Sorry, it's been a while since I've updated you.  I want to share Leo's newly home "newborn" pictures and let you know how he's doing.
Leo is doing very well. He spent exactly 12 weeks in the NICU and got to come home late on Monday February 28.  Riley ophthalmology followed Leo biweekly for his first six weeks home to make sure his blood vessels formed correctly. His eyes look good now and he only needs yearly follow ups. He is still on a blood pressure medicine and is being followed by nephrology for premature kidneys and hypertension.  We are hopeful this will resolve soon also.  Wednesday 4/27 Leo had his tongue and lip ties revised because we are still working on transitioning from combination breast and bottle feeding to fully breastfeeding.  He sees a craniosacral therapist and will be able to start First Steps physical therapy this month which should also help with breastfeeding.  His pediatrician doesn’t have any concerns. He is gaining weight well and just hit 11 pounds. We are so relieved to have him home even with the normal challenges like the newborn sleep schedule and adjusting to the addition of a new baby sibling.
Photo credit to our good friend Maike (M.Rinaye Photography). The newborn pictures were taken on March 6th, the day Leo turned three months old and still seven days before his due date.  I also attached a picture from Easter and one of him at 5 months old.

Leo might come home in two days on Monday February 28th.  More details to follow.  He's on day 3 of his going home count down.  He has to go 5 days without having an event where he stops breathing or his heart rate drops while he's sleeping.

Here are some pictures to see how far he's come.  Today is Saturday February 26. Leo is 37 weeks and 6 days gestational age or 11 weeks and 5 days old.  He weighs 6 lb 12 oz.  For reference, Max weighed 6 lb 10 oz at birth.

Jan 19 was the first day I held Leo while I was standing up.  Before that I always sat in the chair and waited for the nurses to place him on my chest.  It was usually a team of two nurses to make sure he and his collection of tubes and wires were handled correctly.  Now that he's on the lower oxygen support with the nasal cannula and in a crib, we are allowed to pick him up any time we want without assistance.

Talking about and trying to remember milestones for Leo can be hard.  I switch back and forth from gestational age/ adjusted age to his actual age.  Leo's gestational age (ga) was 32 weeks + 3 days (32+3) and his actual age was 6 weeks old when he got his crib.  How was that only 6 weeks from birth to crib milestone? Thinking back it felt like a tremendous amount of time.  It's taken me so long to post, he's now 11 weeks old.  He's already passed another huge span.

These 5 weeks in a crib are part of the change.  Now that we interact with him more like a typical baby, my mind's vice like grip on his gestational age is fading.  I sometimes think of his actual age, or more often I forget everything.  I realized after the fact, I wasn't at the hospital when Leo turned 1 month old.  I didn't commemorate his 1 month with a picture.  I took that day off instead, not thinking about the date.  I thought it was just due to fatigue, but a nurse reminded me that it is also a normal part of being a second child.  Not every milestone gets marked quite like with your first child.  I also wasn't with Leo the day he turned 2 months old.  Max and I went ice skating with friends instead and had a great day.

Max's new daycare asked for a photo for a family picture binder they are making.  I forgot to include Leo the first time.  I had to make a second order with the print lab to get a print of this collage I made.  The top image is from Nov 6, 2021.  I'm 22 weeks along, one month before Leo was born.  The bottom image of Leo is from January 25.

When we dropped it off at school another little boy said that was a picture of Max as a baby.  Max's response was something like, "No.  It's my . . . little . . .  My brother . . . baby Leonidas.  It's kind of a ninja name."

Leo is 33 weeks and 2 days adjusted gestational age (Jan 25). Today was his second eye exam to follow up from the first one at 31 weeks.

A baby’s retinal blood vessels begin to grow at 16 weeks and don’t finish growing until after the baby is born.  So an early birth can disrupt this growth or cause abnormal growth leading to a potentially blinding disease called Retinopathy of prematurity (ROP).  Leo's blood vessels are developing normally and have looked good in both of his exams.  They will continue biweekly follow up exams until the blood vessels are fully grown.

Leo was uncomfortable and didn't like the exam.  Luckily it was very short.  Leo was alone for his first exam.  I'm glad I got to observe today.  I'd say it took 3-4 minutes.

Next I held Leo for skin-to-skin and to practice non-nutritive sucking.  Leo was too tired and just wanted to sleep today.  After that Leo got a bath.  (Tuesday and Saturday are bath days in the NICU.  This is only the second bath I've seen.  They usually do them early in the morning before we get there, but they were delayed today waiting for his eye exam)

After our skin to skin time today, I got to see Leo dressed in a shirt for the first time. When I arrived today he only had on a diaper and this sleep sack. The nurse said he spit up on his shirt and she hadn't gotten him a new one yet.

Leo has started to "smile."  I don't think these are actual smiles.  Just his mouth making different shapes that sometimes are a smile, but they sure are cute.

Leo is 32 weeks gestational age today (41 Days old). Last night at 10:40, probably as they started his 11 pm care time, they popped his top to let him be in ambient room air. This change means clothes for the first time. Peter reported it looked like they wrapped him in a blanket with arms holes cut to make it a shirt, then they wrapped him in a new fuzzy sleep swaddle.

Also in the picture, you can see the syringe tube being held up by the bendy support arm. This tube is connected to the orange feeding tube that goes into Leo's stomach, and is how he burps. Air can get out this way to give him relief from pressure in his belly caused by his respiratory support.

Today when I got to Leo's room I didn't see the nurse for almost 30 min.  (That's not very typical, they are usually quick to come say hi.)  It gave me time to really look at all of his environment and stats.  I noticed his temperature monitor was turned off.  Later the nurse explained that they turned off the temperature control function of his isolette incubator.  The isolette was controlled by a temperature monitor on Leo, causing the bed to go up and down in temp based on what was needed to keep Leo in temperature range (goal = 36.5 deg C).  Now the bed is set to a constant 28 deg C and Leo is regulating on his own.  Also, instead of always knowing Leo's temp, now his care team only checks it every 3 hours with a thermometer placed in the arm pit.  This is one of the three criteria for Leo to sleep in a bed without a lid. (1) show ability to self regulate, (2) gain weight for 5 days in a row, (3) weigh at least 1700 g (3lb 12 oz).  The plan is to pop the lid off his bed tomorrow officially when he is 32 weeks gestational age.

This change caught me by surprise.  I have only been to the hospital a few days over the last two weeks to avoid getting Leo sick with my cold.  At 32 weeks he should still be in sensory deprivation in the womb.  It feels unnatural to me for him to be exposed to lights and sounds for the whole day.  I'm not ready for him to make this change.  I still want him protected under his lid and cover, but I don't get a say.  

I held Leo for almost 4 hours today since we have a lot of missed time to make up for.

Leo had a good weekend. He didn't have any events, and the ibuprofen seems to be working to shrink his PDA. He had an echo this morning that confirmed the PDA was a little bit smaller. He has been getting a little less fluid in order to keep less volume flowing across the PDA. I was a little worried about that at first, but he continues to gain weight. The doctors also checked his hematocrit levels, and they were a little low. That means he's going to get a blood transfusion later on this afternoon. It'll be his second one.

Leo is doing pretty well. He is on day three of getting ibuprofen to treat his PDA. It seems to be working. He hasn't had any "events" since they started the ibuprofen on Friday. He'll be getting another echo on Monday to see if his PDA has shrunk or closed up.

I got to hold him for about an hour and a half today. It was the first time I've held him since his second day alive. I've been trying to save skin to skin time for Stacey since he does so well with her normally. Today the timing just worked out well that I could hold him for a while.