Risk-adjusted/neuroprotective care services in the NICU: the elemental role of the neonatal therapist (OT, PT, SLP)

Craig, J W; Smith, Catherine R.

doi:10.1038/s41372-020-0597-1

Cited by 19 publications

(27 citation statements)

References 45 publications

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“…Further, we were able to define a national average of 17 beds per neonatal therapy FTE in the US. This aligns with previous neonatal therapy staffing calculations aimed at informing NICUs as to how many therapists to have on staff to serve the needs of infants and families within different units [1]. Previous models are based on allocating time for…”

Section: Discussionmentioning

confidence: 72%

“…Neonatal therapy is an advanced, highly-specialized clinical practice area [1], which is recognized as a crucial service to optimize the short and long-term outcomes of hospitalized infants [7]. NANT's Professional Collaborative (NPC) developed a scope of practice document that strongly recommends neonatal therapists work within a dedicated interprofessional team, with representation of all therapy disciplines (OT, PT, SLP) [7].…”

Section: Discussionmentioning

confidence: 99%

“…Other research reports on the makeup of a dynamic therapy team of 10 neonatal therapists in a single, 75-bed level-IV unit [24]. These publications highlight the important role of neonatal therapists and have contributed to the development of a defined algorithm for staffing neonatal therapists in the NICU [1].…”

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confidence: 99%

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Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

et al. 2021

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Objectives. To 1) estimate the total pool of neonatal therapists and the average number represented in each US-based NICU, and 2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors. Study Design. This study used several methods of data collection (surveys, phone calls, website searches) that were combined to establish a comprehensive list of factors across each NICU in the US. Results. We estimate 2333 neonatal therapy FTEs, with 4232 neonatal therapists covering those FTEs in the US. Among 564 NICUs, 432 (76%) had a dedicated therapy team, 103 (18%) had PRN therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level IV (n=112; 97%) and III (n=269; 83%) NICUs compared to level II NICUs (n=51; 42%) (p<0.001). Having a dedicated therapy team was related to having more NICU beds (p<0.001), being part of a free-standing children’s hospital or children’s hospital within a hospital (p<0.001), and being part of an academic medical center or community hospital (p<0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p=0.001), but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p>0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred US-based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of Level IV NICUs had at least one CNT). Conclusions. Understanding the composition of neonatal therapy teams at different hospitals across the US can drive change to expand neonatal therapy aimed at optimizing outcomes of high-risk families.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

et al. 2021

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“…Multiple interdisciplinary developmental care interventions for families are being successively reassessed by nursing and neonatal therapy researchers ( 233 – 235 ). Design of these studies requires consideration of improvements in neonatal unit construction ( 236 ) that encourage family participation.…”

Section: A Fetal/neonatal Neurology Program Includes Convalescent Neonatal Carementioning

confidence: 99%

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

Scher

2021

Front. Pediatr.

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Gene–environment interactions begin at conception to influence maternal/placental/fetal triads, neonates, and children with short- and long-term effects on brain development. Life-long developmental neuroplasticity more likely results during critical/sensitive periods of brain maturation over these first 1,000 days. A fetal/neonatal program (FNNP) applying this perspective better identifies trimester-specific mechanisms affecting the maternal/placental/fetal (MPF) triad, expressed as brain malformations and destructive lesions. Maladaptive MPF triad interactions impair progenitor neuronal/glial populations within transient embryonic/fetal brain structures by processes such as maternal immune activation. Destructive fetal brain lesions later in pregnancy result from ischemic placental syndromes associated with the great obstetrical syndromes. Trimester-specific MPF triad diseases may negatively impact labor and delivery outcomes. Neonatal neurocritical care addresses the symptomatic minority who express the great neonatal neurological syndromes: encephalopathy, seizures, stroke, and encephalopathy of prematurity. The asymptomatic majority present with neurologic disorders before 2 years of age without prior detection. The developmental principle of ontogenetic adaptation helps guide the diagnostic process during the first 1,000 days to identify more phenotypes using systems-biology analyses. This strategy will foster innovative interdisciplinary diagnostic/therapeutic pathways, educational curricula, and research agenda among multiple FNNP. Effective early-life diagnostic/therapeutic programs will help reduce neurologic disease burden across the lifespan and successive generations.

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“…They incorporate the influence of the biological, developmental and psychosocial aspects of humans, expressed through meaningful occupations (AOTA, 2018). This perspective provides a unique and valuable addition to the Neonatal Unit, (AOTA, 2018;Nightlinger, 2011) and requires a high level of education, skills and ongoing professional development (Craig & Smith, 2020).…”

Section: Introductionmentioning

confidence: 99%

Neonatal Occupational Therapy in Australia: A Survey and Recommendations for Developing Guidelines for Clinical Practice

McPharlin

Stewart

Gibbs

et al. 2020

tahs

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Aim and Background: Occupational Therapists form an essential part of the development and care of infants and families in Neonatal Units (NNU) across the world, however, little is documented about their practice in Australia. This article aims to develop a greater understanding of the role of Occupational Therapy in NNU in Australia, compared with international practice guidelines, and recommends the adoption of UK guidelines until Australia specific guidelines emerge. Method: An online questionnaire was developed from a systematic scoping review and piloted by an expert panel. Invitations were sent to thirty Occupational Therapists working in NNUs around Australia. Data analysis included using descriptive statistics and qualitative themes. Results: Twenty two (73%) of NNU Occupational Therapists responded to the survey, representing all levels of NNU. Results describe the current Occupational Therapy role in Australia as encompassing assessment, intervention, teamwork and a variety of ‘other’ activities, all of which required advanced knowledge, skills and paediatric experience, and involved ongoing high-level professional development. Occupational Therapy has a unique role to play in neonatal units. Future development of the role is reliant upon good advocacy and promotion, specialised training opportunities, prospects for networking, support and mentorship for the many Therapists working part-time, and ongoing research. The Australian Occupational Therapy NNU role compares similarly with those cited internationally (UK & US). The development of guidelines for evidence based clinical practice of neonatal Occupational Therapy in Australia was highly sought by clinicians. The adoption of the ‘Occupational Therapy in neonatal services and early intervention: practice guideline’ (RCOT 2017) is proposed until the emergence of specific Australian guidelines.

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Risk-adjusted/neuroprotective care services in the NICU: the elemental role of the neonatal therapist (OT, PT, SLP)

Cited by 19 publications

References 45 publications

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

Neonatal Occupational Therapy in Australia: A Survey and Recommendations for Developing Guidelines for Clinical Practice

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