needs to be entirely infection free and well again before a date will be scheduled. We continue to wait in the next few days to see when the doctors deem him well enough for surgery. 

Looking at our little man, we can see huge improvements from Wednesday and Thursday especially. He opens his eyes more and moves around more. We are also very excited that our oldest and biggest triplet is now 3 whole pounds! 

Taylor Joy:

Our baby girl has been having a great last few weeks and we almost started getting too used to it. On Sunday evening, she started acting a bit unlike herself and having a lot of dips on heart rate and oxygen saturations. Some blood work and preliminary test results indicated she might have had an infection and so she was started on general antibiotics. At 2 in the morning, we received a phone call that they were taking Taylor off her CPAP and inserting a breathing tube to better support her breathing needs. On Monday, we received a phone call for consent to do a lumbar puncture as well. Similar to her brother Liam, Taylor's blood cultures did not show what kind of infection it was. However, x-rays of her lungs and stomach seem to show an infection in the intestines or bowels around her stomach. As a result, her belly was really round and not allowing her lungs to expand adequately. In addition to this infection, Taylor was having a lot of nose secretions that might be indicative of a small cold. Nose and lung secretions are normal for babies who have a breathing tube in because the body is trying to fight the foreign object in its nose, throat, and lungs. However, the colour of Taylor's secretions might indicate she is a sick and unable to get enough air in through the CPAP. As of Tuesday evening, Taylor is still considered sick but is doing much better. She is way more active and spunky. She has started getting small amounts of breast milk again and this will slowly go up to full feeds over the next number of hours. The healthcare team believes that she will be ready to be extubated tomorrow or the day after, if she continues to do well! 

While CPAP is way better for the babies, we have really enjoyed seeing Taylor's sweet little face and head these past few days. It was a really strange feeling seeing her face without the CPAP hat and mask for the first time in weeks. It hardly even felt like it was our baby girl! Being able to see her face has rekindled all sorts of paternal and maternal feelings in us, and we are falling in love with her all over again!

Malachi John:

Our youngest little man has also had a busy weekend. On Sunday afternoon, Jodi was holding Malachi while Nathan was sitting beside the chair when we heard Malachi's voice make some little noises for the first time. In any other situation we would have been overjoyed to finally hear his little voice, but since he is intubated we knew it was not a good thing. The respiratory therapists immediately took him back into his incubator and assessed him to figure out what was going on. It turns out that Malachi has a small leak around his breathing tube in his throat. In certain positions, some air can leak out and cause him to lose the pressures the machine is giving him. It also allows some space between his vocal chords so they can vibrate and make noise. The next size breathing tube is too big for him, so the healthcare team has to be careful with how they position him. 

As if that wasn't enough excitement for one day, Malachi started vomiting three or four times on Sunday evening and through to Monday. He was tested for an infection and again nothing yet has showed up in the blood work. He hasn't been vomiting any more, but he also hasn't been having very much milk. An IV was started on Monday when they stopped feeding him entirely. On Monday evening they started him on 4 mL of milk and on Tuesday 5mL. A full feed for Malachi is arojnd 16 mL so they are just taking it slowly. Malachi has an echocardiogram scheduled for Wednesday because the doctors suspect that his PDA might be impacting his breathing needs more. Thus, heart surgery is staying on the table.

We continue to covet your prayers. We have learned again this week to never take anything for granted. It is so up and down in the NICU that we need to rely on our Father one day at a time for His grace. 

Friday December 16

We have had a pretty busy and stressful week. The NICU life is certainly exhausting and emotionally draining at times. On Wednesday, we met with the neonatologist and a few other healthcare professionals to discuss each of our triplets. We had to make a few decisions during this meeting. It is so difficult to try to learn about what is going on with each baby from a medical perspective, try to understand and process it all, and then have to collaborate on what we have just learned.

Liam:
As mentioned in our last posts, Liam's PDA (a duct which brings oxygenated blood between the placenta and the heart while the baby is in the womb) is still open and remains a cause for concern. It is clear from the many chest x-rays that the PDA is impacting Liam's lungs. After four rounds of medication, the doctors indicated that the medication options were exhausted. Because Liam's breathing support needs are so high, the medical team strongly recommended to us that Liam needed heart surgery. As parents, we listened to the risks and benefits and decided to go ahead with the heart surgery. We were told that Liam would be a priority case because of the severity of his situation, and that the surgery would happen within a week's time. On Wednesday night, we made the rare decision to go to bed early rather than spending the evening at the hospital. When we called the NICU to check in before bed, the receptionist told us we were unable to speak to Liam's nurse because he was in a procedure. Naturally, we sort of panicked and Nathan ran over to the hospital to check it out. Liam had started showing signs of infection early in the evening. His health had been deteriorating so quickly that the healthcare team had not been able to update us. They had run a number of tests on him, taken blood cultures, and performed a lumbar puncture. They put a catheter in to help him urinate and put him on medication to bring his blood pressure down. They also put him on general antibiotics because preliminary tests strongly indicated a blood infection.
As of Friday night, Liam is doing much better. He is much less lethargic and he looks much better. However, the blood cultures have not indicated what type of infection Liam has. The hypothesis is that Liam's PICC line had a blood clot on the end of it which is a source of bacteria collection and potential infection. The PICC line is out and a temporary IV line put in. In the meantime, heart surgery has been postponed for at least a week until the signs of infection are gone and a course of antibiotics has been finished. We will also need to reconsider heart surgery entirely once he is well enough, as there is the possibility that the situation will have changed.

