Things are looking up

After Josh's surgery yesterday he is recovering well and resting. His pain levels seem to be low and he has not needed extra doses of medicine just the drip of continuous medicine. Tomorrow he will be weaned off the drip if his pain remains tolerable.

According to the nurse his lungs no longer sound "juicy" which is a good sign that the PDA closing has helped his lungs improve. Another good sign is that the heart murmur is gone. He is currently on low levels of oxygen and the doctor's have turned down the ventilator levels. The nurses will also give him a small amount of milk again today and see how he tolerates it.

Josh's day

Josh's PDA surgery was completed this morning around 10 am and he came through with flying colors. The surgical team was able to tie off and clamp the PDA and his immediate responses look good. He is currently still under anesthesia and will remain in a private room until tomorrow.

The surgery involved making an opening under his left shoulder blade (about 2 inches) so he will be on pain medicine for the next few days. The doctors will also continue to evaluate him to see how his lungs look and the hope is to wean him off the ventilator soon. In a few days he will begin his feedings again, although starting over at small amounts, and eventually they will work him back up to larger feeding amounts and less IV fluids.

Big day for a little guy

Josh had a busy day today with not one, but two, echo-cardiograms. The echo showed that his PDA was still significant, even after a week on the ventilator. The doctors and cardiologists decided that it's time to surgically close the PDA. The surgery has been scheduled for tomorrow, Tuesday, morning and we will be down there to lend Josh our support and love and have a chat with the pediatric surgeon and his team. After his surgery we will have a Care conference with the NICU team and we hope to see some growth charts and get a debrief of how the surgery went and plot Josh's course for the next couple weeks.

The surgery itself should be rather quick but Josh will have to go under anesthesia. The surgery involves making an incision near Josh's shoulder blade and then when the PDA is in view the surgeon will physically tie it shut. By closing the PDA Josh's lungs should improve and we hope he will be off the ventilator in the near future and breathing on his own with just the help of the c-pap.

Josh is also back on an IV today after not being able to tolerate his feedings very well. For the next few days he will not receive any milk but instead will be fed solely by IV. The doctor's believe that this is also a side effect of the PDA and that the surgery should help his digestive system work properly.

Despite the excitement of the day Josh was able to get some Kangaroo time with mom and did really well out of the Isolette for an hour. He enjoyed looking around and sleeping on mom's chest.

Quick Update

This weekend had some ups and downs. Josh was taken off the ventilator on Saturday and given some steroids to help his lungs. Unfortunately it appears that he was not ready yet and on Sunday they put him back on the ventilator. This has been very frustrating for us to watch him struggle. The cause for his struggles is still unknown but they are going to do another echo on his heart today to look at the PDA. If this is the problem the next step will probably be surgery to clamp the PDA shut. Josh is also being watched closely for signs of hypothyroidism. He flagged on a state test for possibly having a thyroid problem but his TSH (Thyroid Stimulating Hormone) levels are normal so the doctors are going to consult with an endocrinologist.

Josh has had some improvements over the last few days. He has gained a little weight and is tolerating his fortified milk. They are currently adding 4 calories of vitamins, fats, minerals, etc to the breast milk which means the milk he receives is 24 calories per ounce vs. 20 calories for regular breast milk. Because he is able to tolerate these feeds his PICC line has been removed. We also found out that Josh is making his own red blood cells which was unexpected. We hope that he will continue to make red blood cells and he won't have to have a transfusion (which is common for preemies).

Thank you to everyone again for all the good wishes and prayers.

A typical day at the NICU

We have been getting a lot of questions about the NICU and particularly Josh's isolette. Josh spends the whole day in this bed with limited time outside (only about an hour for kangaroo time). We change his diaper in the isolette and the nurses and doctors do most of his care with him inside.There are armholes on either side that we open and reach through and then you have to maneuver around the cables, tubes, blankets, etc. By the time we come home changing a regular diaper should be easy!

The side of the isolette does open when needed but in general he is in complete isolation. The isolette provides heat and humidity so that he does not have to expend energy to keep his temperature consistent.

