1. Clinical Bottom Line: Overall analysis of ten selected research studies suggests that early intervention performed by a physical therapist, or in collaboration with specially trained nurses improves motor development of infants born prematurely and with low birth weight (LBW). Intervention implementation for premature and LBW infants appears to be valuable for those residing in neonatal intensive care units (NICUs), for infants with additional medical complications, and for infants receiving care at facilities lacking well established NICU follow-up programs involving parent training/education components. This conclusion needs to be evaluated with caution based on the many different intervention techniques implemented throughout each study and the fact that none of the studies look at outcomes over the long term.
2. Clinical Scenario: Obtaining birth histories via parent report is an integral part of the initial pediatric physical therapy evaluation. During our student pediatric clinical internships, parental mention of prematurity or LBW was repeatedly reported in many of preschool to elementary school age children receiving physical therapy. These parents often stated that beyond the medical care that their premature infants received in the NICU, the infants received no other special care. They frequently stated that they weren't even referred to therapy until sometime later when their children were found to not be meeting developmental milestones. Some parents themselves even wondered if something else could have been done earlier to prevent the motor problems their child was facing.
3. Our clinically answerable question: The question that then arises is whether a preventive therapy approach could have been implemented. Rather than waiting until the point where the child was brought in to therapy to be treated from a remedial approach, could the child's motor development issues have been treated early on to prevent the concerns that the child is now facing? Could the parents have been taught ways to interact and care for the child to allow more normal development? If so, could this intervention have been started as early as in the NICU to have the best outcomes? These questions led us to form a PIC0 through our experience in working remedially with children who were born prematurely with LBW.
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