Our sick little man

Taylor:
We don't have too much to report for Taylor as she is still doing quite well. She is not quite ready for the lowest type of CPAP yet but is doing well for her gestational age and size. She still has spells where her heart rate drops quickly and/or her oxygen saturation levels drop. However, overall she is having less that she has in the past. We still enjoy lots of cuddles from our little girl because she is almost always well enough to come out of her incubator.

Little princess

A nice surprise from the nurses

Malachi:
At our meeting on Wednesday, the neonatologist discussed how coming off of steroids can cause a baby to do a little bit worse for a few days before improving. This did happen but in the past few days his breathing support needs have been fairly consistent. The doctors are hoping that he can continue to stay the same so that as he gets bigger and stronger he will be able to improve. We were told that 4.5 lbs is the goal before his lungs will begin to improve to come off of the breathing tube. Right now, he is about 2.6 lbs (1210 grams). Today, Malachi's ventilator machine was switched to one that has more settings and can therefore provide more consistent pressures in his lungs. The healthcare team has indicated that heart surgery is not off the table for Malachi but there are no definite plans for him yet. We continue to wait and pray that his lungs can improve as he grows and gets stronger.

Our baby boy all snuggled up

As parents, it is hard to watch our babies go through so much. All of the pokes for bloodwork, IV lines, tubes pushed down their noses and throats, medication... it seems to never end and most likely won't for a long time yet. We sometimes half-joke that we will have full-blown anxiety disorders by the time we are able to take our babies home from the hospital. Perhaps it is not a very funny joke though, because we hope and pray that the LORD God will continue to strengthen our faith and trust in Him. "The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus." (Philippians 4:5-7). May His peace be with each of you, also during this holiday season.

30 Weeks Gestation

Maybe we have said it more than once, but we never know what the day will bring in the NICU! 

Liam Josiah:

After hearing about how Liam's lung disease was significantly impacting him last week, we were extremely surprised to come into the NICU on Friday and hear that the plan was to extubate our oldest baby boy. The doctors and respiratory therapists explained that they wanted to give CPAP a try even though there was a possibility that Liam was maybe not quite ready. "The baby is the boss" is the saying we have heard more than once. Liam would show us if he was ready or not. So at 2 in the afternoon they took his tube out and put him on CPAP. After 20 hours of repositioning his little body and changing many different settings on the ventilator, Liam was reintubated. Although we were disappointed, we were happy that physically appeared well throughout it all. We are back to square one and the doctors have given Liam a few days to rest before a new plan is drafted. The healthcare professionals will decide whether Liam's PDA needs to be surgically fixed or whether a round of steroids might be an option. While they are the professionals, as parents we also have to weigh in on the decisions and give our consent. This is because of all the risks that either option entails. Right now, they are leaning heavily towards heart surgery within the coming week.

On Sunday, Jodi finally had a successful snuggle with our precious baby boy. He continues to grow well.

Taylor Joy: 

Our little sweetie continues to do well. Her oxygen levels hover in the 20s (remember that 21% is what you and I are breathing). She has been having more of the pressures and settings weaned down as well. It's still a ways in the future, but after CPAP there are still a few other forms of breathing support that babies generally still need. 

Taylor has also been giving her parents some great cuddles lately. She is still the smallest but growing well!

Malachi John:

As you may recall, Malachi started his second round of steroids to improve his lungs this past week. As of Monday night, he is nearly finished the steroids. While he is nowhere near coming off his breathing tube, he has definitely improved from the steroids. As parents we were disappointed that he was not near being extubated but the healthcare team assured us that the steroids improved Malachi's lungs pretty much as they were expecting. We will be meeting with the doctors in the next few days to decide on what the next steps for Malachi might be. We are very hesitant to put him on a third dose of steroids but there are not many options for our little man in terms of interventions that can improve his lungs. 

In the meantime, coming off of his steroids will hopefully mean that Malachi can start to grow more quickly again. Growing bigger for all of our triplets means developing and getting stronger because their breast milk is being fortified with lots of good stuff like protein, vitamins, and minerals to help them develop. We love to watch them and see the changes in each of our babies. Looking back on the pictures of their sticky red skin and bony little bodies, we are thankful to see the improvements they have made so far.

