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| Division of Occupational Therapy - OT Connect Prematurity
An infant is considered premature if born before 37 weeks of gestation. Premature infants are small, and usually weigh less than 2.5 kg (5.5 lbs.). Upon observation, the infant’s skin often appears thin, shiny and pink. The premature infant’s veins are easily seen through the thin skin, and little subcutaneous fat, hair or external ear cartilage exists. The infant’s muscle tone and spontaneous activity are reduced, and the infant’s extremities are not held in the normally flexed position demonstrated by full term infants. (Merck 1999, 2127-2128) Cause The cause of preterm labor is usually unknown, however there are a variety of risk factors that can contribute to the likelihood of premature labor. These risk factors include:
Common Symptoms/Course of Disease Self-care:
Sensorimotor Activity:
Cognitive:
Psychosocial:
(Reed, 2001) Age of Onset: Birth preceding 37 weeks gestation Sex Bias: None Cultural bias: None Current Medical Treatment: Premature infants in the neonatal intensive care unit (NICU) often need a combination of medical interventions. Commonly, the infants require assistance breathing, and require oxygen therapy with or without assisted ventilation until their lungs have matured sufficiently to sustain breathing on their own. These infants are consistently monitored for heart rate and temperature changes while in the NICU. Maintenance of body temperature is aided by the use of incubators or isolettes, which are clear plastic heated boxes that provide the infant with an environment similar to that of the mother’s womb. Premature infants may require assistance with feeding, to ensure adequate nutrition that will assist the infant’s development. There are two main methods by which premature infants receive nutrition, tube-feeding and intravenous (I.V.) feeding. Tube-feeding: A nasogastric tube is a thin, plastic tube that is inserted into the nose and threaded down to the stomach. A gastrostomy tube is a short, plastic tube that is directly inserted into the stomach through an incision made in the abdominal wall. I.V. feeding: An umbilical catheter is inserted in the umbilical cord, and is used for giving nutrition and fluids, and also for drawing arterial blood and giving medications. (http://www.webmd.com) Occupational Therapy Involvement Occupational therapists assist preterm infants in the following areas: In the NICU:
During first years of life:
References
How OT Makes a Difference: Evidence-Based Practice In the article titled “ An Efficacy Study of Occupational Therapy with High-risk Neonates”, a research study was conducted to evaluate the efficacy of occupational therapy intervention on the nutritive and non-nutritive sucking behaviors of three high-risk, premature infants. The infants studied were 34 to 35 weeks of age, and had been documented as poor feeders. Occupational therapy treatment consisted of individual, multimodal sensory stimulation with emphasis placed on vestibular and proprioceptive input according to the infant’s specific sensory needs. Measurements were taken at baseline and during intervention, and monitored movement components of the tongue and jaw during nutritive and nonnutritive sucking. Test results showed that the sucking scores improved dramatically for two of the three infants, and rapid improvements occurred in oral-motor functioning for all three infants. The results of this study suggest that occupational therapy intervention can improve the rate of development of sucking in the premature infant. Case-Smith, J. (1988). An Efficacy Study of Occupational Therapy with High-risk Neonates. American Journal of Occupational Therapy, 42, 499-506. “Emma” was born at 28 weeks gestational age, as her mother “Jenny” was nearly 7 months pregnant. “Emma’s” mother was in her mid-thirties, and worked at a local doctor’s office as a receptionist. Upon her birth, “Emma” weighed only 1.14 kilograms, or 2.2 pounds. She required assistance breathing immediately after birth, and was placed into an incubator to assist with temperature regulation and to encourage further development. “Emma” began receiving nutrition through a nasogastric tube that was inserted into her nose and down into her stomach. Shortly after her child’s birth “Jenny” claimed that she felt scared and helpless as a parent of a preemie. Within hours, “Emma” was starting to show signs of stress. She was having difficulty regulating waking and sleep patterns, and was constantly fussy. The occupational therapist working in the NICU stepped in to help “Jenny” and her tiny daughter. The O.T. helped “Emma” to regulate responses to her sensory environment through positioning and other self-regulation strategies. She (the O.T.) provided a special hammock that helped to put “Emma” into a position more similar to that of the womb. She also helped to regulate her sleep and wake cycles through organized timing of care and placing a cover over the isolette for resting times. The occupational therapist also taught and demonstrated stroking techniques to “Jenny” that would help to regulate sensory responses. When asked about the care her daughter received in the NICU “Jenny” stated, “The occupational therapist helped us so much.” “She was very supportive and taught me things that I never would have known to do otherwise.” She said that she really developed a good relationship with the therapist during the time her child spent in the hospital.
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