Finn is 36 days old today.

Today is day 6 of his steroid course and four doses remain.  Over the past 6 days, like with everything in the NICU, we have seen some positive outcomes from the steroids and also some negative ones as well.

We will start with the good news: as of this morning, his CPAP pressure is now at 6. Finn started out at a level of 8 and has slowly worked his way down.  This means that right now his lungs are requiring less pressure to remain open than they were when he first started on CPAP.  His oxygen levels have remained between 23% and 25% pretty consistently since starting the steroids.

And now for the downside: “roid rage.” In babies in the midst of a course of steroids, you will often see increased heart rate, weight loss, and more feistiness (which we all know he doesn’t need!).

Taking those in turn, Finn’s heart rate has been elevated since he started the steroids (which is a common side effect).  He was receiving caffeine when intubated to help him keep his heart rate up and avoid spells, and when he first transitioned to CPAP, the NICU team had maximized his caffeine dose to help him avoid reintubatation.  Since starting steroids, however, his heart rate has continued to remain higher than they would like to see, so his caffeine dose is now being weaned.  The hope is that once the steroids have been completed — his last dose is scheduled for Tuesday morning — that his heart rate will return to a comfortable range.

As for his weight, before starting the steroids, Finn was tipping the scales at 1060 grams (about 2 pounds, 5 ounces).  Shortly after the steroid course was started, he lost 30 grams (1 ounce) and has now regained 10 grams.  They are adding “HMF” (human milk fortifier) to his breast milk to increase the calorie and fat content, and he is also on a cocktail of supplements, including Vitamins D and E, Iron and Sodium.  He continues to receive 20 mL of breast milk per feed every 3 hours… and the deep freezer was delivered last weekend to house Mom’s round-the-clock output. We are looking forward to the day that he is eating more and can work his way through the freezer stash!  Finn’s weight today is 2 pounds, 4 ounces.

We have been forewarned that it is not uncommon for babies to temporarily backslide once they complete the steroid course.  This means that we might see his oxygen requirements increase in the coming days, and we might also see his baseline pressure requirements move back up to 7 — but this should be nowhere near the support he was receiving pre-steroids.  His doctors, nurses and respiratory therapists have told us not to be discouraged by this, and that as he continues to grow, his lungs will continue to become stronger and level of support needed will continue to decrease.

Finally, as for his increased feistiness… he’s now showing us he’s not happy by crying! This is something you take for granted, or let’s be honest, may even become bothered by with a full-term baby.  But after having an intubated child for a month — one who would sadly look like he was crying, but no noise would come out because the tube was down his throat — this is something that is music to our ears.  The louder the cry, the stronger the lungs.  So keep on crying, little buddy!