Posted Sep 24, 2012 6:30pm

That’s the time they started Oscar’s blood transfusion today.
No, we didn’t know he needed one. Didn’t see that coming. Maybe the Dr did, but I sure didn’t.
They warned us there would be a hiccup. This is ours. Well, I hope this is ours because I am not sure how much more my nerves can manage.
This morning was Oscar’s hematocrit level test. It was low. Hematocrit is the percentage of red blood cells in your body. Oscar already had one transfusion when he was two days old. We were now faced with another. The doctor ordered a follow up test to see how many new red blood cells Oscar’s bone marrow is generating. They are able to discern the new ones from the ones given during the transfusion a month ago.
That came back low too.
I needed to decide what we wanted to do.

Some information:

Because they are born early, preemies may develop more a more severe type of anemia called anemia of prematurity. In the last weeks of pregnancy, two changes occur that help full term babies to make red blood cells. First, a lot of the iron needed to make new red blood cells is transferred from the mother to baby in the third trimester. Also, in the last weeks of pregnancy, red blood cell production switches from the liver to the bone marrow. Because the processes that make new red blood cells are immature in preemies, preemies have a higher rate of anemia and their anemia is more severe than in term babies.

NICU care can make anemia in preterm infants worse. Doctors and nurses try to limit the amount of blood that’s drawn for lab tests, but even small blood losses can affect very small preemies.
The symptoms of anemia are subtle and may look like other illnesses, such as infection or respiratory distress. Babies who are anemic may have the following symptoms:

Pale color
Tachycardia, or rapid heart beat
Tachypnea, or rapid breathing rate
Apnea and bradycardia
Poor weight gain
Trouble feeding due to tiredness
Increased need for oxygen or respiratory support

How is Anemia in Infants Treated?

In term infants, anemia doesn’t usually require treatment. As long as a baby gets enough iron through breast milk or iron-fortified foods or formula, normal anemia will get better on its own.

In preemies, anemia may cause enough symptoms that it needs to be treated. A premature baby’s anemia may be treated with:

Blood transfusion: The fastest way to increase the number of red blood cells in a baby’s blood is with a blood transfusion. In a blood transfusion, packed red blood cells from donor blood or from a family member (called a direct donation) are given through an IV line.

Another point: Blood units expire. The donor from whom Oscar had received blood the first time was set to ‘expire’ at midnight tonight. So there was a benefit to deciding quickly. Less risk of exposure to another donor.
I stepped out to call Matt. He and I agreed that he needed the blood and we didn’t want to expose him to more risk. I went and informed the doctor. He told me that due to emerging studies that feeding during transfusions can increase the incidence of NEC (Necrotizing enterocolitis,- a condition where the intestines become infected and can begin to die), they would hold Oscar’s feeds for 15 hours.

I was starting to crumble.

I left again and called Leigh. She’s in that category I spoke of yesterday. She is my sage. My gift from the universe. She is a pediatrician and one of the very smartest people I know. She has this special voice when she puts on her doctor hat and I have come to revere it. Its all business, all know how, all yes I know where you’re going with that three minutes before you realize it. We did our own surgery on the issues. We pulled it apart and put it back together. Leigh’s real gift which her VIP patients like my kids benefit from is her ability to add the mommy to all those smarts. Her compassion and heart always shine through. They are the closing argument of her well researched case. She always makes me feel like she’s talking about her own children. Her kids are my kids and my kids are her kids. Its just that simple.

I felt like we did the right thing, and I had the right follow up questions to ask Dr Rakos (why this anemia??? What is the cause? Will this fix it or will it happen again? Is there some underlying pathology that is particular to Oscar or is this something common for preemies?) I was armed with intelligence. Not all mine, but I feel entitled to cheat right now. Its for Oscar after all.

Turns out its really common for a preemie as early as Oscar. It shouldn’t happen again because the next time his rbc levels decrease (this happens in waves) he will be closer to full term and more equipped to handle it and recover. The Dr feels confident this will really help Oscar make a jump to fewer As & Bs and desats, eat better, have better color, all good things.

I went back to my Transitional Room. Have I mentioned that I now have my own room in the NICU? TV, bathroom, pullout couch. Yep, its my home away from home. I am happy to have some space to relax and I needed it today. I lost it.

The idea of Oscar not eating for that amount of time is abhorrent to me. It offends my senses and breaks my heart. The one thing, the ONE thing I do better than the NICU for this baby is feed him. He loves nursing. I say it a lot I know. That’s because its my touchstone, my only normal moment of mothering this child. And the thought of him starving for any amount of time makes me cry. Summer, my nurse and godsend today, assured me he would be hydrated through the IV and not be miserable at all. If he was then Golda (his night nurse) would hold him and soothe him with his paci. Ok. But I hate this. I know he’s going to be fine, better than before they tell me. But today my four and a half pound baby needs a blood transfusion and it feels anything but ok.

We decided I would do the 9, 12 and 3 o’clock feeds and then they would start him up. It will take four hours. He’s a little over two into it now. Say a prayer for Oscar tonight.

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