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PT / OT consultation guidelines

The Guidelines for Perinatal Care, 5^th edition recommends that every specialty (Level II) and subspecialty (Level III) NICU employ/have access to an occupational or physical therapist with neonatal expertise.

Physical therapists are postural control and gross motor specialists. They can assist the nurse or parent to help the infant with movement organization, positioning to facilitate movement, and range of motion exercises.

Occupational therapists are hand and fine motor specialists. They can assist the nurse or parent by facilitating infant behavioral organization, demonstrating non-nutritive oral motor stimulation to decrease oral tactile hypersensitivity, and by splinting the infant with soft splints and aquaplast.

Tennessee Early Intervention Services (TEIS) include physical and occupational therapy evaluations and interventions in their strategies to improve infant outcomes. Early intervention services have been shown to modestly improve cognitive outcomes in infants at risk for developmental delay, especially in those children from underprivileged environments.

All premature infants born at a gestational age of < 30 weeks are eligible for TEIS and will receive a referral upon discharge. Infants born at 30 – 36 weeks gestational age may also qualify for TEIS referral if they meet other criteria for high risk of developmental delay. In-hospital referral of certain NICU patients to PT/OT may enhance the parents understanding of physical and occupational therapy’s techniques and goals, and ease their transition into TEIS in the home environment. In-hospital consultation of PT/OT for other infants may benefit the infant’s progress toward discharge goals or improve developmental stimulation during prolonged hospital stays.

Recommended patients to refer for PT/OT:

The following patients should receive PT/OT consultation as soon as they are medically stable: Infants with congenital or acquired musculoskeletal abnormalities, an identified abnormality of tone or neurologic injury.

All premature infants born at < 30 weeks gestation or < 1000g birthweight, or larger more premature infants with neurologic complications of prematurity (Grade III – IV IVH, PVL, or ventriculomegaly) should receive a PT/OT referral when they are medically stable and at > 33- 34 weeks postconceptual age. Infants at 33-34 weeks postconceptual age have mature vestibular systems and improved tolerance to touch.

Term or near-term infants should receive PT/OT referral if they experience a prolonged hospitalization to assist with developmental care. PT/OT consultation should occur when the infant is medically stable but has remained in the NICU > 2 months.

In-hospital PT/OT referral will occur by physician or NNP order. Bedside nurses and case-managers are encouraged to assist in the identification and timely referral of NICU patients who may benefit from PT/OT consultation.

Resolved at the Clinical Division Meeting 11/18/02.

References:

AAP/ACOG. Guidelines for Perinatal Care, 5^th ed. 2002. “Inpatient perinatal care services.” p. 28.

McCarton CM, et al. Results at age 8 years of early intervention for low-birth-weight premature infants: the Infant Health and Development Program. JAMA 1997; 277: 126-32.

Brooks-Gunn J, et al. Enhancing the cognitive outcomes of low birth weight, premature infants: for whom is the intervention most effective? Pediatrics 1992; 89: 1209-15.