ROLE OF

OCCUPATIONAL
THERAPY IN NICU

SUBMITTED BY- DEEPANSHI, FASEEHA, ADEEBA,

AFREEN
 INTRODUCTION

The NICU is a complex hospital unit in which specialized care is provided

to infants who are born prematurely or born with significant medical
problems. Occupational therapists who work in the NICU must be armed
with specialized knowledge about neonatal medical conditions, intensive
care equipment, necessary precautions related to handling the neonates,
preterm infant development, and interventions that promote behavioural
organization and interaction.
Occupational therapy services emphasize the developmental supportive
care, developmentally appropriate interactions, and interventions that
facilitate the neonate’s neurobehavioral organization. Occupational
therapists are sensitive to the family’s response to preterm birth, and
they coach parents in how to care for the neonate and help to prepare
the family for the neonate’s discharge from the NICU. Best practice
services emphasize preventive interventions and protect the infant from
unnecessary stress. Services are also directed to the parents as primary
caregivers to promote their skills in handling and interacting with an
infant who may be vulnerable and medically fragile when discharged
from the from NICU. .. ..
 CHANGING FOCUS OF NEONATAL
OCCUPATIONAL THERAPY

Traditional Occupational Therapy: Rehabilitation and Stimulation

Traditional neonatal occupational therapy in the 1980s (and still persisting in some NICUs) consisted solely
of rehabilitation and developmental stimulation. Infants were identified as appropriate candidates for
occupational therapy by specific risk factors (e.g., very low birth weight, prenatal drug exposure), diagnosis
of pathology (e.g., congenital anomalies, severe asphyxia), or performance indicators (e.g., abnormal tone,
poor feeding, chronic illness with developmental delay).Therapy targeted specific problems such as limited
range of motion, high or low muscle tone, extreme irritability, poor feeding, or developmental delay.
Remediation and rehabilitation continue to be appropriate for NICU infants with pathology affecting
development and function. Older chronically ill infants in the NICU may also need developmental therapy,
although many of these infants are now transferred to step-down units or are discharged with home health
services if they remain medically fragile and dependent on medical technology.
 STATE OF ART OCCUPATIONAL
THERAPY: DEVELOPMENTAL
SUPPORT
The unique knowledge and skills of neonatal occupational therapists support an expanded
role beyond traditional rehabilitation to proficiency as developmental specialists.
Developmentally supportive care begins at birth rather than once the baby is medically
stable. This approach acknowledges that any infant young enough or sick enough to
require intensive care has inherent developmental risks and vulnerabilities, that parenting
an infant in the NICU is stressful and difficult, and that both infant and family must
receive individualized support throughout the NICU hospitalization for optimal outcome.
Developmental support includes a protective and preventive
component of care that is not inherent in the traditional rehabilitation
model. In contrast with the previous emphasis for direct “hands on”
contact, protecting the fragile new born from excessive or
inappropriate sensory input is often a more urgent priority than
direct interventions or interactions with the infant. Trust, acceptance,
and respect are gradually earned from protective NICU staff as each
neonatal therapist consistently demonstrates competency in
knowledge, skills, and interpersonal professional relationships.
 NICU ENVIRONMENT

LIGHTING IN NICU:-
 In contrast with the dark womb, many NICUs have chaotic and unpredictable lighting patterns. Neither
continuous dim nor continuous bright light has been demonstrated to be optimal for the development of
preterm babies, and often the youngest and sickest infants are exposed to the highest levels of light,
such as during phototherapy or for medical procedures.
 Combinations of direct and indirect deflected lighting, adjustable ambient lighting at each bedside, no
light source in an infant’s direct line of sight, focused adjustable task lighting, and separate well-lit
areas for tasks such as charting or medication preparation are beneficial.
 At least one source of natural daylight visible from each patient care area provides psychological
benefits to NICU families and staff, and assists with day-night cycled lighting.
• Because bright lights can disrupt sleep, current recommendations
suggest a baseline (ambient) level for the patient care area of 10
to 20 lux.88 This continuous dim lighting is probably best for
infants younger than 28 weeks’ gestation.
• After 28 weeks gestation, there is some evidence that diurnally
cycled lighting (dim lighting at night with daytime levels
increased to 250-500 lux) has potential benefits for the
infant(e.g., longer sleep, improved growth, more stable breathing,
and decreased levels of stress hormones) and no evidence that
cycled lighting in the NICU is harmful.
• The eyes of a preterm infant should always be protected from
bright and direct light.
SOUND IN NICU:-
• Environmental noise can stress NICU infants with a resultant decrease in oxygenation and
an increase in vasoconstriction, blood pressure, intracranial pressure, heart rate, and
respiratory rate. High noise levels can contribute to apnea and bradycardia.
• Noise disrupts sleep, which can impede an infant’s growth, medical recovery, sensory
system development, and early neural circuitry formation.
• Background noise in the NICU may interfere with the infant’s ability to discriminate speech
of parents and other caregivers.
• Loud or prolonged sounds may damage the delicate developing cochlea with resultant
hearing loss, in the same frequency range as that of the damaging sound; preterm infants
are at risk for hearing loss in both low-frequency (speech) and high-frequency ranges.
• Optimum level of Sound in NICU is 45 dB as recommended by the American Academy of
Paediatrics.
REFERENCES

 Case-Smith/O’Brien: Occupational Therapy for

Children, 6th edition.
 American Academy of pediatrics.
Thank you!