1. { Therapeutic Interventions for the NICU and High Risk Neonate, Part II Meg Christy, OTR/L Pediatric Occupational Therapist Phoenix Children’s Hospital

2.  Risk for physiologic instability with activity exertion (i.e. cardiac diagnosis)  Late Preterm  Surgical-hospitalized past two weeks  Multiple physical anomalies  Multiple medical complications The High Risk Neonate

3.  Pediatrics. 129(1): e9-16, 2012 Jan.  Title: Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial.  Tools: Mother-Infant Transaction Program.  Outcomes measured via Child Behavior Checklist report and Strengths and Difficulties Questionnaire (teacher and parents).  146 infants.  Nutshell: Fewer behavioral problems when received early intervention. Early Intervention

4.  Early Human Development. 89(5):301, 6, 2013 May.  Title: The effect of in-hospital developmental care on neonatal morbidity, growth, and development of preterm Taiwanese infants: A randomized controlled trial.  178 VLBW infants. Control group:5 sessions care, Intervention group: 5 sessions care. 62 normal infants included to compare.  Conclusion: Developmental care results in short term reduced risk ROP, feeding desaturation, and enhanced weight gain at term age. Recent Research

5.  Myelomeningocele  Foam pillow: cut out for prone positioning  Prone Positioner:  Diaper cloth: rolled, folded  *RN’s not in favor of using beanie rolls due to firmness of beads on joints/skin. Positioning Techniques

6.  Journal of Perinatal & Neonatal Nursing. 16(1): 58-70, 2002. Jun.  Title: Musculoskeletal implications of preterm infant positioning in the NICU.  Discussion reveals the importance of nursing and therapists’ roles in preventing skull deformities, extremity malalignment, and gross motor delays via positioning. Positioning Relevance

7.  Sidelying: Zflo pillow used to support the omphalocele  Tumbleform seat: Zflo pillow under omphalocele to support its weight Omphalocele with Wound Vac

8.  Peanut Ball at bed height: infant prone over ball with head to side.  **Good positioning to get parents involved with infant and at eye contact with their infant while monitoring his/her physiology. Significant Neuro Injury: Low tone

9.  Used as much as possible as soon as infant physiologically stable enough, and mature enough.  Wonderful tool for parent bonding. Can be left bedside for out of bed positioning time for the chronic infant outside of therapy time. Mat Time

10.  Materials:  IV boards  Tan strapping material  Blue soft restraints  Kinesiotape  Aquaplast  Wet Suit material  Cotton balls Splinting

11.  Important for chronic patients  Term and post term infants tend to thrive more with routines  Family and caregivers can be better able to support infant’s developmental needs with a schedule or routine as medically appropriate. Schedules and Routines

12.  Beneficial for chronic and/or long term patients.  Help parents identify goals and needs for their infant’s developmental success.  Calming and comforting tool for parents  Discharge teaching tool.  Bonding tool. Developmental Care Conferences

13. Mat Activities

14.  IV board: for wrist neutralization  Tan strapping material: thumb abduction splints,  Blue restraints with/without cottonball: Thumb abduction splints  Kinesiotape: for wrist extension, finger extension, thumb abduction.  PT used: frequently for club feet for ankle neutralization Splinting Examples

15.  Body Glove  For Wrist extension, thumb abduction  In place of hard thermoplastics More Splinting

17.  American Journal of Occupational Therapy. 58(5): 509-20, 2004 Sept-Oct.  Parent Stress in the Neonatal Intensive Care Unit and the Influence of Parent and Infant Characteristics  Utilized Parental Stress Scale. 162 infant/parent combo. Parent Bonding

19.  Limitations:  Social: family life  Financial  Work  Maternal medical limitations  Transportation  Language barriers and familial understanding of child’s needs  Depression Need for Further Bonding

20. Family Communication

21. 2005  Created in part due to Picker Score results: Parent satisfaction, parent education  Defined:  DC Teaching Tool  Parent Bonding Tool  Creative means of therapeutic play for the more mature and/or chronically hospitalized infant. Development of Therapeutic Play Group

22. Therapeutic Touch

23.  Staffing  Operation  Stats Therapeutic Play Group

24.  Picker surveys mailed to family members to identify their understanding of infant’s developmental goals.  4.27 point increase in parent understanding of infant goals between year prior to developmental of group and year after group began. Therapeutic Play Group Results Research

25. Mom and Baby at Therapeutic Play Group

26. Parental Bonding in Therapeutic Play Group

27. Parent Bonding

28.  HEP Visual Aids:  My Hospital Notebook  The Way We Grow  Tummy Time brochure  Computer software program: bilingual Journey Quilt Beads Further Teaching Tools

29.  Lower head of bed as medically appropriate  Loosen nest  Remove /decrease supportive positioning aids  Change posted developmental goals  Work with nursing on discharge teaching  Provide more stimulation for infant Transition to Home

30.  Criteria  Orders  Procedure  Write up  Recommendations PCH NICU Follow Up Clinic

31.  Procedure: Outside Referrals

32. NICU Follow Up and Early Outpatient Services

33. Follow Up is Essential

34. Thank you!

37.  The effect of in-hospital developmental care on neonatal morbidity, growth and development of preterm Taiwanese infants: A randomized controlled trial.  Source Early Human Development. 89(5):301-6, 2013 May  Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial.  Source Pediatrics. 129(1):e9-e16, 2012 Jan. Resources

38.   Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics.     Source :American Journal of Occupational Therapy. 58(5):509-20, 2004 Sep-Oct. Resources

39.  Orenstein, Susan R.,MD,  JOURNAL OF PEDIATRICS 1990;I17:184-7)  Title: Prone positioning in infant  gastroesophageal reflux: Is elevation of  the head worth the trouble?

40.  mstocker@phoenixchildrens.com mstocker@phoenixchildrens.com