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Ogata Y, Matsugaki R, Zaizen M, Kuhara S, Muramatsu K, Matsuda S, Suga S, Ito H, Saeki S. Implementation Rate of Physical Rehabilitation in Neonatal Intensive Care Units in Japan: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1075. [PMID: 39064504 PMCID: PMC11279125 DOI: 10.3390/medicina60071075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014-2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at <28 weeks of age and extremely low birth weight infants (ELBWI) were more likely to receive physical rehabilitation interventions. The length of stay at the NICU and hospital, as well as the rate of discharge, were higher in patients who received physical rehabilitation than those in infants who did not. Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU.
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Affiliation(s)
- Yuto Ogata
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Ryutaro Matsugaki
- Department of Work Systems and Health, Institute of Industry Ecological Sciences, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Manami Zaizen
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Satoshi Kuhara
- Department of Rehabilitation, University Hospital of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan; (K.M.)
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan; (K.M.)
| | - Shutaro Suga
- Department of Pediatrics, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan
| | - Hideaki Ito
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan (S.S.)
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu 807-8556, Japan (S.S.)
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Merino-Andrés J, Pérez-Nombela S, Álvarez-Bueno C, Hidalgo-Robles Á, Ruiz-Becerro I, Fernández-Rego FJ. Neonatal hyperbilirubinemia and repercussions on neurodevelopment: A systematic review. Child Care Health Dev 2024; 50:e13183. [PMID: 37842871 DOI: 10.1111/cch.13183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Accumulation of bilirubin above normal levels is considered a neurological risk factor for both premature and full-term newborns. This systematic review aimed to determine the effect of neonatal hyperbilirubinemia on neurodevelopment in preterm and full-term newborns. METHODS PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus and Lilacs databases were searched for articles published until 1 June 2022. The quality of cohort and case-control studies was assessed with the Newcastle-Ottawa Scale, and the MINCir scale was used to evaluate the methodological quality of therapy studies or the therapeutic procedures. Premature neonates without neurological conditions and those born at term with hyperbilirubinemia as the sole risk factor were included. Studies reporting one or more neurodevelopmental outcomes were included with an inter-group comparison of a hyperbilirubinemia group versus a non-hyperbilirubinemia or non-pathological hyperbilirubinemia group. The main outcomes were auditory function, visual function, cognitive function, motor function, behavior, global development and neurological risk. RESULTS The search identified 951 studies, 19 of which (n = 2210 newborns) were finally included. Fifteen of the cohort and case-control studies presented low risk of bias, and six studies showed high methodological quality. Within the preterm population, hyperbilirubinemia as the sole risk factor was not shown to affect neurodevelopment. Auditory, neurological and motor development alterations were found in the population of full-term newborns with hyperbilirubinemia, which were more evident during the first year of life. CONCLUSIONS Elevated bilirubin levels may be a trigger for the onset of neurodevelopmental disorders in full-term infants during the first year of life. More studies are warranted in the preterm population with hyperbilirubinemia to draw conclusions about its impact on their neurodevelopment.
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Affiliation(s)
- Javier Merino-Andrés
- Faculty of Physiotherapy and Nursing, Physiotherapy Research Group of Toledo (GITFO), Universidad de Castilla-La Mancha, Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
- Centro Crecer, Toledo, Spain
| | - Soraya Pérez-Nombela
- Faculty of Physiotherapy and Nursing, Physiotherapy Research Group of Toledo (GITFO), Universidad de Castilla-La Mancha, Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
| | - Celia Álvarez-Bueno
- Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Álvaro Hidalgo-Robles
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, Toledo, Spain
- Universidad Internacional de La Rioja, La Rioja, Spain
| | | | - Francisco Javier Fernández-Rego
- Physiotherapy Department, University of Murcia, Murcia, Spain
- Early Care Research Group (GIAT), University of Murcia, Murcia, Spain
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Bosserman J, Kelkar S, LeBlond KD, Cassidy J, McCarty DB. Postural Control Measurements to Predict Future Motor Impairment in Preterm Infants: A Systematic Review. Diagnostics (Basel) 2023; 13:3473. [PMID: 37998609 PMCID: PMC10670104 DOI: 10.3390/diagnostics13223473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Preterm infants are more likely to demonstrate developmental delays than fullterm infants. Postural measurement tools may be effective in measuring the center of pressure (COP) and asymmetry, as well as predicting future motor impairment. The objective of this systematic review was to evaluate existing evidence regarding use of pressure mats or force plates for measuring COP and asymmetry in preterm infants, to determine how measures differ between preterm and fullterm infants and if these tools appropriately predict future motor impairment. The consulted databases included PubMed, Embase, Scopus, and CINAHL. The quality of the literature and the risk of bias were assessed utilizing the ROB2: revised Cochrane risk-of bias tool. Nine manuscripts met the criteria for review. The postural control tools included were FSA UltraThin seat mat, Conformat Pressure-Sensitive mat, Play and Neuro-Developmental Assessment, and standard force plates. Studies demonstrated that all tools were capable of COP assessment in preterm infants and support the association between the observation of reduced postural complexity prior to the observation of midline head control as an indicator of future motor delay. Postural measurement tools provide quick and objective measures of postural control and asymmetry. Based on the degree of impairment, these tools may provide an alternative to standardized assessments that may be taxing to the preterm infant, inaccessible to therapists, or not sensitive enough to capture motor delays.
