INTRODUCTION

A neonatal intensive care unit is a specially outfitted nursery where sick and unstable

neonates receive treatment for a variety of illnesses and conditions as well as life

support1.A neonatal intensive care unit (NICU) is for newborns who are preterm and

have low birth weight, as well as for those with perinatal issues, congenital

abnormalities2, respiratory conditions like hyaline membrane disease, meconium

aspiration syndrome, pneumonia3, and neuromuscular conditions like muscular

dystrophy, spinal muscular atrophy, congenital myopathies, amyoplasia, and muscular

disgenesis4. It is also for those who have had thoraco-abdominal surgery3.

When providing services in the neonatal intensive care unit, an interdisciplinary team

includes physiotherapy as one of its members5.Cardiopulmonary physical therapy

primarily consists of chest physical therapy, which makes use of widely utilised

methods such percussion, vibration, posture for postural drainage, and airway

suctioning6.It is helpful for maintaining a clear airway, as well as to re-expand

collapsed lung segments, prevent respiratory complications, maintain acceptable

levels of oxygenation3, facilitate early weaning7, and lower the chances of

reintubation6.

Common therapeutic techniques for early intervention in neuromuscular dysfunction

include positioning, skin-to-skin holding (kangaroo care), therapeutic handling,

orofacial stimulation, taping, range-of-motion exercises, soft tissue mobilization

(surgical scar release), hydrotherapy, and parent education (feeding, dressing,

positioning of infants for sleep, interaction/play) 8.These developmental strategies are

beneficial for the promotion of posture and movement appropriate for gestational age

and medical stability, for the modulation of sensory stimulation in the baby's neonatal

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ICU environment, for the promotion of behavioralorganization and physiological

stability, for the promotion of infant-parent attachment, and for the direct intervention

of neonatal feeding dysfunction and oral motor deficits9.

Physiotherapists were involved in chest physiotherapy and neuromuscular

physiotherapy, according to previous study conducted in India to determine the role of

physiotherapists in NICUs, but in Gujarat state there is less data which showing that

what is specific physiotherapy clinical practice in Neonatal Intensive Care Unit.So,

There is a dearth of literature regarding exact what physiotherapist doing clinically in

Neonatal Intensive Care Unit India specifically in Gujarat. So, accordingly we can

assess and manage of neonates in intensive care unit. Therefore, there is a need to

identify the current clinical practice of physiotherapists in Neonatal Intensive Care

Unit.

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 AIM & OBJECTIVES

AIM

The aim of the study is to determine the standard physiotherapy clinical practice in the

Neonatal Intensive Care Unit across the Gujarat.

OBJECTIVE

 Observe current physiotherapy assessment in the neonatal intensive care unit

in the Gujarat state.

 Observe current physiotherapy management in the neonatal intensive care unit

in the Gujarat state.

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 REVIEW OF LITRATURE

1. Tejas chokshi at al, (2013) conducted a study on “Practice patterns of

physiotherapists in neonatalintensive care units: A national survey”A

cross-sectional survey was conducted across India, in which 285

questionnaires were sent via e-mail to physiotherapists working in neonatal

intensive care units. A total of 139 completed questionnaires were returned

with a response rate of 48.7%. This study conclude that , the practice pattern

of physiotherapists for neonates in neonatal intensive care units involves both

chest physiotherapy(airway clearance techniques including percussion,

vibration, postural drainage and airway suction) as well neuromuscular

physiotherapy(parent education and passive range of motion exercise,

therapeutic handling & positioning).

2. Franciane R. dos Anjos et al, (2021) conducted a study on “Effects of

hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm

infants admitted in the Neonatal Intensive Care Unit” study was aimed to

evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the

birth weight of preterm infants admitted in the Neonatal Intensive Care Unit. It

was a RCT, without blinding, in which 44 preterm infants of both sexes with

gestational age between 32 and 34 weeks were included into two groups:

hydrotherapy group (n=22) and tactile-kinesthetic stimulation group (n=22).

Weight gain was the parameter assessed daily. Concluded that Hydrotherapy

group presented significantly increased weight after the

interventions,indicating that this technique can interfere with weight gain in

preterm infants.

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3. Jenene at al, (2019) conducted study on “Risk-adjusted/neuroprotective care

services in the NICU: the elemental role of the neonatal therapist” This article

presents a perspective on the role of neonatal therapists—occupational

therapists, physical therapists, and speech–language pathologists—in the

provision of elemental risk-adjusted neuroprotective care services.

