Medical Considerations and Practice Guidelines for the Neonatal Occupational Therapist

Abstract

Provision of safe and effective occupational therapy in neonatal intensive care units requires an understanding of neonatal medical conditions and treatment modalities. This article explains basic medical concepts and technology with terminology frequently encountered in neonatal intensive care. Discussions of neonatal thermoregulation, respiratory care, hemodynamic monitoring, and metabolic support are presented as general areas of focus. Equipment usage and precautions are included. Several case studies illustrate the incorporation of medical knowledge into neonatal occupational therapy practice.

Survey of neurodevelopmental allied health teams in Australian and New Zealand neonatal nurseries: Staff profile and standardised neurobehavioural/neurological assessment

“…Increasing evidence mandates that neurodevelopmental allied health staff across all disciplines possess higher level qualifications, and have graduated entry into the NICU/SCN environment . In the current study on average, physiotherapists and occupational therapists reported the highest qualifications, with speech pathologists reporting the lowest.…”

“…3 Increasing evidence mandates that neurodevelopmental allied health staff across all disciplines possess higher level qualifications, and have graduated entry into the NICU/SCN environment. 3,6,9,10 In the current study on average, physiotherapists and occupational therapists reported the highest qualifications, with speech pathologists reporting the lowest. Rapport 5 surveyed 709 NICUs across the USA: 60% of physiotherapists and occupational therapists had completed or were completing a masters or other advanced course, while 40% had no postgraduate certifications/qualifications.…”

“…3 The role of neurodevelopmental allied health within the multidisciplinary team is to work with medical staff, nursing staff and parents in executing and assimilating developmental care into the nursery environment serving to avert long-term developmental dysfunction. 3,[7][8][9] Due to their fragility, working with preterm infants in NICU/ SCN is deemed an advanced specialisation for physiotherapists, occupational therapists and speech pathologists, 10 with staff requiring specific skills, knowledge and training. 4 Neurodevelopmental allied health staff have a key role in the administration of standardised neurobehavioural/neurological assessments, including when and which assessment tools to use.…”

NICU Primer for Occupational Therapists: Exploring the Needs of Fragile Infants, the Context in Which They Are Cared For, and the Role of OT in This Specialized Practice Area—Part I of II

“…Premature infants often have difficulty feeding orally and obtaining enough nutrients for adequate growth (Caretto, Topolski, Linkous, Lowman, & Murphy, 2000;Hunter, Mullen, & Dallas, 1994); coordinating the suck-swallow-breathe triad to prevent aspiration of liquids while feeding (Glass & Wolf, 1998;Mathew, 1988); and operating immature lungs to breathe on their own (Glass & Wolf; Mathew). Immature oral reflexes, high stress levels, reduced oral sensory input, and decreased opportunity to suck as a result of non-oral feedings can all contribute to oral feeding inefficiencies and delayed oral motor development (Anderson, 1986;Case-Smith, 1988;Einarsson-Backes, Deitz, Price, Glass, & Hays, 1994;Hunter et al).…”

“…Immature oral reflexes, high stress levels, reduced oral sensory input, and decreased opportunity to suck as a result of non-oral feedings can all contribute to oral feeding inefficiencies and delayed oral motor development (Anderson, 1986;Case-Smith, 1988;Einarsson-Backes, Deitz, Price, Glass, & Hays, 1994;Hunter et al). These experiences can further lead to poor growth and longer hospital stays, as an infant's ability to fully feed by bottle and/or breast is a common criterion necessary for discharge to home (Shaker, 1999).…”