The Special Care Nursery

Providing services to high-risk infants and their families in the neonatal intensive care unit is a complex subspecialty of pediatric physical therapy requiring knowledge and skills beyond the competencies for entry into practice. The newborns in the neonatal intensive care unit (NICU) are among the most fragile patients that physical therapists will treat, and detrimental effects can occur as the result of routine caregiving procedures. Pediatric physical therapists (PTs) need advanced education in areas such as early fetal and infant development; infant neurobehavior; family responses to having a sick newborn; the environment of the NICU, physiologic assessment and monitoring; newborn pathologies, treatments, and outcomes; optimal discharge planning; and collaboration with the members of the health care team.256 This chapter describes the neonatal intensive care unit and the role of the physical therapist within this setting. Practice in this setting requires knowledge of neonatal physiology, development, and health complications including prematurity, pulmonary conditions, neurologic conditions, fetal alcohol syndrome, fetal abstinence syndrome, and pain. A framework for physical therapy examination, evaluation, prognosis, and interventions for infants in the special care nursery is presented. The follow-up of infants after discharge from the intensive care nursery is addressed. Two case studies are presented to apply knowledge to practice