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Affiliation(s)
- Jennifer Bosserman
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD 21205, USA;
| | - Sonia Kelkar
- Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Kristen D. LeBlond
- Physical Therapy and Occupational Therapy, Duke Health, Durham, NC 27705, USA
| | - Jessica Cassidy
- Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Dana B. McCarty
- Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
- North Carolina Children’s Hospital, Chapel Hill, NC 27599, USA
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McCarty DB, Dusing SC, Thorpe D, Weinberger M, Pusek S, Gilbert A, Liu T, Blazek K, Hammond S, O'Shea TM. A Feasibility Study of a Physical and Occupational Therapy-Led and Parent-Administered Program to Improve Parent Mental Health and Infant Development. Phys Occup Ther Pediatr 2023; 44:316-335. [PMID: 37867378 PMCID: PMC11018484 DOI: 10.1080/01942638.2023.2271102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
AIMS Extremely premature birth puts infants at high risk for developmental delay and results in parent anxiety and depression. The primary objective of this study was to characterize feasibility and acceptability of a therapist-led, parent-administered therapy and massage program designed to support parent mental health and infant development. METHODS A single cohort of 25 dyads - parents (24 mothers, 1 father) and extremely preterm (<28 wk gestation) infants - participated in the intervention. During hospitalization, parents attended weekly hands-on education sessions with a primary therapist. Parents received bi-weekly developmental support emails for 12 months post-discharge and were scheduled for 2 outpatient follow up visits. We collected measures of parent anxiety, depression, and competence at baseline, hospital discharge, and <4 and 12 months post-discharge. RESULTS All feasibility targets were met or exceeded at baseline and discharge (≥70%). Dyads participated in an average of 11 therapy sessions (range, 5-20) during hospitalization. Lower rates of data collection adherence were observed over successive follow ups (range, 40-76%). Parent-rated feasibility and acceptability scores were high at all time points. CONCLUSIONS Results support parent-rated feasibility and acceptability of the TEMPO intervention for extremely preterm infants and their parents in the Neonatal Intensive Care Unit.
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Affiliation(s)
- Dana B McCarty
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Deborah Thorpe
- Department of Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susan Pusek
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alana Gilbert
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tianyi Liu
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kerry Blazek
- Department of Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Sara Hammond
- Department of Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - T Michael O'Shea
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Rogers SC, Malik L, Fogel J, Hamilton B, Huisenga D, Lewis-Wolf C, Mieczkowski D, Peterson JK, Russell S, Schmelzer AC, Smith J, Butler SC. Optimising motor development in the hospitalised infant with CHD: factors contributing to early motor challenges and recommendations for assessment and intervention. Cardiol Young 2023; 33:1800-1812. [PMID: 37727892 DOI: 10.1017/s1047951123003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Neurodevelopmental challenges are the most prevalent comorbidity associated with a diagnosis of critical CHD, and there is a high incidence of gross and fine motor delays noted in early infancy. The frequency of motor delays in hospitalised infants with critical CHD requires close monitoring from developmental therapies (physical therapists, occupational therapists, and speech-language pathologists) to optimise motor development. Currently, minimal literature defines developmental therapists' role in caring for infants with critical CHD in intensive or acute care hospital units. PURPOSE This article describes typical infant motor skill development, how the hospital environment and events surrounding early cardiac surgical interventions impact those skills, and how developmental therapists support motor skill acquisition in infants with critical CHD. Recommendations for healthcare professionals and those who provide medical or developmental support in promotion of optimal motor skill development in hospitalised infants with critical CHD are discussed. CONCLUSIONS Infants with critical CHD requiring neonatal surgical intervention experience interrupted motor skill interactions and developmental trajectories. As part of the interdisciplinary team working in intensive and acute care settings, developmental therapists assess, guide motor intervention, promote optimal motor skill acquisition, and support the infant's overall development.
