Home Support for the Premature Infant

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Home Support for the Premature Infant

• WATCH Preemie presentation

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Objectives

• Identify resources that therapists can access to
  provide great preemie care.
• Understand 3 subtle issues to watch for as
  therapists provide services, especially in the
  early months, with preemies

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Agenda

• HHIP program description/changes
• Impact of changes on other agencies
• Transition to home/early treatment
• Therapist techniques
• Child issues/concerns
• Motor issues
• Later/other issues
• Other programs/resources

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WakeMed HHIP HospitalHome Intervention Program

• Beth Cooper
• Ann Marie Elmore
• Jim Helm
• Cindy Redd
• Funded by Wake County SmartStart, an organization
  that ensures children are prepared for success in
  school and life.

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WakeMed HHIP HospitalHome Intervention Program

• Changing model
• 3 year grant funding cycle
• IT-P high risk eligibility criteria changed

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Eligibility

• Past
• lt 32 weeks
• lt1500 grams (3lbs 5oz)
• Vent gt 6 hr

• Current
• lt 27 weeks or
• lt 1000 grams (2lbs 3.5 oz)

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Impact on other CDSA contract agencies

• Will be treating preemies earlier
• Will need to address self-regulation as a 1
  concern that impacts other areas of daily care

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Most Common Challenges Reported by Parents

• Sleeping
• Feeding
• Self-Regulation
• Social Interactions

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Impact on other CDSA contract agencies

• Parent consultation vs. hands on therapy
• Parents may need weekly support vs. children may
  need monthly developmental monitoring.
• Transitional issues include lots of Q/A on
  parenting

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When ready to do hands on

• recognize and respond to behavioral cues for
  avoidance vs. approach
• support regulatory efforts to help baby succeed

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Ready or not?
Not Avoidance!
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Ready or not?
Ready - Approach
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Ready or not?
Ready Supported for Success!
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Motor Issues

• Encourage - Facilitate
• Flexion
• Trunk/Pelvic Mobility
• Weight Shifting
• Varied Positions

• Monitor Prevent
• Extensor Dominance
• Limited Rotation
• Head Preference/
• Plagiocephaly

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Extensor Dominance
Flexion Trunk/Pelvic Mobility
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Limited Rotation
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Head Preference/ Plagiocephaly
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Later/Other Issues

• issues with older children and regulation
• monitor other potential concerns

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Outcome of VLBW ELBW without major mental or
motor impairments

• Poor attention/ Hyperactivity
• Lower IQs
• Behavioral / Social Skills Difficulty
• Visual Perceptual / Visual Motor Problems
• Problems with Executive Function
• Msall Park 2008

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Other programs/resources

• Family Support Network
• SICC
• Beyond the NICU workshop
• Transition Visits
• Children that get discharged from I-TP
• Parents As Teachers
• Child Service Coordination Program