We want to again express our thanks to everyone for their cards, emails, texts, messages, care packages, and comments. We feel so uplifted by the communion of saints. 

Romans 15:13: "May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope."

4 Weeks (and 1 Day)

The triplets are now over 4 weeks old and have passed the milestone of 29 weeks gestation.

Liam: 

In terms of progress, we don't have too much to report for our little Liam besides growth. His latest weight is over 1200 grams! 

However, Liam's lungs have been getting worse in the past while. As we have mentioned before, being intubated does not help with lung growth and healing and babies can become more and more dependant on the ventilator for breathing support. A chest X-ray on Wednesday afternoon showed that Liam's lungs are significantly impacted by what the doctors call "chronic lung disease". We have heard this term many times with Malachi and it simply means to hat the lungs are underdeveloped (which is unsurprising due to how early the triplets were born). Because of the chronic lung disease, the doctors may consider steroids as a medication to help improve his lungs to be able to get the tube out of his throat and onto the less invasive CPAP machine.

In the meantime, Liam is on his fourth dose of medication to try to close the PDA by his heart. As you may remember, the open duct causes complications due to breathing and so treating the PDA often helps lower the breathing support babies need. However, using medication to treat a PDA is generally only effective for the first month of life, after which it doesn't usually work.  So, the doctors have indicated that they are not optimistic this will work. Surgery to close the PDA is not definite at this point, but will be something the doctors will consider in the coming days or weeks.

We have not been able to hold our Liam very often because of his breathing difficulties. His tube is very positional which means that if it is moved a certain way, his heart rate or oxygen requirements might change quickly. (This could mean that the tube is hitting a spot in his throat or trachea that is uncomfortable or that the tube is going too deeply or too far out of his lungs). Another issue is that being intubated causes lots of secretions (which is like thick saliva) in the lungs, throat, and mouth. Both Liam and Malachi need to have this suctioned every few hours or so. These issues have made it hard to be able to safely hold Liam without his heart rate dropping or oxygen support needs going way up. Nathan and Jodi have both experienced attempts to hold him this past week where he needed to be put back in his bed in an emergency situation. Not only is his scary but it's also so disappointing to have to helplessly watch our baby boy without being able to hold him. We try to do as many diaper changes and assist in his care as much as we can.

Liam also continues to finish his antibiotic course via his PICC line although we don't see traces of the infection in his physical appearance. He has needed two blood transfusions in the past few days for his hemoglobin levels and his skin looks a healthy pink colour again. He still loves to lay on his belly (as do his siblings) and suck on his soother. We have also been noticing that our babies are getting better at focusing their eyes on our faces when we talk to them.

Taylor:

The healthcare teams continue to call our little girl "feisty" and we love to hear that. Taylor remains on CPAP and is doing much better than her brothers in terms of breathing support needs. She has not been having nearly as many bradys (drops in heart rate and oxygen saturation) these last few days for which we are. very thankful! Although her PDA remains open, it does not seem to be impacting her lungs as much as her brothers and so the doctors plan to leave it and monitor it, in hopes that it will eventually close on its own.

Taylor has finished her antibiotic dosage. (As you might recall, all her tests came back negative for infection but she was put on antibiotics just to be safe). Because she is done her antibiotic course and is now getting her milk fortified, she no longer needs her IV and had it pulled out on Wednesday. Another small step forward! She looks to be pretty much recovered from whatever sickness or infection she had.

We have been able to hold our baby girl pretty much every day lately and she generally does very well, although sometimes needs to be put back early because of her breathing support requirements go up. We are told this is normal for such premature and little babies. 

Taylor is now past 2 lbs/ 900 grams! She has finally started fortified feeds as well. 

Malachi:

For the first time ever and after 4 weeks of waiting, Nathan was finally able to hold Malachi on Wednesday evening! What a blessing! 

The doctors tell us that Malachi remains our sickest baby- particularly in terms of his lungs. He is on quite high support and oxygen levels and the team has not been able to wean him down. Thus, on Tuesday we gave our consent to start him on a second round of steroids which will be a slightly different kind and a slightly higher dosage. This will hopefully lead to his lungs improving enough to be able to get him back on CPAP. 

Malachi's PDA is also still open and impacting his lungs, yet the doctors feel as though his lungs are so sick that they take priority to treat before addressing the PDA. 

Although his lungs are not developing and improving, we still have opportunities to hold Malachi because he is quite stable in his support levels. He is also growing well and pretty close to his brother's weight. His PICC line also remains in (like Liam) so that he can finish his antibiotics, which will be mid-December.