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Affiliation(s)
- Stefanie C Rogers
- Children's Health Rehabilitation and Therapy Services, Children's Medical Center Dallas, Dallas, TX, USA
| | - Lauren Malik
- Primary Children's Hospital, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | - Anne C Schmelzer
- Duke University Pediatric and Congenital Heart Center, Durham, NC, USA
| | - Jodi Smith
- The Mended Hearts, Inc., Leesburg, GA, USA
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Wang H, Wang Y, Liang X, Zhang C, Guo B. Value of red cell distribution width-to-platelet ratio as a predictor for morbidity and mortality in neonatal intensive care unit. Clin Hemorheol Microcirc 2022; 81:281-291. [PMID: 35404269 DOI: 10.3233/ch-221388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scoring neonatal acute physiology is significant for improving the survival rate of neonates in neonatal intensive care units (NICU). Red blood cell distribution width to platelet ratio (RPR) has been used to evaluate physiology of multiple diseases. However, the value of RPR as a predictor for morbidity and mortality in NICU remains unclear. The score for neonatal acute physiology and perinatal extension II (SNAPE-II) was used to evaluate the physiology and separate neonates into Mild (n = 45), Moderate (n = 45) and Severe (n = 45) groups. White blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in cord blood were examine. Spearman’s correlation and receiver operating characteristic analysis were performed to demonstrated the correlations of these indicators. There was a positive correlation between the SNAPE-II scores and RPR in neonates in NICU. The WBC, PCT and CRP levels increased with the upregulation of SNAPE-II scores in neonates in NICU and there were positive correlations between RPR and WBC, PCT and CRP, respectively. RPR could be used as a supplementary predictor for the evaluation of neonatal morbidity and mortality in NICU beside SNAPE-II.
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Affiliation(s)
- Haiyan Wang
- Department of Neonatology, Cangzhou Central Hospital, Xinhua Road, Cangzhou, Hebei, China
| | - Yuchun Wang
- Department of Neonatology, Cangzhou Central Hospital, Xinhua Road, Cangzhou, Hebei, China
| | - Xiuying Liang
- Department of Neonatology, Cangzhou Central Hospital, Xinhua Road, Cangzhou, Hebei, China
| | - Chunyan Zhang
- Department of Neonatology, Cangzhou Central Hospital, Xinhua Road, Cangzhou, Hebei, China
| | - Binfang Guo
- Department of Neonatology, Cangzhou Central Hospital, Xinhua Road, Cangzhou, Hebei, China
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Johnston C, Stopiglia MCS, Ribeiro SNS, Baez CSN, Pereira SA. Reply to: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit. Rev Bras Ter Intensiva 2022; 34:310-311. [PMID: 35946666 DOI: 10.5935/0103-507x.20220033-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cíntia Johnston
- Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Leone M, Alsofrom J, Kane M, Laryea S, Abdelatif D, Mohamed MA. Length of Neuromuscular Re-education Therapy and Growth Parameters in Premature Infants. Am J Perinatol 2022; 39:429-435. [PMID: 32916750 DOI: 10.1055/s-0040-1716492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuromuscular re-education (NMRE) therapy including bracing, containment, facilitation techniques, joint compression, weight (WT) bearing, and myofascial release has been shown to improve neurodevelopmental maturation in premature infants. This study aimed to examine the association of NMRE with growth parameters including WT and length (L) at 36 weeks postmenstrual age (PMA) and at discharge. STUDY DESIGN We analyzed data of infants <34 weeks gestational age (GA) or <1,800 g birth weight (BW) to examine the association of NMRE with growth parameters using correlation coefficient analysis. The effect of potential confounders was examined using multilinear regression models. RESULTS Study includes 253 premature infants. Average GA was 300/7 weeks (±23/7) and BW was 1,315 g (±416), 49.8% were females and 65% were African Americans. NMRE has inverse correlation with WT at birth and at 36 weeks PMA, -0.66 (<0.001) and -0.21 (<0.001), respectively, but not at the time of discharge. NMRE has direct correlation with change in WT from birth to 36 weeks PMA and time of discharge, 0.50 (<0.001) and 0.62 (<0.001), respectively, and from the time of