Caffeine is commonly used to treat idiopathic (no known source) apnea in preterm infants (like Frankie, especially neonates born before 30 weeks). Thean (Frankie's daddy) did not like to hear that he was recieving caffeine because he remembers my soap box on how too much caffeine is bad for the adrenal glands; so here he is thinking we may be doing damage to Frankie before he is even out of his artificial womb. I tried to come at Thean with the idea of costs versus benefits but then decided I needed to do some more research to learn about caffeine and preemies to see if there might be an alternative or at least no lasting effects from its use.

The subject is well researched and the research I found is encouraging. Here is some of what I found out:

• A look at caffeine and theophylline found that they have the same effect on apnea/bradycardia (low heart rate) but caffeine has more therapeutic effects (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000273.pub2/abstract)
• Caffeine citrate (which is what Frankie is getting - 9.2mg/kg and he is just 1 kg) at doses of 20mg/kg does not result in adverse outcomes for development, temperament, or behavior; while effects on cognition need further study (https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1754.2010.01943.x).
  
• Early caffeine therapy shows better outcomes in preterm infants (https://www.nature.com/articles/jp201252).
  
• A study on caffeine and brain development found that preterm infants who had caffeine had improved white matter microstructural development (https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.22098).
  
• Looking at the safety of caffeine for AOP (Apnea of Prematurity) it has repeatedly been found to be a safe treatment method (https://www.karger.com/Article/Abstract/442813).
  
• A particularly great study found that early administration improves neurodevelopment outcomes compared with later introduction (full pdf https://relaped.com/wp-content/uploads/2019/01/Early-Caffeine-Administration-and-Neurodevelopmental-outcomes-in-preterm-infants.pdf).
  

I could go on and on with all the great research but I think you get the point. I feel pretty good about Frankie being on Caffeine Citrate after I did the research to figure out why he would be on it; without just taking his doctors/nurses word for it.

Getting my milk to come in after a Cesearean at 27 weeks 5 days was no easy feat.

I pumped every three hours for three days with nothing but sticky droplets of colostrum that my Mom helped me chase with a special syringe. Getting just a cc or less to be swabbed in Frankie's mouth. My milk has come in and I am consistently pumping more than he will eat in a day in each sitting. He eats about 4ml and I pump close to 40ml.

Pumping at home while my newborn is at the hospital consists of waking up at all hours... massaging my boobs... and staring at pictures, videos, and live feed of Frankie while pumping trying to get my milk to come down.

Pumping at Frankie's bedside with just a curtain between me and the nurse's station may seem awkward at best. However, seeing him in person and holding him helps the milk come. My body knows he is near and needs sustenance.

Good milk comes from persistence, lots of water, lactation tea (Mother's Milk), and good calories (like in the Madre cookies).

Frankie weighed 1150 grams at birth... today he is 1040 grams... the lowest he got was 980 grams. Nutrition matters!

Personal post - welcoming baby #3 Frankie! He is a preemie and joined us this week... at just 27 weeks, 5 days gestational age. 

Here is our birth story - I will spare most of the juicy details but since so many people have been asking what happened I thought I would distill our story and share some blessings.

Monday, June 3rd, 2019
8am @work - little bit of blood and mucus - call the midwife
9am still @work - more blood - update doctor
10:30am More blood - amazing colleague drives me to labor and delivery in Boise at the direction of my midwife.
11am Assessed by medical staff and given IV Fluids, Magnesium Sulfate and Steroid shots. Told  not to eat or drink :( mild contractions approximately every 10 minutes.
12pm and later - Lots more blood loss, Frankie looks good on the ultrasound (measuring 29 weeks and 2 pounds, 13oz), monitoring labs for changes because of blood loss, Catheter overnight (worst feeling ever) because not allowed to move around because of blood loss. Tested for autoimmune diseases, different clotting issues, etc. Why is this happening?

Tuesday, June 4th, 2019
Catheter removed. 9am labs look good. Allowed to eat and drink again :)
Very optimistic doctor shares that I could potentially go home in a week as long as I stop bleeding and Frankie monitors okay. Some blood loss but not like the night before. Hot and foggy from Magnesium but mostly okay day. Getting settled in for the long haul - every day in the womb is three less days in the NICU they tell me.

Wednesday, June 5th, 2019
Not as much blood loss but still losing. Labs came back significantly lower. Ultrasound shows that my waters had ruptured at some point in time and Frankie was running out of room. Started antibiotics (like lots of antibiotics). Stopped Magnesium only to be started again later.

As the evening went on - I expressed my concerns for my own health and that I really didn't want to see my "room crashed" because of Frankie doing poorly. As my blood work continued to decline the medical team made the decision to deliver Frankie via Cesarean section. At 9:57 on June 5th Frankie made his entry into the world with some welcome screams (they told me to not expect to hear crying since he was so little). He was 2 pounds 9 ounces and 15.5 inches of perfect.

I should actually probably say, almost perfect. When they were taking him out they had to cut some membranes that were around his ankle. They said a few more hours with that tight band on his ankle and we would have been looking at amputation of that foot. If he would have gone to term with that band his foot would have likely been reabsorbed into the amniotic abyss. They told me he would have a permanent anklet but it is already practically undetectable.

A couple of things that I would like to mention about my stay at the hospital - I made sure it was known that the priority was always me. I have two other kids I need to be around for, and while the situation was sucky I wanted to make sure I would be priority. I discussed this with many of the nurses and it seems that in the US the focus is often on saving the baby. This a cultural perception that I think needs to change. 

Another mention about my stay is after Frankie was born I really made sure the nursing staff helped me stay on top of my Tylenol and Ibuprofen rotation so that I would not have to take anything harder to manage the pain. So far so good.

Frankie is breathing on his own with the assistance of a CPAP. My milk is starting to come in (with lots of effort but it is) so he is getting great nutrition. I get to go home tomorrow - Sunday but he will be here until his due date, August 28, 2019.

Special shout outs to Shanae for coming to stay with me and my Mom for flying up in a pinch! Thanks to everyone that has visited me and the nursing staff! The support feels good!

If you would like to help support the long journey ahead for my family please support this podcast via Patreon or PayPal. Add encouraging comments or stories here too!