Doctors, Part Two

Thursday - UNC Special Infant Care Clinic

Thanks to our friend, Adam, we were able to get into the UNC SICC very quickly. We really wanted to see what someone else said about the need for the g-tube so we were very happy to get in so fast.

The visit was great. Despite the 8am appointment, we actually made it in time. Ben went with us which was a big help. The nurses were so nice and everything was really quick. They even gave us two lift-the-flap books as a first time visit gift. Of course, they weighed them. Abby is now 12.5lbs and 24.173 inches. Natalie is 11.5lb and 23.858 inches.

We saw Dr. Diane Marshall, who was just wonderful. We also had a feeding therapist stop in and do a quick evaluation. Overall, they were pleased with the girls. When plotting their stats on a chart for low birth weight babies, they both made the chart - although Natalie just barely. Dr. Marshall thought they seemed to be following their own curve very consistently. Their head circumferences were good for their weight and height (which means their brains aren't starving:-)) They looked at their average weight gain for the past month or so and they are gaining about 12g a day. The recommended weight gain is 10-30g a day. (30g = 1 ounce) Once again, they are in that window, but just barely.

However, they are in the window, and they are gaining weight. As a matter of fact, since coming home, Natalie has gained an average of 17.5g a day and Abby has gained an average of 15.94g a day. Dr. Marshall also looked at their developmental progress, which is fantastic, and their general overall health. If you look at the girls, they LOOK healthy. They even look a little fat. They have pudgy little bellies and fat rolls on their legs. Abby even has a double chin. They smile and laugh all the time. The sleep well, nap well, and play well.

In the end, Dr. Marshall said she would not recommend a g-tube at this time. As long as they continued to follow their own curve on an upward trajectory, they were doing okay. She also admitted that the truth is "they" don't really know exactly how much babies are supposed to grow and weigh, especially for micro-preemies. That's one reason the range, 10-30g, is so wide. Dr. Marshall also agreed with the feeding specialist that it's possible that the girls simply don't need as much as they are "supposed" to need. The girls have always had a ceiling on what they were comfortable eating. They would often eat well the first 15ml, 30ml, 45ml, 60ml, etc., then shut down. It may be that that amount is where they feel comfortable and full. Maybe their little tummies can't handle any more. It may also explain why when we tried to gavage them back in November with larger amounts, they couldn't handle it and just threw up. It may be that the girls instinctively know how much they need to maintain their health. So far, it seems to be working pretty well.

The bottom line is that the girls seems to be doing okay. Dr. Marshall did not recommend a g-tube now or in the future AS LONG AS they continue their current growth curve. If they were to ever stop gaining 3-4 oz a week, we would have a problem. Or, I suppose, if they started to lose energy or become fussy and act as if that 3-4oz is no longer enough for them.

We were thrilled, of course. We have been very reluctant to move in the direction of the g-tube. Natalie and Abby just seem too healthy to need surgery. We still struggle with their feeding and will continue to work hard to increase their caloric intake. We have started solids and are working on that 10am feed. If they would take a bottle then, it would make all the difference.

We are going back to the Duke SICC Tuesday and will report on the recent appointments we have had. They do know we saw the doctors at UNC since they requested the girls' records. I'm a little nervous about it, honestly. The doctors at Duke have been so good to us, and I don't want them to think we don't trust their judgment. Hopefully, they won't be too offended.

We will report on that appointment Tuesday, but for now, everything looks good and we are NOT having surgery.