4. Carmen Giannantonio et al, conducted study on “Chest physiotherapy in

preterm infants with lung diseases” test the applicability in preterm infants of

‘reflex rolling’, from the Vojta method, in preterm neonates with lung

pathology, with particular attention to the effects on blood gases and oxygen

saturation, on the spontaneous breathing, on the onset of stress or pain. The

study included 34 preterm newborns The neonates underwent phase 1 of

‘reflex rolling’ according to Vojta method three times daily. Respiratory rate,

SatO2, transcutaneous PtcCO2 e PtcO2 were monitored. This study concluded

that using the Vojta method, allows to affirm that this method is safe for

preterm neonates, but further investigations are necessary to confirm its

positive effects and to evaluate long-term respiratory outcomes.

5. Suzi Laine Longo dos Santos Bacci et al, conducted study on “Role of

physical therapists in the weaning and extubation procedures of pediatric and

neonatal intensive care units: a survey” the physical therapist’s performance in

the weaning procedure from mechanical ventilation and extubation in

neonatal, pediatric and mixed (neonatal and pediatric) intensive care units. A

cross-sectional survey was carried out by sending an electronic questionnaire

to 298 neonatal, pediatric and mixed intensive care units in Brazil. In this

survey, intensive care units using physical therapy assistance 24 h/7 days per

week were associated with the use of a mechanical ventilation weaning

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protocol, an extubation decision and success commonly on the first attempt of

extubation.

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 MATERIALS AND METHODOLOGY:

SOURCE OF DATA:

 Multidisciplinary or specialty hospital of Gujarat where NICU is there and

refer for patient.

 NABH accredited and MCI registered hospitals will be preferred.

STUDY DESIGN: Cross sectional study.

STUDY DURATION: Study will be conducted over a period of 10 to 12 months

after obtaining ethical approval.

STUDY POPULATION: Physiotherapist involved in the treatment of NICU

patients.

INCLUSION CRITERIA:

Hospitals having a NICU/Ward set up,where physiotherapy is administered by

qualified physiotherapists.

Physiotherapist with minimum of 6 month of experience in treating NICU patients.

EXCLUSION CRITERIA:

Physiotherapist who does not have Gujarat State Council For Physiotherapy

registration.

PROPOSED SAMPLE SIZE: The sample size is 256, the sample size is calculated G

power 3.1.9.4based on outcome variable neurophysiotherapy value is 80% so the

calculated sample size is 256.

SAMPLING TYPE: Convenience sampling.

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MATERIAL TO BE USED:

1. Phone

2. Laptop

3. Google form

4. Social media platform

 METHOD: After obtaining Institutional ethical approval, data will be

obtained Preferably who is working from NABH website, MCI approved

hospitals. Physiotherapist will be include in this study based on inclusion

criteria. Informed e-consent will be taken from all the physiotherapist who

agreed to participate.A questionnaire is obtained from Tejas et al, “Practice

patterns of physiotherapists in neonatal intensive care units: A national

survey” article.The Google form is made from this questionnaire.The Google

form link will be provided via mail or distributed by social & private network

or by direct contact.Reminder will be sent one week after invitation. The

questionnaire consist of two sections with a total of 29 questions. These

covered two primary roles of physiotherapy in a neonatal ICU: Chest and

neuromuscular physiotherapy.Chest physiotherapy mainly focused on

assessment and treatment whereas neuromuscular physiotherapy primarily

focused on treatment.Answers has to fall into the grades: “Always”

,“Frequently” ,“Sometimes” ,“Seldom” or “Never”.

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 STATISTICAL ANALYSIS

Descriptive statistical analysis will be obtained using frequency in form of

percentage of each.Subgroup analysis will be done to find the association.P

value is < 0.05 will be considered as statistically significant.

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 REFERENCES

1. Karlsen, Kristine A et al, “National survey of neonatal transport teams in the

United States.” Pediatrics vol. 128,4 (2011): 685-91. doi:10.1542/peds.2010-

3796

2. Smith M, Ball V. The neonatal unit and specialist support. In: Chapman J,

Parker A, Yeo L, editors. Cash’s textbook of cardiovascular/respiratory

physiotherapy. London: Elsevier; 1998. p. 305

3. Bertone N. (1988). The role of physiotherapy in a neonatal intensive care unit.

The Australian journal of physiotherapy, 34(1), 27–34.

https://doi.org/10.1016/S0004-9514(14)60599-7

4. Kliegman RM, Stanton BM, Geme J, Schor N, Behrman RE. Neuromuscular

disorder. In: Sarnat HB, editor. Nelson Textbook of Pediatrics. 19th ed.

