OT in the NICU

In recognition of OT month the Occupational Therapy staff would like to suggest that all step out and help someone this Spring season by donating gently used/new gym shoes for adults and children. These will be donated to the Durham Rescue Mission to help dress those in need in the Durham Community. Donations may be turned in at Room 6218, Duke North (PT/OT gym) during April.

By Karen M. Buckmiller MS, OTR/L

An occupational therapist helps people be as independent as possible and maximize their performance of their "occupations," including the things they do on a daily basis - such as getting dressed, bathing, attending school, eating, playing or driving a car.

But occupational therapy is for more than adults.

At Duke University Medical Center, occupational therapists work in the Neonatal Intensive Care Unit (NICU). Duke is providing current best practice in that it has seen the value in our (OT) services and the important role we play in the development of these premature and fragile infants.

The NICU population includes infants who are acutely ill or premature, and who are often unstable, fragile and easily compromised by environmental conditions. Their primary "occupations" include sleeping, feeding, interacting with their parents and caregivers and use of their eyes and hands to explore their environment.

OT in the NICU helps protect these fragile babies from excessive or inappropriate sensory aspects of the environment, and assists the family in fostering optimal development for their baby. That includes the development of age-appropriate occupations (i.e., feeding), sensorimotor processes, caregiver-child bonding, and neurobehavioral organization.

To help foster an infant's neuromotor development (how the brain and muscles work together) occupational therapists assist with optimal positioning of the infant in the isolette and/or crib as well as educating caregivers in supportive ways to hold the infant, including "Kangaroo Care." Occupational therapists might also fabricate special supports in the form of splints to help manage muscle tone or range of motion.

OT plays a very important role with the premature infant's sensory system and their ability to organize and regulate the stimuli in the world around them. Often these babies have a difficult time adjusting to being outside the womb. Occupational therapists assist these infants with regulating touch, sound, and light.

Occupational therapy and Speech therapy work together as a feeding team in Duke's NICU. Feeding is not just about the infant being able to eat enough food to get the nutrients they need to grow. Occupational therapy focuses on the quality of the feeding skills, which includes suckswallow-breathe coordination and the ability for an infant to maintain a calm organized state during a feed.

OT's role in the NICU is probably best described by the recent story of beautiful twin girls. These precious babies were born prematurely at only 25 weeks gestation.

Baby Girl A was born weighing 1.7 pounds and Baby Girl B weighing 1.6 pounds.

OT became involved when they had reached the age of 32 weeks.

Therapists educated the parents on how sensitive these two little ones were to noise, light and touch. Their parents were taught ways to help support their daughters to tolerate being a part of this busy world.

One of the first goals for the girls, when they were big enough, was to tolerate coming out of their isolettes to cuddle with mom and dad and remain stable. Once that goal was achieved we helped them to be able to suck on their pacifiers while outside the isolette.

As they achieved these goals we were able to gradually start introducing the bottle and breastfeeding one to two times a day, using a special nipple and certain feeding strategies. With each successful feeding experience we were able to progress the girls to attempting to feed more often. Both girls are now taking a majority of their required nutrition by bottle and/or breast, are less reliant on feeding tubes and will be discharging home in the near future.

Occupational therapists in the NICU at Duke do their best to serve the infants and their families by providing the best match or fit between the infant and the NICU environment as well being sensitive to family circumstances, priorities/goals, concerns and cultural beliefs.

After discharge, many of these premature infants continue to require intervention to help assist their development. This continuum of care can be provided through Duke's Special Infant Care Clinic, community based early intervention services, as well as through the outpatient facility at Lenox Baker Children's Hospital.