Monday, October 29, 2007

About RSV (Or, Why We Need to Take Out Stock in Purell)...

Now that Fall is upon us and Winter is right around the corner, it is RSV season. Many friends and family members have asked us what RSV is. So we wanted to post information on what RSV is and how it impacts preemies.

RSV causes respiratory tract infections in patients of all ages. It is the major cause of lower respiratory tract infection during infancy and childhood. In temperate climates like Massachusetts there is an annual epidemic during the winter months. In tropical climates, infection is most common during the rainy season. In the United States, 60% of infants are infected during their first RSV season, and nearly all children will have been infected with the virus by 2-3 years of age. Natural infection with RSV does not induce protective immunity, and thus people can be infected multiple times. Sometimes an infant can become symptomatically infected more than once even within a single RSV season.

It is very, very easy to contract RSV. It is spread by physical contact (such as shaking hands with an infected person) or thru the air (usually from sneezing or coughing). RSV can also live for several hours on surfaces, such as doorknobs, telephones, faucet handles, counters or used tissues, towels, etc. RSV infections are very common in areas where people are crowded together. In homes where there are multiple children, such as us, RSV can spread very rapidly from child to child. And older siblings can even bring the virus home from school or a friend's house.

For most people, RSV produces only mild symptoms, often indistinguishable from common colds and minor illnesses. The Centers for Disease Control consider RSV to be the "most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age." Infants born at less than 36 weeks gestational age are at a significantly elevated risk for severe RSV disease. According to the Centers For Disease Control and Prevention (CDC), each year, up to 125,000 children are hospitalized with serious RSV disease and some of these children may die from RSV complications. RSV is the leading cause of hospitalization for children under 1 year of age. And severe RSV infections may increase the risk of wheezing and asthma-like illness through childhood.

The practical implications of RSV are scary. At best, recuperation takes place at home with 2-hour breathing treatments through a nebulizer. Multiply those breathing treatments times three, and add other difficulties of having sick babies, not to mention the daily schedule that life with triplets brings, and you have a recipe for a long three weeks. But the worst part is that it would take years to repair the damage RSV does to premature lungs, including vulnerability to respiratory infection, likelihood of asthma, and continued reliance on nebulizers and steroids to clear bronchial passageways.

To illustrate, here's how RSV affects lungs (courtesy of the Synagis website). To see the pictures better, double-click on them.





Severe RSV disease is more likely to develop in babies with the following risk factors:

1. Premature birth. In infants born prematurely (ie, more than 4 weeks early), RSV can become a serious respiratory tract infection that requires hospitalization, especially early in life.
2. Being born with lung disease. Babies younger than 2 years old born with chronic lung disease who have needed medical care for it within 6 months before RSV season are at high risk.
3. Being born with heart disease. Babies younger than 2 years old born with serious heart disease may be at high risk.
4. Low birth weight. Low birth weight (less than 5½ pounds) greatly increases the risk of death from RSV.
5. Older brothers and sisters. Babies in contact with school-aged siblings can get RSV, particularly during the cold and flu season.
6. Going to daycare. Babies who go to daycare are at higher risk for getting RSV.3 (Daycare is defined by the Centers for Disease Control and Prevention [CDC] as any setting outside the home where a child regularly spends ≥4 hours/week with ≥2 unrelated children.)
7. Family history of asthma. There is a higher risk for severe RSV in children with a family history of asthma.
8. Tobacco smoke and other air pollutants. You should never allow anyone to smoke around your baby. Tobacco smoke and other air pollutants can irritate your baby’s lungs and make it harder to fight RSV.
9. Multiple births. Multiple births (for example, twins) increase the risk for RSV because of low birth weight and an increased number of young siblings in the household.

Of these factors, we have several--premature birth, a baby with a mild heart condition, family history of asthma, and multiple births, at least. That makes our triplets high-risk. Even though they appear healthy, our boys' lungs are still immature, and so we have to be extra careful.

There are simple steps that we can take. Thus we ask that:

1. Visitors and family members and caregivers wash their hands with warm water and soap before touching the babies.
2. Visitors must be free of cold symptoms for five days and should delay visits if they have been in contact with someone who is sick. It is a must to avoid being around the babies if you have a cold or fever. Even if the babies don't catch anything, we could, which means that either one of us would have to care for the triplets or that the sick parent would have to constantly change clothes and wear masks.
3. Avoid exposing the babies to other children with cold symptoms.
4. Please try to get a flu shot before they run out.

In essence, we're "quarantining" the babies and ourselves as much as possible this RSV season. Unfortunately, that means that we have to miss out on a lot of fun events, and risk angering people who may not understand the seriousness of RSV. We really want to make it through the triplets' first winter without ending up in the hospital. Their lungs have come a long way. But believe it or not, they are still very fragile, at least until they are 2. Then we can all breathe a little easier!

Sunday, October 28, 2007

Grumpy Pumpkins and Grandma!

The boys are doing very well! Everyone's gaining weight and growing like weeds. Jacen (4.7 lbs at birth) weighs 7 lbs 7 oz, Alex (3 lbs 7 oz at birth) weighs 6 lbs 7.5 oz, and Ty (3 lbs 13 oz at birth) weighs 6 lbs 12.5 oz). In fact, Jacen's working on his third chin and Ty and Alex are plumping up their cheeks. Everyone's getting so round that we decided to take a series of grumpy pumpkin pictures. We tried the pumpkin costumes on Alex first...

A sleepy Alex pumpkin...



Ty got stuffed in a pumpkin as well...




The pictures were so cute that we took all three outside on a warm day and planted our own pumpkin patch!





Jody's mom couldn't resist picking two of them (that's all she could hold)...




We also started putting the boys on their play gym mat.