Philadelphia: Elsevier; 2011. p. 2109-47. Mahoney M, Cohen MI.

Effectiveness of developmental inter

5. Mahoney, M. C., & Cohen, M. I. (2005). Effectiveness of developmental

intervention in the neonatal intensive care unit: implications for neonatal

physical therapy. Pediatric physical therapy : the official publication of the

Section on Pediatrics of the American Physical Therapy Association, 17(3),

194–208. https://doi.org/10.1097/01.pep.0000176574.70254.60

6. Giannantonio, C., Papacci, P., Ciarniello, R., Tesfagabir, M. G., Purcaro, V.,

Cota, F., Semeraro, C. M., & Romagnoli, C. (2010). Chest physiotherapy in

preterm infants with lung diseases. Italian journal of pediatrics, 36, 65.

https://doi.org/10.1186/1824-7288-36-65

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7. Main, E., Castle, R., Newham, D., & Stocks, J. (2004). Respiratory

physiotherapy vs. suction: the effects on respiratory function in ventilated

infants and children. Intensive care medicine, 30(6), 1144–1151.

https://doi.org/10.1007/s00134-004-2262-0

8. Sweeney, J. K., Heriza, C. B., Blanchard, Y., & American Physical Therapy

Association (2009). Neonatal physical therapy. Part I: clinical competencies

and neonatal intensive care unit clinical training models. Pediatric physical

therapy : the official publication of the Section on Pediatrics of the American

Physical Therapy Association, 21(4), 296–307.

https://doi.org/10.1097/PEP.0b013e3181bf75ee

9. McManus, B. M., Chambliss, J. H., & Rapport, M. J. (2013). Application of

the NICU practice guidelines to treat an infant in a level III NICU. Pediatric

physical therapy : the official publication of the Section on Pediatrics of the

American Physical Therapy Association, 25(2), 204–213.

https://doi.org/10.1097/PEP.0b013e31828a4870

10. Dusing, S. C., Van Drew, C. M., & Brown, S. E. (2012). Instituting parent

education practices in the neonatal intensive care unit: an administrative case

report of practice evaluation and statewide action. Physical therapy, 92(7),

967–975. https://doi.org/10.2522/ptj.20110360

11. Byrne, E., & Garber, J. (2013). Physical therapy intervention in the neonatal

intensive care unit. Physical & occupational therapy in pediatrics,33(1),75–

110. https://doi.org/10.3109/01942638.2012.750870

12. Umphred DA. Neurological rehabilitation. In: Sweeney JK, editor. Neonatal

and infants at neurodevelopment risk. 5th ed. USA: Elsevier; 2007. p. 303-56.

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13. Norrenberg, M., & Vincent, J. L. (2000). A profile of European intensive care

unit physiotherapists. European Society of Intensive Care Medicine. Intensive

care medicine, 26(7), 988–994. https://doi.org/10.1007/s001340051292

14. Dos Anjos, F. R., Nakato, A. M., Hembecker, P. K., Nohama, P., & Sarquis,

A. L. F. (2022). Effects of hydrotherapy and tactile-kinesthetic stimulation on

weight gain of preterm infants admitted in the Neonatal Intensive Care Unit.

Jornal de pediatria, 98(2), 155–160. https://doi.org/10.1016/j.jped.2021.04.011

15. Craig, J. W., & Smith, C. R. (2020). Risk-adjusted/neuroprotective care

services in the NICU: the elemental role of the neonatal therapist (OT, PT,

SLP). Journal of perinatology : official journal of the California Perinatal

Association, 40(4), 549–559. https://doi.org/10.1038/s41372-020-0597-1

16. Bacci, S. L. L. D. S., Pereira, J. M., Chagas, A. C. D. S., Carvalho, L. R., &

Azevedo, V. M. G. O. (2019). Role of physical therapists in the weaning and

extubation procedures of pediatric and neonatal intensive care units: a survey.

Brazilian journal of physical therapy, 23(4), 317–323.

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