We’ve had Margo home for 3 days now. Compared to a toddler, a baby seems so simple! Margo’s needs are straightforward: eat, sleep, poop. Sam’s needs are much more complicated, with emotions, opinions, and questions. It makes me wonder why having Sam as a baby seemed so hard. It also makes me thankful that we had Sam first. Transitioning home with a NICU baby on the first go around would be hard. It’s hard to transition from a world of constant monitoring and measuring to a world of attunement.

Bringing Margo home makes Sam seem HUGE in comparison! Sam’s butt seems gigantic compared to Margo’s—it really is time for Sam to be potty trained.

I know I said before that I didn’t want my babies to come home separately, but it turns out that getting one at a time has been good for the transition. There are pros and cons to NICU babies.

Pro: NICU babies come home on a schedule. Margo was consistently fed and cared for every 3 hours. In her final days in the NICU, she was switched to ad lib but no more than 3 hours between feedings, so in those days she ate a little more frequently than every 3 hours. Now that she’s home, sometimes she demands food around 2-2.5 hours after the last feeding, and she has started to cluster feed in the evenings, but for the most part she is on a 2.5-3 hour schedule.

Con: Margo came home with a somewhat complicated cocktail of feeding and supplement requirements. All of her milk needs to be fortified with preemie fortifier. She also gets iron twice a day and vitamins once a day, both of which are liquid that need to be added to her milk. This just requires more planning than a typical baby. I mix up batches of 6-9oz of fortified breastmilk, and then I just try to remember when to add in the iron and vitamins — iron around 9am / 9pm and vitamins sometime midday. She only needs to be on the fortifier until she reaches 10 lbs, but she’ll be on the iron and vitamins for a year.

Pro: NICU babies are more alert than your typical newborn! While her adjusted age is 3 days old, her actual age is about 2 months. She doesn’t have the sleepy “I just went through delivery” newborn haze. She’s had awake periods for a solid few hours where she watches what we are doing. The outside world is so much more interesting than the NICU.

Con: We still have to keep a close eye on her while she’s eating. The last few days were so stimulating for her, and I can tell that she’s exhausted. She had a few events around eating last night where she checked out and stopped breathing. The good news is that we are pros at dealing with this. You just have to set her up and pat her back to get her going again. The bad news is that it’s a little unsettling. We have been using the breathing monitor on her at night as an extra precaution.

Pro: Margo likes to snuggle! I think especially since she spent so much time in the NICU, now that she’s gotten a taste of being held more, she wants to be held and snuggled all the time. Sam has never been a big snuggler, so this is nice.

Pro/Con: Margo is pretty much entirely bottle fed. On one hand, this is nice because it allows us to take shifts at night. Erin takes the midnight feeding, and I do the 3am/6am. This works with my pumping schedule and it lets us both get some sleep. On the other hand, bottle logistics are more complicated than breastfeeding. We set up a tiny mini fridge (it holds 6 Coke cans) in the baby room, where I put the fortified milk. I also set up 4 bottles each night before I go to bed. This allows us to take fewer trips up and down the stairs at night. When baby wakes up, we just have to put the fortified milk into a bottle and start feeding her. We don’t heat it because Annalee is on cold milk, and we don’t want to bother with one baby on warm milk and one on cold if we can avoid it. Margo doesn’t mind. I have mastered the art of pumping while bottle feeding. I can do this in the rocker or when Margo laying on the twin z pillow. With the twin z pillow, I like to imagine how Annalee will be inserted into the process once she comes home and can eat consistently well.

Con: Margo looks like a normal baby, and it’s easy to forget about everything she has been through unless you review her discharge summary. Her immune system is still very sensitive, and we have to be extra careful about germs. She’s not so immunocompromised that we have to put ourselves on lockdown, but we do need to take more precautions. Limited visitors, no one who is remotely sick, aggressive hand washing and sanitization, limited exposure to public places.

Con: it’s hard to transition away from a world of measuring and monitoring everything.

Other thoughts:

So far, Sam has adapted to Margo pretty well, and he’s been nice to her. I think the transition is still setting in for Sam, so I still expect some tough days ahead for him. He has suddenly shown more interest in potty training. My hope is that he associates diapers with babies and it makes him want to be a big kid. He did kick a kid at school the other day, but it’s hard to say if that’s a new trend or not.

Patches is happy to have another baby at home. She really is the best mama bear when it comes to babies. Ovie is a bit more indifferent but still likes to check in on occasion.

Our 2nd night home with Margo was Halloween. I think we are doing Halloween wrong. Sam just wanted to stay home and watch TV. This made me sad, so I was able to at least coax him into trick or treating at our neighbor’s house. I asked if he wanted to go to more houses and he said no. The issue is that he’s too smart. He doesn’t see the point in trick or treating if we have a huge bag of candy at home already. We will try harder next year.

Meanwhile, Annalee is still making really slow progress on her feeding. The good news is that she hasn’t had any events in several days, and she is more consistently taking her 20ml per feeding, but she still has ~70% to go. She’s been self limiting around the 20ml mark so they haven’t been able to increase her limit. I keep hoping that we will come in one day and she will be suddenly eating better, but that hasn’t happened. And it likely won’t. The team is still considering the option of sending her home on the feeding tube, but we are waiting a few days to see how she does before making any decisions. As the days go by with limited progress, it’s hard for me not to worry about Annalee. My brain starts going to a bad place — what does this mean for her long-term feeding development? Will she struggle with solids too? Will she struggle with other aspects of development too? The team continues to assure me that she’s still in the realm of normal and that there often isn’t a correlation between early feeding issues and more issues down the road, but it’s hard not to wonder. Thankfully, Washington has some great resources to help us with development over the next 3 years, and both girls qualified for Medicaid for their first year of life to help with expenses. I guess I need to stop thinking “this will get easier when…” and just accept each day for what it is. My heart aches for Annalee, especially when we have to say goodbye to her each day. I just want her home with the rest of us!

Now that Margo has been discharged, Annalee got kicked out of the awesome twin room we had. Thankfully, our NICU lets Margo come visit, and they kept a bassinet for her.