All the boys also got new bibs, courtesy of their Grandma...





Wednesday, October 17, 2007

The Boys' First Week at Home...

You might wonder why we haven't updated the blog in about a week...happily, it's because the past week has been as uneventful as a week spent taking care of triplets can be. The boys eat, and sleep...then eat, and sleep, then eat, and sleep...then eat, and sleep...then eat, and sleep...then (you guessed it) eat, and sleep. That's pretty much a triplet day--six cycles of feeding and snoozing. Jacen likes to deviate a bit from that schedule to weedle on Jody or Matt now and then while he's being changed. What a life, huh?

On Saturday the triplets (dirty boys, all of them!) enjoyed their first bath. Afterwards we wrapped them in bathrobes that their Grandma Trisha had gotten them which supposedly are "newborn" sized. We probably could have fit Ty and Alex in each sleeve of the robe. What resulted were cute pictures of babies wrapped in oversize terry robes. Think of the triplets as hapless victims of the shrinking ray on the old Rick Moranis movie "Honey, I Shrunk the Kids"--or think pint-sized Hugh Hefners.

Other than that, the pictures this week are of--yes--the triplets sleeping. We think it's cute how they will curl up together. Alex, who sleeps in the middle, has cuddled up to both Jacen and Ty. How cute!

Here's Ty wrapped up in his robe...



And lounging around on the changing table...



Here's Alex, burrowed in his robe (see how big the sleeves are!)...



Note Alex's spiky blond hair...that definitely comes from the Madeira side!



Here's Jacen in his robe...(he has his lip curled up for some reason...perhaps he's trying to look a bit snooty and spoiled!)





Here's Alex curled up to Jacen...



And Ty curled up to Alex...



And Alex asleep in his boppy...



A strong wind must blow through the nursery to blow off the triplets' hats...either that or they all have miniature geysers on the tops of their heads. This is so odd.

Tuesday, October 9, 2007

Finally...A Party of 5! (Jacen comes home!)

At noon on October 9th Matt and Jody made their final trip to the NICU, to pick up Jacen. This time all three boys traveled in style in their triple decker stroller, which caused a lot of stares and comments. People would actually pull out their cell phone and make a phone call to tell someone else that they saw triplets! Matt and Jody know it's just because their boys are so darn cute.


Here's some pictures from the happy event...

Jacen's all ready to go, and bundled into his car seat...



Matt and Jody proudly stand by their trio in the deluxe triple decker (a.k.a. triplet limo...)



Here's Alex, in the front...

Ty in the middle...

And Jacen brings up the rear!

You can tell that all three are so excited to be home...



Reunited!



Monday, October 8, 2007

All Bottled Up and Nowhere to Go

Tonight Matt and Jody tentatively tried a technique known to triplet parents as "bottle propping," in which you nest each triplet in a boppy pillow (a U-shaped soft pillow) and then give them their bottles, which are then balanced on rolled flannel blankets or some other surface. It was a runaway success. Ty especially loved the boppy pillow and looked extra comfortable. It definitely made the 3:30 a.m. feeding go quickly as well; it cuts the time that each feeding takes down a full half-hour to an hour. That leaves more time to cuddle them afterwards!

Here are pictures from the bottle propping experiment...

The boys belly up to the bar...er, boppy...




Alex waiting to be fed...



Mmmm...efficient and tasty!



Ty contemplating a yummy bottle!



Orc wants his too...

Sunday, October 7, 2007

Ty and Alex Come Home!

This week something exciting happened! Ty came home on Friday, and Alex followed on Sunday!

Ty proved to be an extremely easy baby to take care of, leading Matt and Jody to believe that one is "easy." Alex's addition proves that two are more difficult. Apparently the boys have a competition as to who can unswaddle themselves first. Matt and Jody are splittiing the feeds, so we'll see what Jody thinks after she completes the 3:30 a.m. feeding cycle by herself...

Here are some pictures from this weekend...

Jody gets Ty dressed in his (rather large) coming home outfit (it's newborn sized!)...



Ty says "Oh no! I need to grow to fit into my own clothes!"



Fortunately, however, Ty does fit into his carseat...



And so Matt is able to pick him up and carry him out of the NICU after all! Ty is hiding beneath his blue cap...



Ty gets more alert however when he's home and dressed in something more comfy and is allowed to hang out on his own changing table before the first feeding...



Ty dines in style on the new leather Lazy Boy rocker recliner (Matt and Jody didn't tell him that they bought it for their own comfort!)...



And after Ty gets to relax on his own in a big crib! He looks lonely though.



Fortunately on Sunday Alex gets to join Ty at home. Here's Alex dressed and ready, next to a sleeping Jacen...



Jacen's left on his own until Tuesday morning...



Well, Alex is ready to join Ty at home...Ty (on the right) looks exhausted by the whole affair!



Now when they get home both brothers are snoozing...



Ty is so happy to have Alex home he just can't stay away and keeps breaking out of his swaddling to cuddle with (and bat at) Alex!

Friday, October 5, 2007

October is here!

This week the boys continued to grow and gain weight. All three were put on a four-hour feeding schedule and spent the week adjusting to that.

Jody brought in clothes from home for the boys, and they were styling in their new duds!



A mellow Ty decked out with alligators...




Alex says "I will eat my sleeve!"





But he looks as cuddly as a teddy bear...





Jacen finds his rainbow stripes way too exciting and lets loose with a huge yawn...clearly not much of a fashion mavin, is he?




Also, two of the triplets had baths with Matt and Jody. Matt scrubbed Ty first...

Ty says, "I'm not sure I want to go in there..."



Matt scrubs Ty...



Ty relaxes during the bath...



Jody gets ready to soap up Alex...



Everyone poses for the camera!