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Background: There are no evidence-based standards for if/when developmental interventions should be initiated while an infant is in the neonatal intensive care unit (NICU), or these services yield incremental benefit. To support future prospective studies evaluating the neurodevelopmental benefits of NICU-based services as well as standardizing protocols for developmental interventions in the NICU, a thorough descriptive investigation of current developmental intervention practices is necessary. Objective: To describe trends in the delivery of developmental interventions [physical therapy (PT), occupational therapy (OT), speech-language therapy (ST), child life (CL), and music therapy (MT)] in high-risk infants in a large level-IV NICU. Methods: Electronic records of infants discharged over a 30 month period were manually reviewed to extract demographic variables and therapy patterns. Results: Records for 449 extreme and very preterm infants (23 0/7 to 31 6/7 weeks gestation) were reviewed. Birth weights ranged from 0.340 kg to 2.570 kg. Overall, ST had the lowest rate (6.7%) and child life had the highest rate (73.3%); ST was started at the oldest postmenstrual age at 53 0/7 ± 8.4 weeks. Eight percent of the infants had a tracheostomy, 18.0% had a gastrostomy-tube. Infants with a tracheostomy or gastrostomy-tube were more likely to receive all of the interventions (p < 0.05). The tracheostomy infants receiving ST had a higher birth weight and a longer hospital stay (p’s < 0.05), irrespective of gestational age. For each developmental intervention, infants receiving the therapy had a longer hospital stay (p < 0.0001). There were no significant differences in use of any of the therapy types related to gender, race, or language. Conclusions: This study reveals varying rates of developmental interventions in < 32 week gestation infants, with longer hospital stays associated with higher rates of interventions. ST was the least utilized modality and initiated on average at the oldest postmenstrual age, possibly reflecting low provider familiarity with potential ST benefits. More trends on NICU-based services is needed to support prospective studies investigating the benefits.


Behavioral Medicine | Pediatrics


Presented at the The Children's Hospitals Neonatal Consortium, Columbus, OH, October 2018.

Developmental Intervention Patters in a Level IV Neonatal Intensive Care Unit (NICU)