Neonatal intensive care unit

The NICU is needed for infants after complicated births. The goal of the NICU team is to address the acute or extremely severe symptoms or conditions of such infants so that they can become physiologically stable (i.e., maintain a stable body temperature, heart rate, and respiratory rate).

The medical team closely monitors the medical status of NICU clients. A neonatologist serves as the leader of the NICU team (Figure 3-1). In addition to conducting a neonatal assessment, the neonatologist consults with the other professionals on the medical team about the specific needs of the infant. The following conditions may indicate that an infant should be admitted to the NICU:

When presented with an infant who has one or more of these conditions, additional medical team members take part in consultations and provide further examinations. Pulmonologists (lung specialists), cardiologists (heart specialists), gastroenterologists (digestive specialists), neurologists (brain specialists), social workers, and respiratory therapists are some of the additional medical team members who may be needed to address the needs of infants in the NICU.

Pediatric intensive care unit

When the medical team determines that the infant has met certain physiologic requirements, the infant is moved out of the NICU. If the infant still requires some form of hospital-based medical care, the infant can be transferred to a step-down nursery or pediatric intensive care unit (PICU) (Figure 3-2). In addition to continuing to address the infant’s acute symptoms, the goals of the PICU team are to attempt to wean the infant from external sources of medical support and, when applicable, provide sensorimotor stimulation. As the infant is moved from one unit to another, additional team members may be required, and the services of certain other members may no longer be needed. For example, in the PICU, the infant’s medical team leader is no longer a neonatologist; it is a pediatrician.

Subacute setting

As an infant’s condition improves, he or she may no longer require the level of care provided in a PICU; however, the infant may not yet be ready to be discharged home. In this instance, the infant may be transferred to a subacute setting (Figure 3-3). The medical needs of the infant, as well as the desires of the infant’s primary caregivers affect this decision. The goals of the subacute team are to provide appropriate medical treatment while continuing to wean the infant off medical supports and carrying out development-based therapeutic interventions.

Home

As an infant’s status improves, discharge plans are formulated. The issue of where the infant goes after being discharged is discussed with the infant’s primary caregivers. Going home is the ultimate goal for infants in acute, step-down nursery, and subacute settings. Once at home, the goals are to facilitate caregiver and infant bonding and promote the continued acquisition of developmentally appropriate skills.

The infants receive medical care through scheduled clinic and outpatient hospital-based visits (Figure 3-4). The coordination of an infant’s nursing, therapy, and equipment needs are often transitioned to a community-based home care agency. These agencies monitor clients’ medical needs and coordinate home-based therapeutic services. The age of the client determines where the services are provided. Infants and young children usually receive home-based services. As children mature, their services may remain at home, or they may transition to an outpatient clinic or community-based early intervention (EI) or Early Head Start setting.

Long-term care facility

During discharge planning, some primary caregivers may decide that they are unable to handle their child’s specific medical needs. In these cases, residential (long-term care) facilities are options available to them. The goals of the long-term care team are to provide appropriate medical care and carry out appropriate therapeutic interventions. An example of a therapeutic intervention is providing sensorimotor stimulation to prevent the development of contractures and prevent or minimize losses in range of motion.

Role of the occupational therapy practitioner

Medical-based OT practitioners are either occupational therapists or occupational therapy assistants (OTAs). Occupational therapists are responsible for providing the overall framework for medical-based services. Collaboration between OT practitioners is essential and is facilitated by the OTA’s knowledge of the occupational therapist’s responsibilities, which include conducting screenings and evaluations, formulating and carrying out daily intervention plans, and documentation. The OTA’s responsibilities include formulating and carrying out daily intervention plans and documentation. OTAs also assist with or conduct portions of the pediatric medical-based screening and contribute to the pediatric medical-based evaluation.

After receiving a referral from a physician, medical-based pediatric screening and evaluation are usually completed by the occupational therapist within 24 hours and 72 hours, respectively. The screening and evaluation are conducted by means of formal and informal measurement tools as well as through clinical and parental observations. Throughout the assessment process, a medical-based OT practitioner should be aware that certain factors, such as time, the severity of the illness, and the overall stress associated with being in a hospital environment, may mask a child’s true abilities in a given performance area.

The deficits that are identified during screening and evaluation are addressed in a medical intervention plan. An occupational therapist formulates the long-term goals and short-term objectives that will guide the intervention plan. The medical intervention plan is developed either solely by an occupational therapist or jointly by an occupational therapist and an OTA. The medical intervention plan is an outline of the activities and tasks that are used during treatment sessions.

The OT practitioner initiates OT interventions only when the medical stability of a child has been determined. Medical stability is used to determine the manner in which services are provided and how often they are provided. The goals of the intervention plan should be gradually integrated into the child’s environment. Intervention strategies are designed to increase the child’s functional level.