In this picture you can see the ventilator. He also has cords that monitor his body heat, his heart rate, his breath frequency, and his oxidation levels. In his right arm is his PICC line and he has a feeding tube that goes directly to his stomach. All in all there are a number of cords, gadgets and tubes which Josh loves to grab :).

Back on the Ventilator

Josh has continued to struggle to breathe on his own and after a number of significant incidents of apnea yesterday morning he was placed back on the ventilator. The hope is that the ventilator will allow him to rest and grow stronger while his lungs continue to develop and that in a few days they can once again put him back on the c-pap.

Father's Day Visit

                                                   Thanks to Mark and Cindy McGee for Josh's new quilt.


As we keep saying, "no news is good news, or at least the status quo". Josh has recently been given the nickname "Brady King of the NICU" for his continued preemie struggles. But, as the nurses say this is to be expected from a preemie his age and eventually he'll grow out of it. For now we just continue to watch him and to give him a little rub to help him remember to breathe when he forgets. He has also gotten some extra doses of caffeine and gone up on his oxygen levels slightly to help keep his breathing regular and his saturation levels high. The neo-natal nurse practitioner has assured us that most babies outgrow these Brady incidents around 34-36 weeks of gestation.

In other news we visited on father's day and Evan and Josh took a little nap together. Josh really enjoys being held for about an hour. At about the hour mark he usually gets a little stressed out from all the noise and stimulation of the NICU. This stress often coincides with larger desaturation levels or a longer recovery time after a Brady. The best place for him right now is to be in his isolette where it is quiet and less stressful. We hope that as the weeks go by he'll be able to handle longer sessions being held. Josh is also going to go off his IV soon as he is tolerating his feedings of milk really well. The nurses are increasing his feedings by 1cc every 9 hours and he is now getting 12 cc's every 3 hours. This is up dramatically from last week when he was getting just 3-4 cc's of milk every 4 hours. We hope this will help him gain some weight which in turn should help him grow stronger.

Thanks to everyone for your continued support, prayers, and kind thoughts. We have also received a number of nice gifts and will try to get some pictures up over the next week.

Ups and downs

Josh is still having breathing issues, which causes a lot of stress for Becky and Evan. At times, he will stop breathing for up to 20-30 seconds, after which the medical team will put a mask over his face and pump air into his lungs.  Not the kind of thing you want to see happening with your baby.The breathing problems are probably due to the PDA condition still letting extra blood into his lungs.

On the bright side, Becky's friends and colleagues Jenny and Sarah came down to visit yesterday. And, Josh is now tipping to scales now at just over 1 kg.

The other big news has been the arrival of Grandma Jorgensen from Minnesota. She has been keeping busy knitting hats for all of the NICU babies among other things. We'll try and get a photo of her handiwork on the blog soon.

1 week old!

Today was a good day with lots of good news on all fronts. Josh is off the ventilator and back on the breathing machine. The PDA, while still open a bit is now closing and responding to the medication. Josh also gained a bunch of weight yesterday - 180 grams in total. If he keeps this up, he'll be a mega baby by the time he reaches his due date! The other very big news is that a brain ultrasound was done today and they found zero bleeding. This means that they will not have to do this test again until he reaches 36 weeks and it is also unlikely that any bleeding will occur since most bleeding generally happens during the first week.

Evan went back to work yesterday and Becky will go back to work next week. They have decided to work a modified schedule from 7 am-2 pm daily, and then will make up time in the evenings and weekend. Extra big thanks to their employers for making this happen and giving them the flexibility to spend the afternoons with Josh doing the kangaroo care and general bonding.

5 days old

A few medical updates today... First, the doctors determined that the medicine is not working to the extent needed for the PDA and the bypass artery is still quite large. Therefore, they will continue the medicine to see if they can close it up without doing any surgeries. Second, the doctors are also working to put in a central line called a PICC. This will allow them to avoid giving Josh IVs all of the time. This is a surgical procedure which requires sedation and it is successful 85% of the the time. (Becky and Evan should hear tonight if it worked or not). Third, the doctors will also increase Josh's nutritional allotment since he has lost 15% of his birth weight and is now down to 850 grams. Finally, sometime in the next couple of days they will do an ultrasound of his brain to see if there has been any bleeding.

