Early intervention services help the child reach their developmental potential, while also helping support the families of these young children. When babies are born too early or have a medical diagnosis necessitating intensive care, they spend a prolonged period of time in the hospital and are at risk for developmental delays. At the same time, families experience a wide range of emotions when their child is in an intensive care nursery. The initial focus tends to be on the child’s medical condition before focusing on how the child will develop. Once the medical situation is stable or resolved, many families will begin to ask what their child will be like developmentally as they get older. For the majority of children there is no answer for how their prematurity or medical diagnosis will affect them. Therefore, families will experience feelings of anxiety, helplessness, and sadness. This can negatively impact the well-being of the family as well as the development of the child.

The first 3 years of a child’s life are the most important for growing, learning, and developing qualitative skills. Starting programs and services during these first 3 years may help improve developmental outcomes. It may also decrease the need for specialized services when the child is older. Studies have shown that early intervention improves cognitive outcomes for infants (birth to 12 months) and for preschool age (ages 3 to 5 years); however, it is not conclusive whether the effects of early intervention are sustained through school age. Regarding motor outcomes, the effect was small for infant and preschool age, and even less for the long term.

The Individuals with Disabilities Education Act (IDEA) has key components for a comprehensive system of early intervention services. However, based on the infant’s diagnoses and birth history, each program may be different in the duration and frequency of services provided, and the developmental focus. So, there is great variability among individual states with regard to early intervention services provided and it is their responsibility to provide public awareness regarding their eligibility criteria.

Within the hospital setting, the most common types of therapy provided include physical, speech and language, occupational, and developmental. Therapy may be provided for a short period of time or ongoing depending on the needs of each child.

Infants and toddlers with mild to moderate delays may be more difficult to identify. When the delays are not obvious to the general community, the process can be delayed. Knowing the risks associated with prematurity or a specific diagnosis can help community providers process the referral and understand the need for services based on an underlying condition, rather than wait for a developmental delay. When evaluations and treatments begin early, many delays may be resolved and decrease the need for future services.

In neonatal intensive care units, the majority of infants meet eligibility criteria for early intervention based on an established condition, rather than a documented delay. For example, many states consider children who are born less than 27 weeks’ gestation, weigh less than 1200 g at birth, or have a grade III or IV intraventricular hemorrhage, at risk for developmental delays and they automatically qualify for a referral to their local early intervention program.

Each NICU is different as to the availability of therapy services that they provide. The main areas of development assessed for delay in high-risk babies are state regulation, motor, and feeding. As infants become older, their cognitive skills become more evident and the need for more appropriate developmental stimulation becomes evident.

1. 
   

   Risk factors

   
   

   There are many risk factors for infants who have experienced an intensive care nursery, whether hospitalized for a few days or months. For example, infants who are born of extremely low gestational age (<28 weeks), extremely low birthweight (<1000 g), hypoxic ischemic encephalopathy, congenital anomalies, or severe intraventricular hemorrhage (grade III or IV) are at a greater risk for needing early intervention within the first year of life. Services through early intervention for these conditions, and others, can include motor, sensory, feeding, visual, and cognitive therapy.

   
   
   
   
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      Surgery

      
      

      A few studies, using very small samples, have looked at what effects surgery has on an infant’s development within the first few months. Depending on the surgery and hospital length of stay, these infants are at risk for developmental delays. The longer the hospitalization, the greater chance an infant will have a delay in at least one domain. A Dutch study which assessed 80 infants between 6 months and 24 months of age showed an increased risk of delay in growth and motor skills.

      
      

      Generalized studies have reported that infants who underwent surgical procedures often perform lower on developmental assessments. Using the Bayley Scales of Infant Development (BSID II), children who were tested at 3 years of age were still demonstrating lower scores than their peers who had not required surgery. This continued to be true through early adolescence.

      
      
   2. 
      

      Infection

      
      

      Infants with a documented infection have also been reported to have developmental delays. For ELBW infants, 65% experience at least one infection during their hospitalization. With infections, head growth can become impaired and poor head growth is a known predictor of neurodevelopmental impairment. For infants who were considered very low birth weight (VLBW, <1500 g), 25% are known to have an infection during their hospitalization.

      
      

      In a study comparing infected and uninfected ELBW infants, there was a significant difference in the likelihood of adverse neurodevelopmental outcomes at follow up of 18 to 22 months of age. The infected group had a higher incidence of cerebral palsy and lower scores in motor and cognitive development on the Bayley Scales of Infant Development (BSID II).

      
      
   3. 
      

      Length of stay

      
      

      The duration of an NICU stay has been correlated with using specialized services at the age of 7 to 11.

   
   
2. 
   

   Sensory

   
   

   Hospitalized babies are subject to overstimulation and constant interruptions. It is very important to consider the environmental surroundings for premature and medically fragile infants. Many ELBW infants demonstrate poor state regulation, disorganization, and lack the ability to calm. The environments of NICUs are poorly conducive to positive developmental outcomes. The noise, lighting, and interruptions may lead to long-term sensory issues. These babies often have difficulty calming, transitioning from one activity to another, sleeping, and maintaining periods of alertness. Providers and staff knowledgeable of these sensory stressors can minimize these effects, and therapists trained in this area can begin early intervention in the hospital.

   
   
3. 
   

   Psychomotor

   
   

   ELBW infants are at an increased risk of having motor delays. The positioning of infants is very important during the hospitalization to promote appropriate tone, flexion and extension biases, and head control. Torticollis is a common problem in infants who have severe gastroesophageal reflux, an early head preference, or plagiocephaly. Therefore, routine care and appropriate positioning needs to be part of the infant’s daily assessment during their hospitalization.

   
   

   There is little evidence that intervention has an actual effect on the motor skills of infants in the hospital and up to 1 year of age; however, the quality of patterns of movements can easily be seen in these children with appropriate therapeutic intervention.

   
   
4. 
   

   Feeding

   
   

   Families are often very concerned with their baby’s feeding. For hospitalized babies in the NICU, feeding can be a difficult skill to acquire. Speech therapists or occupational therapists are frequently used in NICUs for infants at risk as they begin working on oral-motor skills.