I received this question from an SLP reading my blog posts on working in the Neonatal Intensive Care Unit (NICU) and thought it worth answering in a new post.
What follow-up care do you recommend when an infant treated in the NICU gets discharged to go home? Do you refer immediately to an outpatient program or wait the 30 to 45 days until early intervention can see the patient? Can you also share any recent studies indicating whether NICU infants are at higher risk for developmental delays or any proven effective intervention timelines?
Here’s my answer:
Overwhelmingly, the literature on infant feeding outcomes shows the NICU population at significant risk for enduring feeding problems into the third and fourth years of life. My experience over the last 30 years in large Level III NICUs suggests that many NICU graduates are not skilled feeders at time of discharge. They often get discharged feeding “well enough,” but not feeding “well.”
Also, a significant number get re-admitted during the first month after discharge. These infants often have negative growth velocities post discharge, which is a critical period when they need to gain weight for brain and lung growth. Interestingly, more recent studies say late preterms are even more at risk for re-admission due to poor feeding than more typically concerning “extremely preterm” infants. This collective literature indicates that prematurity itself sets the infant on a different trajectory, which makes developmental monitoring and support essential.
Early intervention (EI), as an extension of treatment provided in the NICU, is critical, not only for feeding/swallowing, but also for the expected developmental challenges well documented in the literature. “Outpatient” or “community in-home” treatment settings are both forms of “early intervention” delivery models, and both offer positive benefits.
Some in-home treatment programs require moving through long waiting lists and might take 30 to 45 days before patients actually get seen, however. SLP support is often most critical during the first two weeks after discharge. The key is finding patients treatment immediately after leaving the NICU, so parents get support during that most fragile period and beyond. You best know the pulse of your community, so opt for whichever service provides treatment sooner. However, keep options open for patients changing services, because they might in the long run respond better to in-home or outpatient delivery.
As for acquiring skills to provide effective early intervention, many SLPs say they learned treatment techniques essential to working with former preemies after graduate school. I constantly hear how a combination of mentors, networking and continuing education seminars deliver a solid understanding about the unique feeding/swallowing needs of this specialized population and their caregivers.
Do you have questions about NICU Practice for Catherine’s blog? E-mail them to Catherine at firstname.lastname@example.org. She’ll be selecting questions to answer for future columns.
Catherine S. Shaker, MS/CCC-SLP, BCS-S, an SLP since 1977, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando, Fla. Her passion is the NICU. She offers several seminars on neonatal/pediatric swallowing/feeding across the US. Contact her at www.Shaker4SwallowingandFeeding.com or email@example.com.