Inaugural Recipients of the Pioneer in Neonatal Therapy Award

Message from Sue Ludwig, OTR, President – NANT

Inaugural Recipients of the Pioneer in Neonatal Therapy Award

Pioneer in Neonatal Therapy Award – Inaugural Recipients (left to right)

Betty Hutchon, Lourdes Garcia Tormos, Kara Ann Waitzman, Lynn Wolf, John Chappel,
Chrysty Sturdivant, Robin Glass, Rosemarie Bigsby, Jane Sweeney, and Cathie Smith.
(Recipients not pictured: Elsie Vergara, Catherine Shaker and Jan Hunter)

The above recipients have worked for decades to advance our presence and purpose in the NICU and have contributed immensely to educating us all. It was past time to honor them.

You may be tempted to believe that they ‘have arrived’, that they are finished learning, that they no longer understand what it’s like to be you, your first year or 10th year in the NICU,  trying to wrap your brain around all the knowledge you need to work there.

What you may not know is that these pioneers fully understand how much there is to learn. They stood on that stage at the NANT (National Association of Neonatal Therapists) Conference BECAUSE they never stopped learning and they never once assumed they had arrived. They have elevated the experience for patients and families (and for all of us) for decades. It is only because of their trailblazing efforts that NANT was a conceivable notion for me.

Once they were all present on stage, I turned and saw them smiling broadly ear to ear, truly grateful to be in each other’s presence. Funny thing was, I thought to myself, “Wow, this group is a reflection of the bookshelf in my office.” Articles, notes, books with many dog-eared pages, presentations – they have truly led the way for decades.

Pioneers: we cannot thank you enough for your dedication – fierce and enduring – to the babies and families we serve, and to the thousands of neonatal therapists all over the world for whom you have forged a path. Your immense contributions are deeply appreciated.

*For the sake of disclosure- just know that the Pioneers (both nominated and awarded) were submitted by a global international audience and chosen by NANT members. I nominated no one – the results are due to your input and enthusiasm in submitting your support for each pioneer.

Problem Solving: Supporting NAS infants in NICU

Question: I work in a level 2 NICU and we are seeing a rapid increase in infants referred to us with NAS. Are there any courses on this population to help us better support them?

Answer:
Infants with prenatal drug exposure are one of the challenging populations in the NICU. They often present with poor state modulation, sensory-motor disorganization, altered sensory-motor processing and postural control, and a hyperactive sucking drive which can lead to coughing/choking. Their parents are often ill-equipped to have the patience and problem-solving skills necessary to help these infants from a postural, sensory-motor and neurobehavioral perspective.  I am not aware of any courses/seminars specific to this population.

In the NICU there are many different etiologies that cross our paths. Focus on each infant’s unique history and clinical presentation to see what domains for that infant are going to get your focus. As you complete your differential on these infants, determine what areas of function are problematic and then select from the typical NICU interventions often utilized, which are based on clinical wisdom and/or research evidence. This often includes for this population with Neonatal Abstinence Syndrome: secure swaddling to provide compression and containment, facilitating flexion and midline, offering vestibular input to calm/organize, use of a slow flow nipple and co-regulated pacing to optimize coordination, and intermittently resting the infant briefly to maintain reserves and organization.

Our babies with neonatal abstinence syndrome are often term or post-term and may unfortunately be expected by caregivers to have more skill than they actually do.  In the early days/weeks of life, the implications of stressful feeding on their growing brain, and its architecture going forward, may not be appreciated. The growing body of research on neuro-protection should heighten everyone’s awareness of the importance of positive infant-guided feedings for all infants in the NICU, especially those with NAS. For more information on neuro-protection, I recently posted an article on neuro-protection on this list serve; should be in the archives.

Nurses will especially benefit from the SLP’s guidance regarding co-regulated pacing, and why the slow flow nipple is helpful, as they may unfortunately want to offer a faster flowing nipple in response to the infant’s unbridled voracious urge to suck. They may not recognize that the sucking drive for an infant with NAS is a byproduct of an altered neuro-regulatory system, not a sign of true “hunger’ much of the time.

Parent and families will benefit from anticipatory guidance (watching you feed while you describe what you are doing, why and the infant’s communication) and guided participation. They will benefit from many one-on one sessions with the SLP to help them learn to prophylactically keep the infant’s state modulation well-supported through reading the infant’s communication during feeding, understanding what the best strategies/interventions are, and when to use them, and how to support their fragile infant through an infant-guided feeding approach.

The OT in your NICU is a resource regarding sensory-motor and vestibular input. One of my goals is to publish on supporting feeding safety and success with our NAS infants to help support my colleagues; watch for that down the road :-). For now, you can find more information about NICU problem-solving and interventions through the resources on my website http://www.Shaker4SwallowingandFeeding.com.

I hope this helps!

Catherine