06/08/2022
Physiotherapy in a NICU
🔵 What is NICU?
🔹A neonatal intensive care unit is a specially equipped nursery; where critically ill and unstable infants receive diagnostic, therapeutic and life supportive care for a wide range of illnesses and conditions.
🔹In developing countries, almost 99% of neonatal deaths occur mostly due to prematurity and congenital defects.
🔹To decrease the neonatal mortality and morbidity and improving the survival rate of newborns, the NICU is well organized.
🔵 For whom does NICU used?
🔸it is used for infants who are/have,
▪️ Preterm
▪️ Low birth weight
▪️ Perinatal problem
▪️ Congenital abnormalities
▪️ Respiratory disorders
▪️ Neuromuscular disorders
▪️ For those who have undergone thoraco - abdominal surgery
🔸For better prognosis of high-risk infants; diagnostic and therapeutic approaches are being adopted in the NICU.
🔵 Benefits of NICU
◻️Surveillance of neurodevelopment in the first year of life is essential to ensure early detection of specific developmental delays and impairments, and to ensure timely referral for early intervention.
◻️ prolonged immobilization, lack of physical activity leads to demineralization and growth retardation of bone in newborns.
◻️Early intervention is not only important in optimizing long term outcomes for the child, but it also plays an important role in enhancing the parent - child relationship and parental wellbeing.
◻️NICU plays a big role in this duty.
🔵 Physiotherapy Management in NICU
◼️The developmental allied health team in NICU is crucial in early evaluation of gross motor, fine motor, feeding, and language development.
◼️Physiotherapy is a crucial part of the services delivered by the multidisciplinary team in NICU.
◼️The role of physiotherapy in the neonatal intensive care unit is historically been mainly associated with the care of the neonate’s lungs.
◼️ In addition to respiratory care the physiotherapist is also engaged in the assessment and management of neonates with either neurological or musculoskeletal disorders.
◼️ So mainly both chest physiotherapy as well as neuromuscular physiotherapy is used in NICU to treat infants.
◼️ Chest physiotherapy assessment focused mainly on vital parameter assessment (heart rate, respiratory rate, and partial pressure of oxygen saturation Sp O2).
◼️Chest physiotherapy helps in maintenance of a clear air way, re - expand collapsed segments of the lungs, maintain adequate levels of oxygenation.
◼️ Neuromuscular physiotherapy is beneficial for the promotion of posture and movement appropriate to gestational age and medical stability, to modulate sensory stimulation in the infant’s NICU environment, to promote behavioral organization and physiological stability, to foster infant – parent attachment, and to provide direct intervention for neonatal feeding dysfunction and oral motor deficits.
◼️Hydrotherapy in NICU helps in pain reduction and improvement in sleep cycle of hospitalized stable premature newborn.
◼️The neonatal physiotherapist should specialize in range of motion exercises to overcome musculoskeletal problems.
◼️These range of motion exercises performed by the therapist in different joints helps in increasing bone mineral density and weight gain in premature newborns.
◼️The role of the physiotherapist in the NICU has been noted to have an impact by lessening impairments and activity limitations and in the provision of family education.
By Bhagya Pasindu
References
https://pubmed.ncbi.nlm.nih.gov/26597804/
https://pubmed.ncbi.nlm.nih.gov/32054469/
https://pubmed.ncbi.nlm.nih.gov/34181888/
https://pubmed.ncbi.nlm.nih.gov/20137814/
https://pubmed.ncbi.nlm.nih.gov/34572190/
https://pubmed.ncbi.nlm.nih.gov/31110870/
https://pubmed.ncbi.nlm.nih.gov/22336194/
https://pubmed.ncbi.nlm.nih.gov/32077096/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902571/
https://journals.lww.com/pedpt/Abstract/1999/01130/Practice_Guidelines_for_the_Physical_Therapist_in.2.aspx
https://journals.lww.com/pedpt/Abstract/1989/01010/Competencies_for_the_Physical_Therapist_in_the.3.aspx
https://journals.healio.com/doi/abs/10.3928/19382359-20180325-02
https://journals.lww.com/pedpt/fulltext/2005/01730/Effectiveness_of_Developmental_Intervention_in_the.6.aspx
https://academic.oup.com/ptj/article/95/7/1006/2686465?login=true
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