Murray Brandstater, M.D.

Premature Infants Need A Boost Beyond The NICU
Intensive Post-Discharge Programs Can Help Their Development

(LOMA LINDA, Calif. – December 5, 2019) — No pregnant woman expects her baby to wind up in the intensive care unit (NICU), but every year 10% to 15% of babies born in the United States (some 500,000) do so for reasons including prematurity, heart problems, birth defects, breathing irregularities, intrauterine exposure to drugs or alcohol and infections, among others.

In the early 1980s, only 10% of infants born before 28 weeks of gestational age survived to be discharged from the hospital. By 2015, 65% of babies born before 27 weeks were surviving. Those statistics, and others like them, reflect the remarkable recent advances in neonatal intensive care. But these advances raise the question of how best to care for these infants post-NICU to assure that they get the care and attention they need and achieve optimal outcomes.

Babies born preterm often face more future difficulties than those born full-term. Many newborns within a NICU are diagnosed as having failure to thrive – meaning they usually don’t meet the recognized standards of growth and development. Children who fail to thrive often have poor nutrition and other complications that stall their normal development. Many have sensory processing or language problems. Half of children with cerebral palsy are born preterm and preterm babies are at greater risk of asthma and obstructive lung disease. Unless those complications are treated in a timely manner, children may not be able to recover and/or achieve developmental milestones needed to living a normal life.

Once an infant has been stabilized in the NICU, attention must be given to total care of the infant to facilitate growth and development. Unnecessary prolongation of the stay in the NICU is not optimal. While the incredible skills and love of those working in those units are unquestioned, the focus of care in the NICU is on life-saving medical interventions. It is very difficult for staff in the NICU to create the environment and provide those activities that promote age-appropriate development.

These infants need ongoing, specialized care to help them achieve optimal outcomes. Some parents have historically turned to home healthcare to supplement the care that they can provide. But these infants need and can benefit from several types of therapies provided by professional staff on a daily basis. Home health is an important service for short term or chronic care but the intense service needed for these post-NICU patients is not something that most home care models are designed to offer. And for an assortment of reasons, home health care is not always right for everyone.

Fortunately, innovative programs and new alternatives are being designed to care for these infants who have medically complex conditions upon discharge from a neonatal intensive care unit. One such program recently implemented at Totally Kids Rehabilitation Hospital facilitates the development that has been missing in these children by focusing on multiple areas of need and inpatient rehabilitation therapies that are essential for a successful transition to home.

To serve these children, the hospital’s multidisciplinary clinical team evaluates and assesses the child’s neurological status, functional status, developmental levels, and nursing and medical needs. The program then offers a six-layer fast track to development in the areas of physical therapy, occupational therapy, speech therapy, play therapy, respiratory therapy, and child development. By providing 24-hour care and customized therapy in this manner, each child has the best chance of reaching his or her age-appropriate developmental milestones. And that translates into the best chance of minimizing long-term complications or disabilities.

The program at Totally Kids is part of an increasing, ongoing recognition by healthcare providers and payers that along with scientific advances that save and then sustain life, there must be an equal commitment to offering the full array of resources and advanced care that result in the kind of quality of life we all imagine.

Murray Brandstater, M.D. is medical advisor and director of research for the Totally Infants Program at Totally Kids Rehabilitation Hospital in Loma Linda.

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