starting therapy to 36 weeks PMA or discharge, 0.25 (<0.001) and 0.51 (<0.001), respectively. There was no negative correlation between NMRE with daily WT gain from birth to 36 weeks PMA or to discharge, -0.05 (0.43) and -0.07 (0.23), respectively, or from the time of starting therapy to 36 weeks PMA, -0.09 (0.14). There was an inverse correlation between NMRE with average WT gain per day from the time of starting therapy to discharge, -0.26 (<0.001), Similar findings were found examining the correlation between NMRE and changes in L. Multilinear regression analysis examining the relationship while controlling for GA, BW, sex, and race; socioeconomic variables; and concurrent massage therapy and sensory integration revealed similar results. CONCLUSION NMRE, aimed to enhance neurodevelopmental outcomes of premature infants, may not have a negative impact on their physical growth. KEY POINTS · NMRE has been introduced in the care of premature infants to improve neurodevelopmental outcomes.. · It was hypothesized that NMRE may cause stress and lead to failure to thrive or suboptimal growth.. · The association of the duration of NMRE with length and weight gain in very low birth weight infants was examined, and there was no negative correlation..
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Affiliation(s)
- Mariana Leone
- Department of Maternal and Child Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica Alsofrom
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
| | - Megan Kane
- Department of Rehabilitation Services and Occupational Therapy, The George Washington University Hospital, Washington, District of Columbia
| | - Sarah Laryea
- Department of Rehabilitation Services and Occupational Therapy, The George Washington University Hospital, Washington, District of Columbia
| | - Dinan Abdelatif
- Department of Obstetrics and Gynecology, The George Washington University Medical Faculty Associates, Washington, District of Columbia
| | - Mohamed A Mohamed
- Department of Neonatology, Pediatrics Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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Aranha VP, Chahal A, Bhardwaj AK. A randomized controlled trial protocol in modifying neuromotor behavior of hospitalized preterm neonates using multimodal stimulations: MMS trial. J Pediatr Rehabil Med 2022; 15:459-468. [PMID: 35848042 DOI: 10.3233/prm-200752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Noxious sensory inputs from the neonatal Intensive Care Unit (NICU) and lack of placental support negatively impact neuronal organization which has implications later in life. Evidence regarding early interventions (EI) on preterm neonates (PN) at high risk for developmental motor disorders is limited and inconclusive. This study focuses on neuromotor changes following Multimodal stimulations (MMS) with sensory and motor interventions among stable hospitalized PNs. METHODS This single-center, non-blinded pre-test post-test control group study will recruit 60 PNs admitted to the Level II and III NICU of a recognized tertiary care teaching hospital by convenience sampling method into two groups by block randomization. Group A (n = 30) will receive MMS trial lasting for 30 minutes per session for five days per week, until discharge of the neonate from the NICU; Group B (n = 30) will receive regular lifesaving care from the NICU. Anthropometric evaluation, physiological status, and Infant Neurological International Battery (INFANIB) will be the outcome measures used to analyze the neuromotor behavioral modifications among the hospitalized PNs. All the outcome measures will be recorded at baseline, after every five days (to compare trajectories of scores between the groups), and at the end of the intervention at the time of discharge of neonate from the NICU. RESULTS Demographic and outcome measures will be assessed for their normality using the Shapiro-Wilk test. Within and between-group comparisons will be analyzed by the repeated measures analysis of variance/Friedman test and independent t-test/Mann-Whitney U test respectively. CONCLUSION MMS, which includes both sensory and motor interventions, will, to the best of the authors' knowledge, be the first trial for modifying the neuromotor behavior of hospitalized PNs. If successful, the clinical effects of this protocol could be revolutionary in mitigating developmental impairments of PNs.
