Developmental Issues

MissJoRN, RN · May 31, 2005

I'm curious to see the answers you get, maybe try posting to the NICU board? I have nothing to offer (my only "NICU" experience was really a "special care nsy" with relatively short term issues, babies that coped with handling with very few AB spells. I do have experience in long-term peds home care, however and see that all these NICU grads have sensory integration dysfunction. I was a little surprised when I initially returned to long term peds, since I thought the SI would be a thing of the past due to OT involvement in NICU. Turns out when talking to moms referrals may or may not have been made but OT visits were few and far between. I'm not sure what the answer is- aside from ABs could sensory overload also cause future SI dysfunction? All I know is some of these kids are tough to work with, msut be really tough to 'be' that kind of kid!! I have wondered about interventions like reiki- should be very low stress for a preem? I know the grads usually like it! :)

suzanne4, RN · May 31, 2005

You can try an automatic referral system of each new admission and let OT/PT evaluate the neonate. That way no one should get missed.

LilPeanut, MSN, RN, NP · Jun 3, 2005

My NICU did automatic referals for all babies that needed NICU care. Then the OT/PT/ST team would decide what was needed, if anything.

mahal · Jun 4, 2005

My NICU did automatic referals for all babies that needed NICU care. Then the OT/PT/ST team would decide what was needed, if anything.

Thank you for your input. I suggested the same thing to my manager,but 2 of our attending doesn't agree with it.They want me to call other hosp.what they are doing....they want evidenced base practice...etc.Isaid to myself,what more evidence do you want...see what we have in the unit....the kind of babies we have.. Thanks again

mahal · Jun 4, 2005

I'm curious to see the answers you get, maybe try posting to the NICU board? I have nothing to offer (my only "NICU" experience was really a "special care nsy" with relatively short term issues, babies that coped with handling with very few AB spells. I do have experience in long-term peds home care, however and see that all these NICU grads have sensory integration dysfunction. I was a little surprised when I initially returned to long term peds, since I thought the SI would be a thing of the past due to OT involvement in NICU. Turns out when talking to moms referrals may or may not have been made but OT visits were few and far between. I'm not sure what the answer is- aside from ABs could sensory overload also cause future SI dysfunction? All I know is some of these kids are tough to work with, msut be really tough to 'be' that kind of kid!! I have wondered about interventions like reiki- should be very low stress for a preem? I know the grads usually like it! :)

Thanks 4 your input. I thought i was posting this in the NICU board. No wonder I didn't have a lot of reponse. Thanks again

LilPeanut, MSN, RN, NP · Jun 4, 2005

Well, Early Intervention in most states would consider a medically fragile infant to be in need of services/qualify for an eval.

The thing is: none of you are trained to specifically deal with those developmental issues, they need to be evaluated, recognized and attended to by a specialist, but they don't want to evaluate the kids?

Now, some of the kids in my NICU didn't get referred. My daughter didn't because she needed no O2 and was just in for low blood sugar monitoring and to make sure she could maintain her temp. She was gone in 24 hours. My son who needed a vent and other intensive care, he was automatically evaluated and then followed because he was at risk for developmental problems (which he did end up having)

LydiaNN · Jun 4, 2005

Parents are given a referral to California Early Start here. CES is the state funded early intervention program, and free assessment is included. There are also the Medically Vunerable Infant Program, and they follow the most medically fragile of these babies after their release, and the Developmental Follow Up clinics, that follow the babies for up to 3 years.

TTRN · Jun 5, 2005

In our unit the developmental order is on the standard admission orders. The doctors just have to indicate by checking off order. By the next day the OT/PT's & Speech Pathologist that are specifically for our unit assess and evaluate the patient's gestational age, and utilize whatever developmental products are needed. Each patient has and individual developmental and feeding care plan that is posted at the bedside so that their caregiver can follow. We have a very large developmental closet that consists of gel pads, bendy bumpers for pre-term and full-term, Freddie the Frongs, snuggle-ups & toys. We also have several volunteers that actually make our isolette covers, crib covers, gel pad covers and freddie the frog covers. They also make our bereavement clothes, regular clothes, hats, knitted blankets, and socks. Keep in mind, introducing Developmental care in a unit is a slow process, primarily because it is a change, and most people don't like change. I would suggest sponsoring a conference on Developmental Care for your unit and inviting the doctors!

Sincerely,

TTRN:rotfl:

AllyIII · Jun 17, 2005

I work in a Level III and all of our babies even 24 wk are seen for OT/PT consults. Especially just for positioning, and all of our RN's take a developmental care class. Also I work at a Children's Hospital that doesn't do deliveries, so we have a lot of babies that need surgery and ECMO. I can send the developmental stuff if needed.

I need to know what other NICU are doing in their unit for an early referral to OT/PT consult. What are the criteria..such as how early do you refer kids..at birth or at certain gest. age...etc. ANd if your unit are doing it what are the outcome. We are having problem in our unit.It seems like we either missed a kid or it's too late to refer them...unless they are taken by our NNP service.WE have alot of kids that have alot of motor,feeding and developmental issues because of this, and our Medical director don't want an automatic referral to OT/PT unless it is needed or desperate. So, I need info pls. Thanks

mrose22 · Jun 2, 2006

My NICU is working on critreia referrals. OT/PT have made up criteria (which most of our babies fall into) then we eval for needs whether direct or consult intervention.

prmenrs, RN · Jun 2, 2006

The Level III I retired from used specially trained OT's employed from the Hospitals OT/PT dept, but they would often get "kidnapped" to go eval an adult pt somewhere else in the hospital, so best laid plans would go astray--feeding support, discharge exams and the like.

Now the NICU has it's OWN OT, that they are able to control, so she's there full time. She sees almost all the babies (not the r/o sepsis, hyperbili term babies), and spends a lot of time w/the growing premies, developing feeding programs; she makes referrals for d/c planning; parent teaching; nursing support; developmental support. When they have long term pts., they need age appropriate developmental stuff--playing prone, practice sitting, just helping keep them closer to meeting their "milestones".

Having our own OT is a terrific thing, I highly recommend it!