The neonatal intensive care unit (NICU) is a technologically advanced setting that provides care to infants who require highly specialized services. Infants 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 require pediatric experience and advanced training to safely provide services (Sweeney, Heriza, & Blanchard, 2009). This chapter provides a basic overview of service delivery in the NICU. Further study is required for physical therapists wishing to work in the NICU, especially the most intensive level III and IV nurseries.
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, neonatal abstinence syndrome, abnormal feeding behaviors, and other symptoms that put infants at risk for developmental problems are often referred to physical therapy (Ross, Heiny, Conner, Spener, & Pineda, 2017) (Table 15.1).
TABLE 15.1Common Diagnoses of Infants in the Neonatal Intensive Care Unit ||Download (.pdf) TABLE 15.1 Common Diagnoses of Infants in the Neonatal Intensive Care Unit
Preterm birth: Less than 37 weeks of 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 amnio-chorionic 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
Neonatal abstinence syndrome (NAS): Postnatal withdrawal syndrome due to maternal opioid use during pregnancy
Full-term infants are those infants born between 37 and 42 weeks of gestation. Infants who are born at less than 37 weeks of gestation are considered preterm (Darcy, 2009; Engle, Tomashek, Wallman, & Committee on Fetus and Newborn, 2007). Infants are also classified according to ...