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Affiliation(s)
- Vencita P Aranha
- Department of Pediatric and Neonatal Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Aksh Chahal
- Department of Sports Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
| | - Anand K Bhardwaj
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana, Haryana, India
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Maria A, Upadhyay S, Vallomkonda N. Nurturing Beyond the Womb — Early Intervention Practices in Newborn Care Unit. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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KHURANA SONIA, KANE AUDREYE, BROWN SHAARONE, TARVER TALICIA, DUSING STACEYC. Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic review. Dev Med Child Neurol 2020; 62:684-692. [PMID: 32077096 PMCID: PMC7920849 DOI: 10.1111/dmcn.14485] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
AIM To synthesize the existing literature and determine the efficacy of neonatal therapy, starting in the neonatal intensive care unit (NICU), on the motor, cognitive, and behavioral outcomes of infants born preterm. METHOD Databases were searched for randomized controlled trials or quasi-randomized controlled trials of direct therapy early intervention for infants with a gestational age of less than 37 weeks, initiated in the NICU and delivered by a therapist or parent with therapist support. Quality was evaluated using the Cochrane standardized risk of bias assessment tool. Recommendations were made using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS Fifteen studies met the inclusion criteria. Studies were categorized into four intervention categories: (1) parent-delivered motor intervention (PDMI); (2) therapist-delivered postural control intervention (TDPCI); (3) developmental care; and (4) oromotor intervention. Risk of bias varied from low (10 studies) to high (three studies) or was unclear (two studies). INTERPRETATION Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short-term and possibly long-term. TDPCI is effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist appear to be effective in improving short-term behavior but are inconclusive for motor and cognitive outcomes or long-term behavioral outcomes. Regarding oromotor interventions, there is insufficient research to be confident in their efficacy on improving developmental outcomes. WHAT THIS PAPER ADDS Parent-delivered motor interventions (PDMIs) are more effective in improving motor and cognitive outcomes than other interventions. Preliminary support indicates that daily PDMI improves motor and cognitive outcomes in the short- and possibly long-term. Therapist-delivered postural control interventions are effective in promoting short-term gains in motor development. Developmental care programs designed by a neonatal therapist are effective in improving the short-term behavior of infants born preterm. Oral motor interventions were found to have no effect on improving developmental outcomes.
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Affiliation(s)
- SONIA KHURANA
- Motor Development Lab, Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - AUDREY E KANE
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - SHAARON E BROWN
- Physical Therapy Department, Virginia Commonwealth University Health, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - TALICIA TARVER
- Tompkins-McCaw Library for the Health Sciences, Virginia Commonwealth University Libraries, Richmond, Virginia, USA
| | - STACEY C DUSING
- Motor Development Lab, Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
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12
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Yang CF, Xue Y, Feng JY, Jia FY, Zhang Y, Li YM. Gross motor developmental dysfunctional outcomes in infantile and toddler pediatric intensive care unit survivors. BMC Pediatr 2019; 19:508. [PMID: 31862006 PMCID: PMC6925463 DOI: 10.1186/s12887-019-1893-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
Background Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n = 24) or non-dysfunctional (n = 11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r = 0.621, P < 0.001), and negatively correlated with length of PICU stay (r = − 0.556, P = 0.001), days sedated (r = − 0.602, P < 0.001), days on invasive mechanical ventilation (IMV; r = − 0.686, P < 0.001), and days on continuous renal replacement therapy (CRRT; r = − 0.538, P = 0.001). Linear regression analysis showed that IMV days (β = − 0.736, P = 0.001), sepsis (β = − 18.111, P = 0.003) and PCIS (β = 0.550, P = 0.021) were independent risk factors for gross motor developmental dysfunction. Conclusions Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis. Trial registration The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196.
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Affiliation(s)
- Chun-Feng Yang
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yang Xue
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Jun-Yan Feng
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, 130021, China
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Yu Zhang
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Yu-Mei Li
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, 130021, China.