With all the discussions around lung development and breathing support, we have learned this week that our babies will be behind their peers in their development for a number of years. Thankfully, lung tissue can continue to grow and develop during the first few years (we've heard until around 5 - 8 years of age). However, this means that once our babies are able to come home, as parents we will need to take a lot of precautions and measures to protect their weaker immune systems and especially their respiratory systems. It will also likely mean a lot of extra sicknesses (especially respiratory illnesses) and extra trips or stays at the hospital. Obviously it is rather early to be thinking about going home but this was all a surprise to us. 

Another lesson we have been working on this week is thankfulness to God. We were given the devotional called "One Thousand Gifts" by Ann Voskamp which focuses on finding everyday graces. On Wednesday night as Nathan was holding Malachi, the baby girl across from us was passing away. Our hearts ache for them and we pray for that family. At the same time we are able to reflect on how thankful we are for these 4 weeks with our precious triplets and the small improvements that they make each day. It hasn't been an easy road and yet it is a road filled with everyday grace from our Heavenly Father.

Day 23 - 25

It seems to be getting more difficult to write these blogs. The triplets often have similar or reoccurring issues and sometimes it's hard to keep track of each baby. It also often feels like the days are running into the each other to the point that we often forget which day it is!

Liam:
This little sweetheart is still intubated and it seems he will be for at least a little longer. He is not able to come down on any of his settings and stays in the same oxygen requirements as well, which indicates he is not ready for CPAP again. The doctors suspect that a lot of this has to do with his PDA which is again open and again being treated. This is his third treatment and so we are really praying this will work and stick so he can avoid heart surgery. On Monday he will receive another echocardiogram to see if the duct has closed or not. Because he has been swinging in his oxygen needs a bit and having some rougher nights in terms of breathing, we haven't been able to hold him for awhile.
In the meantime, Liam continues to finish his antibiotics but physically seems to be over his infection. He is growing and we can definitely tell by looking at him! His cheeks are starting to get chubbier and we even notice a bit of fat on his little feet! The nurses tell us that this is in part due to the fortifiers they put in his milk.

Taylor:
Our little girl's tests for infection have all come back negative. This includes her blood cultures, her kidney/renal ultrasounds, and her urine sample. However, the doctors were not satisfied with these results as she was showing strong symptoms of an infection. They decided to treat her as though she has one. Early Friday, Taylor spit up some blood mixed with her milk and the doctors decided to do a head ultrasound and a lumbar puncture to check for infection in her cerebral spinal fluid. As of Saturday, we don't yet have results.
In terms of breathing, Taylor is still on CPAP but not doing nearly as well as before she was sick. The doctors warned us multiple times that she may be intubated but so far she has stuck it out. The doctors suspect that her sickness and/or her PDA (which has reopened) may be impacting her breathing. This fits with her chest X-rays that show her lungs have not been able to fully inflate lately. Taylor is on her second round of treatment for her PDA. She continues to have bradycardias, although lately a chin strap to keep her mouth shut has helped a bit. This lets the CPAP get more air and pressure into her lungs via her nose mask. Compared to her brothers who only have two tubes on their faces, she looks so sad with her face mask pulled tight on her tiny face, her feeding tube taped across her chin, her CPAP hat covering her hair, and her chinstrap encircling her head. The face mask really squishes her face because she is so small and it needs to be as air tight as possible.
We also haven't noticed an ounce of fat on our princess yet. She is much smaller than her brothers, especially because she doesn't get fortified milk or full feeds yet due to her being sick. We have been able to hold her twice this week though, which we are very thankful for.

Malachi:

Our youngest sweetheart also remains intubated without being able to be weaned down on his breathing support. He is still being treated for his bladder infection although physically he seems well. Malachi's lumbar puncture did not go as planned since the healthcare professionals did not collect enough fluid. This meant that they were unable to run all the tests they wanted to. The one test they could run was negative but the infection team strongly felt as though this was inconclusive. They told us that all the other signs and blood work indicated that Malachi was much sicker than just a bladder infection and thus decided to treat him for meningitis instead of doing another invasive lumbar puncture which would also take more time to wait for results. Malachi received a new PICC line and will be on antibiotics until the middle of December.
On a lighter note, Malachi is visibly growing like his brother and is also still in fortified milk. Both boys have passed 1000 grams while Taylor is at 860 grams. Malachi's hair is also visibly growing on his head and quite a bit on his arms too! (This is normal for preemie babies). We got to hold him once this week as well.

As parents we are able to more and more become involved in our babies' care and are becoming more comfortable with things like diaper changes. Unfortunately it is cold and flu season, and Nathan picked up a small cold this week which meant he could not see our babies for a number of long days. It's obviously very difficult to be unable to see your own babies and we are praying that we can both stay healthy in the coming months! While we aren't letting in visitors into the NICU besides immediate family, as parents we do enjoy visits from friends and family who do not have any sicknesses or sick family members. We hope you can understand.

We continue to covet your prayers to our Heavenly Father who is the Creator and Sustainer of life!