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.