In some good news, Josh has graduated from his phototherapy for now and the jaundice is gone. Since his shades are off he has been looking around a lot and opening his eyes.

4 days old

Today was a good day for Josh and his parents. Becky and Evan left the hospital for the first time since Wednesday, going out to lunch with Grandpa and Grandma Yeager. Their friends Craig and Samantha also came back for a visit this afternoon. A beautiful floral arrangement arrived from Evan's office, a cheery addition to the hospital room. Grandma Jorgensen is also able to come out earlier than anticipated and will be in Denver on Wednesday. This evening, Becky and Evan will head home for a good nights sleep and they will begin to think through a visit/care schedule that will work for them over the long term.

Josh continues to make good progress. He received his third treatment of the medicine for the PDA condition and tomorrow morning they will do an echocardiogram to see how it worked. Since his white blood count was up a bit, they also did some more blood work to ensure that there are no infections. Today Josh also was able to breath - for the most part- on his own in the incubator, and he did not receive additional oxygen. They will keep him on the ventilator until they know more about the PDA, but the good news is that he is pretty much doing the work on his own at this point.

Josh is also making early strides into academia. He is taking part in a research study for lung growth in premature babies. His participation will continue until he is 12 months corrected age (around 15 calendar months). The study involves some regular blood work and echocardiograms.

Tomorrow  Becky and Evan will participate in their first care consultation with the doctors, so it will be a big day for everyone. Thanks again to everyone who has reached out to Becky and Evan over the past week and for all of the positive thoughts and prayers coming their way.

Josh with dad and frog

3 days old

Today I think it is sinking in more that Josh's journey in the NICU is not a sprint, but a marathon. However, he continues to be a very strong fighter and even though Josh is back on the ventilator, he is not using it too much. According to the "what to expect" manual that Becky and Evan received from the hospital, it can be common for preemies to go on and off ventilators for up to seven weeks while their lungs continue to develop.

Becky said that it is a relief for her and Evan to see Josh stabilize with the machine even though they know that it is not good for him over the long-term. They are working through reconciliation of these feelings and balancing the immediate desire to have him safe versus the long-term health goals.  Their caregivers told them that it is common for things to get stressful for the parents as the reality of the NICU and the long-term stay sink in, and the "honeymoon period" of the birth wears off.

Backtracking a bit, the reasons behind the breathing difficulties that Joshua is encountering are two-fold. First, his lungs are still quite underdeveloped, as would be expected for a 25 week old baby. To treat this, he is still receiving medication. Second, Joshua is experiencing Patent Ductus Arteriosus (PDA), a heart problem that affects some babies soon after birth. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. Before birth, these arteries are connected by a blood vessel that is a vital part of the fetal blood circulation. This usually closes within a few minutes or up to a few days after birth. However, in some babies the vessel remains open, which allows oxygen rich blood from the aorta to mix with oxygen poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries. (Source of information: http://www.nhlbi.nih.gov/health/health-topics/topics/pda/)

The doctors will try and treat this second condition by giving Joshua medicine to try and close up the blood vessel. Within 24 hours, they will know if this is working or not. There are some risks associated with the medication as it can also close up other arteries such as those to the kidney, meaning that this process is monitored carefully. In the worst case scenario, surgery is sometimes required to close the artery, but typically the baby is able to self correct the condition over time. PDA is fairly common, occurring in about 8 cases out of every 1,000 premature births, and it is generally treatable with no long-term side effects.

In other news, all of the tests for infections came back negative today and Josh was also able to do kangaroo care (although not too long, because he gets cold). Becky is also going to start sleeping with a small blanket that they will put in the incubator with Josh so that he is able to be comforted by her smell. They also received a donor breast milk pump, which they can use until Josh is out of the hospital - a great program. Grandpa and Grandma Yeager have continued to come down to the hospital to offer support and lunches. Grandpa and Grandma Jorgensen are offering assistance from afar on many items that they can do remotely until they can get an extended period of time to come out to Colorado - likely to be at the end of the month.

