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Uploaded byDr Zonera Khalid PT
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Pediatric and Neonatal Intensive Therapy and Physical Therapy Roles. Pediatric Physiotherapy

Detailed insights into NICU levels, neonatal care equipment, common conditions, and the critical role of physical therapy in neonatal and pediatric intensive care.

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PEDIATRIC AND NEONATAL INTENSIVE THERAPY Pediatric Physiotherapy Dr Zonera Khalid PT
Neonatal intensive-care unit (NICU) • A neonatal intensive-care unit (NICU), also known as an intensive care nursery (ICN), is an intensive-care unit specializing in the care of ill or premature newborn infants
Cont. • NICUs now concentrate on treating very small, premature, or congenitally ill babies. • Some of these babies are from higher-order multiple births, but most are still single babies born too early. • Premature labour, and how to prevent it, remains a puzzling problem for doctors. • Even though medical advancements allow doctors to save low-birth-weight babies, it is almost invariably better to delay such births.
Cont. • Besides prematurity and extreme low birth-weight, common diseases cared for in a NICU include perinatal asphyxia, major birth defects, sepsis, neonatal jaundice, and Infant respiratory distress syndrome due to immaturity of the lungs. • In general, the leading cause of death in NICUs is necrotizing enterocolitis. Complications of extreme prematurity may include intracranial hemorrhage, chronic bronchopulmonary dysplasia or retinopathy of prematurity. • An infant may spend a day of observation in a NICU or may spend many months there
Equipment • Incubator • An incubator is an apparatus used to maintain environmental conditions suitable for a neonate (newborn baby). It is used in preterm births or for some ill full-term babies. • Possible functions of a neonatal incubator are: • Oxygenation through oxygen supplementation by head hood or nasal cannula, or even continuous positive airway pressure (CPAP) or mechanical ventilation. • Infant respiratory distress syndrome is the leading cause of death in preterm infants,and the main treatments are CPAP, in addition to administering pulmonary surfactant and stabilizing the blood sugar, blood salts, and blood pressure.
• Observation: Modern neonatal intensive care involves sophisticated measurement of temperature, respiration, cardiac function, oxygenation, and brain activity. • Protection from cold temperature, infection, noise, drafts and excess handling:Incubators may be described as bassinets enclosed in plastic, with climate control equipment designed to keep them warm and limit their exposure to germs. • Provision of nutrition, through intravenous catheter or NG tube. • Maintaining fluid balance by providing fluid and keeping a high air humidity to prevent too great a loss from skin and respiratory evaporation
Neonatal intensive-care unit (NICU) • The definition of a neonatal intensive-care unit (NICU) according to the National Center for Statistics is a "hospital facility or unit staffed and equipped to provide continuous mechanical ventilatory support for a newborn infant". In 2012, the American Academy of Pediatric updated their policy statement delineating the different levels of neonatal care
Different levels of neonatal care • Level I, Well newborn nursery • Level II, Special care nursery • Level III, Neonatal intensive-care unit (NICU) • Level IV, Regional neonatal intensive-care unit (Regional NICU)
Level I (well newborn nursery) • Well newborn nurseries have the capability to provide neonatal resuscitation at every delivery; • Evaluate and provide postnatal care to healthy newborn infants • Stabilize and provide care for infants born at 35 to 37 weeks’ gestation who remain physiologically stable • Stabilize newborn infants who are ill and those born less than 35 weeks’ gestation until transfer to a facility that can provide the appropriate level of neonatal care. • Required provider types for well newborn nurseries include pediatricians, family physicians, nurse practitioners, and other advanced practice registered nurses
Level II (special care nursery) • Previously, Level II units were subdivided into 2 categories (level IIA & level IIB) on the basis of their ability to provide assisted ventilation including continuous positive airway pressure. • Level II units are also known as special care nurseries and have all of the capabilities of a level I nursery. In addition to providing level I neonatal care, Level II units are able to: • Provide care for infants born ≥32-week gestation and weighing ≥1500 g who have physiologic immaturity or who are moderately ill with problems that are expected to resolve rapidly and are not anticipated to need subspecialty services on an urgent basis
• Provide care for infants who are feeding and growing stronger or convalescing after intensive care • Provide mechanical ventilation for a brief duration (<24 h) or continuous positive airway pressure • Stabilize infants born before 32-week gestation and weighing less than 1500 g until transfer to a neonatal intensive-care facility • Level II nurseries are required to have pediatric hospitalists, neonatologists, and neonatal nurse practitioners in addition to Level I health care providers.
Level III (neonatal intensive-care unit) • Level III units are required to have pediatric surgeons in addition to care providers required for level II and level I. • Also, required provider types that must either be on site or at a closely related institution by prearranged consultative agreement include pediatric medical subspecialists, pediatric anesthesiologists, and pediatric ophthalmologists. In addition to providing the care and having the capabilities of level I and level II nurseries, level III neonatal intensive-care units are able to:
• Provide sustained life support • Provide comprehensive care for infants born <32 wks gestation and weighing <1500 g • Provide comprehensive care for infants born at all gestational ages and birth weights with critical illness • Provide a full range of respiratory support that may include conventional and/or high-frequency ventilation and inhaled nitric oxide • Perform advanced imaging, with interpretation on an urgent basis, including computed tomography, MRI, and echocardiography
Level IV (regional NICU) • The highest level of neonatal care provided occurs at regional NICU's, or Level IV neonatal intensive-care units. • Are located within an institution with the capability to provide surgical repair of complex congenital or acquired conditions • Maintain a full range of pediatric medical subspecialists, pediatric surgical subspecialists, and pediatric anesthesiologists at the site • Facilitate transport and provide outreach education
Role of PhysicalTherapist in Neonatal Intensive Care Unit •The PhysicalTherapist (PT) plays an integral role in the life of the newborn infant who has spina bifida. •The PT closely evaluates the neonate and part of that assessment includes determining what muscle groups are actively working in the infants lower extremities as well as available range of motion and neonatal reflexes. •Tolerance to handling and touch are also assessed as well as how the baby tolerates being in several positions.
• PT also works closely with orthopedics regarding recommendations for casting vs stretching exercises, which is specific to each baby. Parental education is imperative at this stage‐‐‐ the PT will teach the parents the following: 1. How to safely complete passive range of motion to the infants lower extremities 2. How to look for active muscle contractions 3. How to safely position your baby and transition from lying on their back to their side to their stomach 4. How to safely pick up your baby and various positions to hold your baby while ensuring that there isn’t increased pressure over your babies back if they had surgery to close their meningocele. 5. Developmental activities that are age appropriate‐‐‐ also selection of developmental activities to facilitate the growth of the babies gross motor skills.
Intensive Pediatric PhysicalTherapy • Intensive Pediatric PhysicalTherapy is scheduled 3 hours a day, 5 days a week for 3 weeks. This intensive level of therapeutic treatment allows enough motor practice for new motor patterns to become more automatic. • Equipment includes the universal exercise unit and theTherasuit.
• The universal exercise unit is designed to allow resistive training for even limited motor control through a system of pulleys and support. • It also provides partial weight support or resistance as needed during completion of functional activities. • The Therasuit™ is a soft dynamic proprioceptive orthotic which allows correction of posture and alignment to as close to normal as possible through a system of elastic rubber bands.
Pediatric and Neonatal Intensive Therapy and Physical Therapy Roles. Pediatric Physiotherapy