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Physical Therapy Management of a Critically-Ill Infant After Cardiac Surgery: A Case Report and Literature Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Lee YN, Shin H. Analysis of Nurses’ Soothing Behaviors in Neonatal Intensive Care Unit: Focused on Babies with Bronchopulmonary Dysplasia. CHILD HEALTH NURSING RESEARCH 2017. [DOI: 10.4094/chnr.2017.23.4.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ross K, Heiny E, Conner S, Spener P, Pineda R. Occupational therapy, physical therapy and speech-language pathology in the neonatal intensive care unit: Patterns of therapy usage in a level IV NICU. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 64:108-117. [PMID: 28384484 PMCID: PMC5484726 DOI: 10.1016/j.ridd.2017.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES 1) To describe the use of occupational therapy (OT), physical therapy (PT) and speech-language pathology (SLP) services in a level IV neonatal intensive care unit (NICU), 2) to describe predictors of early therapy usage, and 3) to test the hypothesis that more NICU-based therapy will relate to better neurobehavioral outcomes. METHODS Seventy-nine infants born ≤32 weeks gestation had therapy interventions, as standard of care, tracked across NICU hospitalization. Infants received neurobehavioral testing prior to NICU discharge. RESULTS All (100%) received OT and PT, and 41 (51%) received SLP. The average age at initiation of OT, PT, and SLP was 30.4±1.4, 30.3±1.4, and 35.9±2.3 weeks postmenstrual age, respectively. Infants received therapy an average of 1.8±.4, 1.8±.4 and 1.1±.5 times per week for OT, PT and SLP, respectively. There were 56 different therapeutic interventions performed. There was overlap in the interventions provided by different NICU therapists; however, interventions unique to each discipline were identified. More therapy was not related to better neurobehavioral outcomes, but rather more frequent therapy could be attributed to more complex medical conditions (p<0.05). CONCLUSION Early therapy services in the NICU can start early in gestation and continue routinely until NICU discharge in order to optimize outcomes. These findings can aid our understanding of how neonatal therapy services are implemented in a level IV NICU.
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Affiliation(s)
- Katherine Ross
- Washington University School of Medicine, Program in Occupational Therapy, USA
| | - Elizabeth Heiny
- Washington University School of Medicine, Program in Occupational Therapy, USA
| | - Sandra Conner
- Saint Louis Children's Hospital, Department of Therapy Services, USA
| | - Patricia Spener
- Saint Louis Children's Hospital, Department of Therapy Services, USA
| | - Roberta Pineda
- Washington University School of Medicine, Program in Occupational Therapy, USA; Washington University School of Medicine, Department of Pediatrics, USA.
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Early Initiation of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Reduces Length of Stay: A Quality Improvement Project. J Pediatr Nurs 2017; 32:59-63. [PMID: 27923536 DOI: 10.1016/j.pedn.2016.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 10/22/2016] [Accepted: 11/06/2016] [Indexed: 11/20/2022]
Abstract
Infants born at ≤32weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization. Half (50.6%) of the infants admitted to this 84-bed Level IV Neonatal Intensive Care Unit (NICU) with a gestational age of ≤32weeks were referred for NIDCAP. The specific aims of this quality improvement project were to 1) compare the age at discharge for infants meeting inclusion criteria enrolled in NIDCAP with the age at discharge for those eligible infants not enrolled in NIDCAP; and 2) investigate the timing of initiation of NIDCAP (e.g., within six days of admission) on age at discharge. During the 12month period of data collection, infants enrolled in NIDCAP (M=27.85weeks, SD=1.86) were 2.02weeks younger than those not enrolled in NIDCAP (M=29.87weeks, SD=2.49), and were 2.32weeks older at discharge (M=38.28weeks, SD=5.10) than those not enrolled in NIDCAP (M=35.96weeks, SD=5.60). Infants who enrolled within 6days of admission were discharged an average of 25days sooner (p=0.055), and at a younger post-menstrual age (by 3.33weeks on average), than those enrolled later (p=0.027).
