Neonatal Intensive Care Unit (NICU)

Introduction[edit|edit source]

NeonatalIntensive Care Units(NICUs) is for those infants who are preterm, have low birth weight, or perinatal problems, orcongenital abnormalities,respiratory disorders,neuromuscular disordersand for those who have undergone thoraco-abdominal surgery^[1]. A NICU has advanced life support equipment and a team of highly skilled specialist medical and nursing staff to meet the unique needs of newborn babies.^[2]

Neonatal staff

Healthcare professionals must collaborate closely with parents, providing them with the necessary guidance and support."There are different types of staff in a NICU including:

• Neonatologists :A pediatrician who specialise in looking after premature or ill newborns.
• Nurses and midwives with special training in neonatal care
• Physiotherapist , Occupational , Speech therapist
• Lactation consultants
• Allied healthcare providers such as social workers
• Other medical specialists such as anaesthetists or surgeons^[2]

Levels of neonatal care[edit|edit source]

• Level 1 :Newborns born 35 - 37 week gestation
• 级别2:特别注意托儿所:32周以上通用电气station and weigh >1500g
• Level 3: Provide life support : Βelow 32 weeks gestation and <1500g

Role of physiotherapy[edit|edit source]

The presence of a physical therapist in the Neonatal Intensive Care Unit (NICU) has been found to be influential in reducing physical impairments and limitations in the infants, as well as in educating the family on how to provide optimal care for their newborn.Parent's education and cooperation are very essential regarding the NICU physiotherapy and invasive procedures adopted in the NICU.^[3]

The practice pattern of physiotherapists for neonates in neonatal intensive care units involves bothchest physiotherapyas well neuromuscular physiotherapy^[1].

Neuromuscular Physiotherapy[edit|edit source]

For neuromuscular dysfunction, common therapeutic strategies for neuromuscular physiotherapy includepositioning, skin to skin holding (kangaroo care), therapeutic handling, orofacial stimulation,taping,range of motion exercise, soft tissue mobilization (surgical scar release),hydrotherapyand parent education (feeding, dressing, positioning of infants for sleep, interaction/play).

These developmental strategies are beneficial for the promotion ofpostureand 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.^[1]The systematic review of studies and meta-analysis shows that the oral sensory-motor stimulation intervention is effective in managing premature infants in the NICU and is beneficial for acquiring independent oral feeding in preterm infants by decreasing the days of admission and the number of days to reach full oral feeding.^[4]

Physiotherapists provide parent education on passive range of motion exercise, therapeutic handling, and positioning. A passive range of motion is mainly given to the infant who has congenital restriction of joint mobility.^[1]

Due to prolonged immobilization, lack of physical activity leads to demineralization and growth retardation ofbonein newborns. Studies tell that the range of motion exercises performed by therapist in different joints helps in increasing bone mineral density and weight gain in premature newborns

Chest physiotherapy[edit|edit source]

Chest physiotherapy techniques eg percussions, vibrations, positioning forpostural drainage, and airwaysuctioningmay be required eg 15 min, twice a day. At least 2—3 min be spent on each affected site while giving chest physical therapy for the airway clearance and to maintain the adequate levels ofoxygenation^[3].

Pain[edit|edit source]

In the NICU, neonates experience long-term sequel ofpainduring invasive medical procedures. Additionally, infants born extremely premature exhibit changes in their pain perception thresholds and an increased activation of cortical regions in response to painful stimuli .

Newborn babies receive routine medical procedures such as heel sticks and blood tests that can cause them pain. Premature or sick babies undergo these procedures more frequently, increasing their exposure to pain.https://www.frontiersin.org/articles/10.3389/fped.2020.00030/full

There are techniques which healthcare professionals can use to eliminate the level of pain such as:

• Glucose or sucrose, can help reduce pain and discomfort during procedures such as heel sticks.

• Kangaroo care, swaddling helps in pain reduction and influences the positive neurobehavioral states.

• Supporting holding:Gentle holding, which involves placing a hand on the infant's head and feet or body, can be a non-intrusive intervention that does not cause distress to the newborn.

• Hydrotherapyhelps in pain reduction and improvement insleep cycleof hospitalized stable premature newborn.^[3]

Developing Countries[edit|edit source]

现代新生儿重症监护病房的象征phistication, and high cost automatically follows. The projected requirements in terms of money, manpower and material involved put this treatment virtually out of reach for the developing countries.^[5]However more neonatal intensive care units are being built in developing countries ( Latin America, Asia, and Africa) in order to reduce their pre-term mortality. Increased understanding of accessible prenatal and neonatal intensive care facilities and high birth levels in emerging regions is driving the growth of this market. This led to a rise in demand for neonatal intensive care centers^[6].

Parental Stress[edit|edit source]

Parentalstressrelated to NICU admission is a worldwide healthcare issue. Immediate and tailored support and education for parents after the birth of their at-risk infant should be prioritized to reduce parental stress and to promote mothers and fathers' emotional well-being and new-born neurodevelopmental outcomes.^[7]

The NICU can be overwhelming for parents as there are many pieces of equipment. The staff should explain to the parents what treatment, equipment and monitoring the baby needs eg. An incubator or heated cot to help regulate body temperature, a ventilator that assists breathing (in NICU), machines to deliver fluids/medicines via tubes directly into their veins, monitors attached to the baby’s body so that their heart rate, breathing rate and blood oxygen levels can be checked^[2].

Mortality[edit|edit source]

Although neonatal care is expensive, it has been shown to be effective. In 1960, a 1- kilogram infant had a mortality risk of 95%. By 2000, it had a 95% chance of survival. The mortality rate dropped from 2.6% in 1960 to 0.69% in 2007 and 0.59% in 2016. These rates are decreasing despite an increase in the number of preterm deliveries, which in 2006 accounted for 12.8% of all births (data from North America).^[8]

References[edit|edit source]