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CHAPTER 15: Neonatal Intensive Care Unit

Rachel Unanue Rose, PT, PhD, PCS

Introduction

The neonatal intensive care unit (NICU) is a technologically advanced setting that provides services to infants who require highly specialized services. Infants who are served in the NICU are at high risk both medically and developmentally, requiring a team approach to their complex care. Physical therapists who work in the NICU provide examination, evaluation, and intervention to these high-risk infants. NICU care is a specialized area within pediatric physical therapy, involving a different approach than that used in other types of pediatric settings. Due to the physiological, medical, and developmental issues facing infants in the NICU, physical therapists working in the NICU require pediatric experience and advanced training (Sweeney, Heriza, & Blanchard, 2009). Advanced training is necessary to safely provide services to these fragile infants and their families. This chapter provides a basic overview of service delivery in the NICU. Further study is required for physical therapists wishing to work in a NICU, especially the most intensive level III nursery.

Infants Served

The NICU serves infants with a variety of diagnoses. Infants admitted to the NICU are born both preterm and full-term. Infants who show signs of central nervous system (CNS) impairment, specific neuromuscular or orthopedic problems, multiple medical or genetic problems, abnormal feeding behaviors, and other symptoms that put infants at risk for developmental problems are often referred to physical therapy in the NICU (McCarton, Wallace, Divon, & Vaughn, 1996; Taylor, Klein, Schatschneider, & Hack, 1998) (Table 15.1).

Table 15.1Premature birth:Low birth weight:Very low birth weight:Small for gestational age (SGA):Large for gestational age (LGA):Microcephaly:Hypoxic ischemic encephalopathy:Genetic syndromes and diseases:Compromised respiration:Persistent feeding problems:Seizure disorder:Amniotic band syndrome:Myelomeningocele:

Common Diagnoses of Infants in the Neonatal Intensive Care Unit

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Table 15.1

Common Diagnoses of Infants in the Neonatal Intensive Care Unit
  • Premature birth:

    Less than 38 weeks' gestation

  • Low birth weight:

    Less than 2,500 grams

  • Very low birth weight:

    Less than 1,500 grams

  • Small for gestational age (SGA):

    Less than the 10th percentile

  • Large for gestational age (LGA):

    Greater than the 90th percentile

  • Microcephaly:

    Occipital frontal head circumference of less than the third percentile for the infant's gestational age at birth

  • Hypoxic ischemic encephalopathy:

    Full-term infant who has had a significant episode of intrapartum asphyxia

  • Genetic syndromes and diseases:

    Chromosomal abnormalities, gene disorders, unusual patterns of inheritance

  • Compromised respiration:

    Infant requires medical or mechanical assistance to achieve functional respiration

  • Persistent feeding problems:

    Infant is unable to take in adequate calories orally without special assistance

  • Seizure disorder:

    Neonatal seizures identified at or shortly following birth

  • Amniotic band syndrome:

    Intrauterine development of amniochorionic strands leading to limb and digital amputations or constrictions and other deformities

  • Myelomeningocele:

    Malformation of the spinal cord resulting from defective closure of the neural tube

Full-term infants are those ...

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