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17
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Effect of time and body position on ventilation in premature infants. Pediatr Res 2016; 80:499-504. [PMID: 27331352 DOI: 10.1038/pr.2016.116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infants with respiratory dysfunction undergo regular position changes to improve lung function however it is not known how often a position change should occur. This study measured changes in lung function occurring over time after repositioning in preterm infants. METHODS Changes in end-expiratory level (EEL) and ventilation distribution were measured 30 mins, 2 h, and 4 h after repositioning into either prone, quarter turn from prone, or supine using Electrical Impedance Tomography (EIT). Physiological measurements were also taken. RESULTS Sixty preterm infants were included in the study. Infants receiving respiratory support (mechanical ventilation or continuous positive airway pressure (CPAP)) had improved ventilation homogeneity after 2 h (P < 0.01), maintained at 4 h. Spontaneously breathing infants had improved homogeneity at 2 h (P < 0.01) and improved global EEL after 4 h (P < 0.01) whereas infants receiving CPAP demonstrated an improved global EEL at 2 h (P < 0.01). CONCLUSION Regional ventilation distribution is influenced by time independent of changes due to body position. Differences exist between infants on ventilatory support compared with those who are spontaneously breathing. Infants receiving ventilatory support have a physiological peak in lung function after 2 h which remains above baseline at 4 h. A change in body position facilitates an improvement in lung function in infants on ventilatory support.
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Ronan S, Liberatos P, Weingarten S, Wells P, Garry J, O'Brien K, Parker-Bozzuto S, Schultz SL, Nevid T. Development of Home Educational Materials for Families of Preterm Infants. Neonatal Netw 2016; 34:102-12. [PMID: 26803091 DOI: 10.1891/0730-0832.34.2.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Parent educational materials describing infant positioning for a home program are vital in supplementing NICU discharge instructions and promoting parent confidence. PURPOSE To document the process of developing a brochure and DVD of a positioning program, using evidence-based practice and NICU expert feedback. METHODS A trifold brochure and companion DVD were developed to demonstrate infant positioning to parents of premature infants for a home developmental program following NICU discharge. A standard process of development was followed for the brochure and DVD script and production. The process included review and comment by eight NICU professionals and several revisions. RESULTS Content of the brochure and DVD and the process entailed in their development is described. Guidelines outlining the process for development of educational materials for families are provided. CONCLUSION Creation of multimedia educational materials for parents of infants who are NICU graduates requires a multistep process to ensure usefulness and validity.
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What is the role of the physiotherapist in paediatric intensive care units? A systematic review of the evidence for respiratory and rehabilitation interventions for mechanically ventilated patients. Physiotherapy 2015; 101:303-9. [PMID: 26051847 DOI: 10.1016/j.physio.2015.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physiotherapy in intensive care units (ICU) has traditionally focussed on the respiratory management of mechanically ventilated patients. Gradually, focus has shifted to include rehabilitation in adult ICUs, though evidence of a similar shift in the paediatric ICU (PICU) is limited. OBJECTIVES Review the evidence to determine the role of physiotherapists in the management of mechanically ventilated patients in PICU. DATA SOURCES A search was conducted of: PEDro, CINAHL, Medline, PubMed and the Cochrane Library. ELIGIBILITY CRITERIA Studies involving PICU patients who received physiotherapy while invasively ventilated were included in this review. Those involving neonatal or adult ICU patients, or patients on non-invasive or long-term ventilation, were not included in the study. STUDY APPRAISAL All articles were critically appraised by two reviewers and results were analysed descriptively. RESULTS Six studies on chest physiotherapy (CPT) met the selection criteria. Results support the use of the expiratory flow increase technique and CPT, especially manual hyperinflation and vibrations, for secretion clearance. Evidence does not support the routine use of either CPT or suction alone. No studies investigating rehabilitation in PICU met selection criteria. LIMITATIONS A lack of high level evidence was available to inform this review. CONCLUSION Evidence indicates that CPT is still the focus of physiotherapy intervention in PICU for mechanically ventilated patients, and supports its use for secretion clearance in this setting. PROSPERO register for systematic reviews (registration no. CRD42014009582).
