1103 - A new clinical service providing Acute Inpatient Rehabilitation for Neonatal Infants with Developmental Delay

To assess the benefits of a new clinical service created to promote early transfer of developmentally delayed infants out of the Neonatal Intensive Care unit (NICU) into a step-down unit into which an intensive rehabilitation program has been incorporated.

Design: A Cohort study in Post-NICU step-down unit for infants who still need in-hospital care. The participants include neonates after the post conceptual age of 36 weeks with developmental delay. They must be responsive and able to tolerate active stimulation. Every infant is provided with standard neonatal, pediatric and nursing care but additionally participates in a formal rehabilitation program provided by trained professionals and coordinated by a rehabilitation physician. The schedule of therapy is flexible, with therapists minimizing interruption of sleeping patterns. The outcome measures are their development as measured with the DAYC and then the BAYLEY-IV, and feeding status at discharge. Parent involvement was assessed.

Results: Among the 134 infants admitted to the program, some progressed rapidly and were discharged home within 1 to 2 weeks. Those who stayed longer all showed developmental progress. The average length of stay (LOS) was 29 days. All infants were on supplemental nasogastric tube feeding on admission. At discharge all infants were feeding orally with only 10 requiring supplemental nasogastric tube feedings while 9 required further evaluation back in the NICU. Many parents responded to the urging of staff to be involved, and parent satisfaction was high. Bayley-IV and DAYC scores showed developmental delay on admission but subsequent improvement.

Conclusions:

This new clinical service that incorporates formal rehabilitation for neonates has been successful. The design of this new service is safe for transferring patients early out the NICU. Infants at this age can participate and tolerate stimulation and formal age-appropriate therapy. Infant development is facilitated.  Parent involvement was a very influential variable affecting the outcomes.