2 days old

Today had its ups and downs. Josh had some breathing issues overnight with six incidents where he stopped breathing up from two the day before. This resulted in the CPAP being turned up a bit. Seeing him stop breathing was difficult for Becky and Evan to say the least. They will continue to monitor his breathing in the NICU and may need to put him back on the ventilator if things do not improve. Josh also continued receiving phototherapy, and will continue to do so over the next few days. This resulted in a bit of dehydration (much like any of us would have if we spent a lot of time in the sun!).

On the positive side, he continued to do well with the milk. He also seemed to relax and breath well  on his stomach during the kangaroo time with mom and dad. As a result, the nurses decided to see if he might do better on his tummy in the incubator. Test results for common hospital infections also came back negative.  The NICU is also fairly empty with only 16 of the 25 beds filled - this has meant that Josh is receiving a lot of one-on-one attention from the nurses. Yesterday, Becky, Evan and Josh received a visit from friends Craig and Samantha, which really lifted their spirits.

Becky and Evan are adjusting to the hospital routine. This adjustment has been eased by the fact that they are able to continue to stay on site; they plan on keeping their room at St. Joseph's through Saturday. Every day, they have rounds at 10:30 am and 9:00 pm. The afternoons are spent doing kangaroo care. This is limited to once a day at present because even though it has great advantages, moving Josh in/out of the incubator is also quite hard on him. Becky and Evan were also able to meet with a social worker today. On Sunday, they will have their weekly check-in with the care team, where they will review Josh's progress from the past week and plans for the coming period.

On a side note, it seems that many of the medical staff are named Kari/Carrie. Coincidence? I like to think that it is a substitute for me not being able to be close by them all.

First family photo

Snuggled in this afternoon with mom

Chilling out in the incubator with my shades...

1 day old

I was able to speak with Becky this afternoon and heard that Joshua did well overnight and was taking in room level oxygen without any extra levels necessary. The  CPAP was also turned down. On several occasions during the night he stopped breathing, but the good news was that he was able to self-regulate and begin again on his own without intervention. Since he is slightly jaundiced, which is very normal for premature babies, Josh is also undergoing photo therapy (light treatment) to eliminate bilirubin in his blood.  

Today, the doctors were also able to remove the arterial line into his abdomen which had been used for drawing blood. This means that Becky and Evan will be able to hold him for the first time this afternoon and will learn about “kangaroo care”. Another great sign is that Josh is also drinking his mother’s milk like a champ. 

Today, Becky and Evan are both learning from the nurses how to take Josh’s temperature and to change his diapers through the incubator. This is a delicate process because of the fragility of his skin, so it takes the “first time parent diaper changing learning curve” to a whole new level. 

Becky and Evan plan on spending the next couple of days in the hospital where they are camping out in a room provided by the NICU. Becky received some lovely flowers from her office, which she said are cheering up their hospital room. As part of next steps, Joshua will be undergoing some additional tests this week to check his health in other areas, but it seems that his condition is about as good as we could expect and everyone is cautiously optimistic.

(Posted by Becky's sister, Kari)

Welcome, Josh!

Welcome, Joshua Dean Yeager

Joshua Dean Yeager was born unexpectedly June 5th at 4:05 a.m. at twenty-five and a half weeks. At birth, he weighed 2.2 pounds and was 14 inches long.


Early morning on June 5th, Becky woke up and was not feeling well. She and Evan decided to go the the hospital to check things out. Thankfully they went quickly, because by the time they made it to the hospital the birth proceeded rapidly.


The doctors are still determining the cause of the pre-term labor, but we are all relieved that Becky is doing fine and was even able to leave the hospital this afternoon, just hours after the birth.


While Becky was recovering, Evan went with Joshua to St. Joseph's hospital in Denver, which is home to the best NICU in the state. Shortly after he arrived, Joshua was able to be removed from the ventilator and is now breathing on his own with the assistance of a CPAP (continuous positive airway pressure) machine.


Evan's parents, Harris and Danielle, were able to quickly lend their support to Becky and Evan with Harris going down to Denver with Evan and Danielle supporting Becky at the hospital. By early evening, Becky and Evan were able to go together to visit Joshua in Denver.


(Posted by Becky's sister, Kari)