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Chokshi T, Alaparthi GK, Krishnan S, Vaishali K, Zulfeequer CP. Practice patterns of physiotherapists in neonatal intensive care units: A national survey. Indian J Crit Care Med 2014; 17:359-66. [PMID: 24501488 PMCID: PMC3902571 DOI: 10.4103/0972-5229.123448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. MATERIALS AND METHODS A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. RESULTS A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Karnataka, Maharashtra and Gujarat. More than 90% of physiotherapists performed chest physiotherapy in neonatal ICUs. Chest physiotherapy assessment predominantly focused on vital parameter assessment (86%) and in treatment predominantly focused on percussion (74.1%), vibration (75.5%), chest manipulation (73.3%), postural drainage (67.6%) and suction (65.4%). In neuromuscular physiotherapy more than 60% of physiotherapists used positioning, and parent education, whereas more than 45% focused on passive range of motion exercise and therapeutic handling. CONCLUSION The practice pattern of physiotherapists for neonates in neonatal intensive care units involves both chest physiotherapy as well neuromuscular physiotherapy. Chest physiotherapy assessment focused mainly on vital parameter assessment (heart rate, respiratory rate and partial pressure of oxygen saturation SpO2). Treatment focused on airway clearance techniques including percussion, vibration, postural drainage and airway suction. In neuromuscular physiotherapy most physiotherapists focused on parent education and passive range of motion exercise, therapeutic handling, as well as positioning.
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Affiliation(s)
- Tejas Chokshi
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - Shyam Krishnan
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - K Vaishali
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
| | - C P Zulfeequer
- Department of Physiotherapy, Kasturba Medical College (A constituent Institute of Manipal University), Bejai, Mangalore, Karnataka, India
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Abstract
Medical and technological advances in neonatology have prompted the initiation and expansion of developmentally supportive services for newborns and have incorporated rehabilitation professionals into the neonatal intensive care unit (NICU) multidisciplinary team. Availability of therapists specialized in the care of neonates, the roles of rehabilitation professionals, and models of service delivery vary from hospital to hospital based on philosophy, resources, and other considerations. To provide quality care for infants and families, cohesive team dynamics are required including professional competence, mutual respect, accountability, effective communication, and collaboration. This article highlights the contribution of each member of the NICU team. The dynamics of team collaboration are presented with the goal of improving outcomes of infants and families.
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Affiliation(s)
- Vanessa Maziero Barbosa
- Rehabilitation Department, University of Illinois Medical Center, Chicago, Illinois 60605, USA.
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Abstract
The purpose of this special issue of Physical & Occupational Therapy in Pediatrics is to present an evidence-based system to guide the physical therapy management of patients in the Neonatal Intensive Care Unit (NICU). Two systematic guides to patient management will be presented. The first is a care path intended primarily for use by physical therapists, and the second is a care path for families of infants being cared for in the NICU. In this article, background information on the concept of using care paths for clinical management is presented, followed by a general description of the two care paths for use in the NICU. Subsequent articles describe physical therapy practice in the context of the NICU team approach to care for medically fragile infants with more detail on use of the two care paths and the evidence supporting their contents.
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Affiliation(s)
- Suzann K Campbell
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60607, USA.
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Abstract
Family involvement is essential to the developmental outcome of infants born into Neonatal Intensive Care Unit (NICU). In this article, evidence has been presented on the parent's perspective of having an infant in the NICU and the context of family. Key points to an educational assessment are also reviewed. Throughout, the parent's concerns and the educational needs of the family are shared, and strategies are given to help therapists enhance their teaching skills and ways to partner with parents. This article also introduces the NICU Discharge Path for parents "Preparing for Your Baby to Come Home". The Path educates parents on the steps towards home and encourages their participation in the process.
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Affiliation(s)
- Lou Ann Goldstein
- Physical Therapy Department, University of Illinois at Chicago, Chicago, IL 60657, USA.
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Byrne E, Campbell SK. Physical therapy observation and assessment in the neonatal intensive care unit. Phys Occup Ther Pediatr 2013; 33:39-74. [PMID: 23311522 DOI: 10.3109/01942638.2012.754827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Assessment in the NICU begins with a thorough review of the health care record. Assessment proceeds by using the least invasive methods of gathering the behavioral, developmental, physiologic, and musculoskeletal information needed to implement a physical therapy plan of care. As the neonate matures and can better tolerate handling, assessment methods include lengthier standardized tests with the psychometric properties needed for informing diagnosis and intervention planning. Standardized tests and measures for screening, diagnosis, and developmental assessment are appraised and special considerations for assessment of neonates in the NICU are discussed.
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Affiliation(s)
- Eilish Byrne
- Neonatal Intensive Care Unit, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94304, USA.
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