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OTs helps premature babies catch up
Wednesday February 13, 2013


For babies born prematurely, the tenuous first weeks of life often are filled with myriad medical interventions in the neonatal intensive care unit to help them adjust to life outside the womb. New research, however, suggests this time in the NICU is a critical window for some less-invasive approaches that can help these children catch up to their full-term peers: occupational and physical therapy.

Researchers at Washington University in St. Louis compared the reflex patterns, tone, stress levels and attentiveness of premature babies at term-equivalent age to full-term babies, and they found significant differences in all of these categories between the two groups. In addition, they tested the preterm infants twice during a six-week period and discovered that certain facets of motor function declined while the babies were in the NICU. The findings were published in October online in the Journal of Pediatrics.

"From a therapy standpoint, there are periods of time when we can make the biggest differences due to the brain’s ability to adapt and respond," said Bobbi Pineda, OTR/L, PhD, lead researcher of the study and a research assistant professor at Washington University School of Medicine in St. Louis. "Our findings suggest that therapy in the NICU prior to term age is important because drastic changes happen before the infant’s due date. This provides an opportunity to use therapy to mold their functional outcomes."

Although therapy for preemies is becoming more common, Pineda said there has been little research investigating the development of preterm infants before term-equivalent age. "NICU therapists have observed developmental change clinically in preterm infants, but research has not yet documented and reported changes that occur prior to term," she said.

Pineda’s team evaluated 75 premature infants at St. Louis Children’s Hospital at 34 weeks gestation and again at 40 weeks, and these results were compared to those of full-term babies at 40 weeks. One of the most significant differences was in the level of tone.

Pineda said she will continue to evaluate the preemies at ages 2, 4 and 6 to determine whether the children who receive physical, occupational or speech therapy after discharge experience improved outcomes.

Therapists in the NICU always are attentive to any indications of stress that signal it is time to stop therapy for the moment. A baby may push out a hand like a stop sign, stiffen and extend the legs, grimace, or arch if the therapy is causing stress. Therapists also are watching for any change in vital signs, such as a drop in heart rate or oxygen saturation level, or discoloration of the baby’s skin to gray.

While some hospitals do have a dedicated team of physical, occupational and speech therapists trained to work with preemies like St. Louis Children’s does, this model is not standard throughout the country, said Sue Ludwig, OTR/L, president and founder of the National Association of Neonatal Therapists. "Over time, I’ve seen a growing wave of neonatal therapists being integrated into the NICU," she said. "It has brought about improved relationships with the nursing and medical staff, and also broadened our perspective about what our roles can be."

Ludwig founded the NANT in 2009 because, frustrated with the lack of consistency in neonatal therapy throughout the country, she wanted to unite these therapists and establish consistent standards of care. Members can join online forums, participate in monthly webinars presented by experts in the field, attend annual conferences and participate in monthly mentoring calls with Ludwig. One of Ludwig’s longer-term goals is to create a certification for neonatal therapists.

"One thing that has become apparent in my work with this population is that preemies are not just little pediatric patients," Ludwig said. "They have their own set of problems and diagnoses and require therapists with a whole different skill set." •

Heather Stringer is a freelance writer.

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Wednesday February 13, 2013
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