Evaluation of infant development in the NICU is a complex process involving integration of information from a variety of sources and interaction with a number of team members.
The purpose of a neonatal therapy evaluation is to assess an infant's capacities and his or her participation in the essential developmental tasks and occupation of infancy.
The major elements of a neonatal therapy evaluation are
These elements can be assessed using standardized assessment tools, observation, handling or combination of these methods.
Medical stability is the utmost prerequisite for neonatal therapy to begin. The most important aspect is stable vital signs. But other medical considerations we shall check before administration of any stimulation is current medication and recent procedures. Is there any medication which an infant is currently receiving or weaned off which can make an infant lethargic. Secondly, check for some procedures or situations that account for physiological instability or fatigue like a recent heel stick, IV may have fatigued an infant, you shall consider a pain management rather than a stimulation session.
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The initial observation should always include observing and analyzing the physiological stability of an infant. Like, look for any changes in skin color, changes in heart rate, respiratory rate, oxygen saturation, and body temperature. If you find all stable signs, we can proceed further. During the handling we may find some instability so it’s important to pause and wait for the recovery and if taking too long or repeating frequently, we shall report to the attending nurse or neonatologist. To recognize when to stop/pause during an assessment or the stimulation session, it is significant to know these signs of instability.
The two most important aspects of Neuro behavioral organization are state of arousal or ability to self-regulate.
State of arousal: An assessment of infant state of arousal provides a baseline for all other behavioral observations. We all know there are 6 states for arousal starting for deep sleep, light sleep, drowsy, quiet alert, active alert and last is crying. As a neonatal therapist what is important to assess and observe is
Infants who have difficulty organizing or regulating their state of arousal may experience difficulty interacting with their environment and participating in age appropriate activities.
Ability to self-regulate: self-regulation includes the infant’s ability to
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Assessment of postural and motor capacities is another essential component of neonatal evaluation. For self-regulatory behavior an infant's capacity to interact with their environment often rely on motor organization. Key components of Neuromotor assessment include: -
1. Undisturbed posture at rest, including position and symmetry of the limbs.
2. Response to handling and repositioning.
3. Age appropriate motor responses- reflex assessment, proprioceptive response, visual response and auditory response.
Physical environment: assessing the physical environment’s possible influence on the infant's neurobehavioral organization is a very important aspect of neonatal intervention. The attributes of environmental stimuli to which the infant is exposed should be noted throughout the entire observation period. The other important stimuli attributes to consider are:
Social environment: Assessment of infant social environment must include various elements of the infant social interactions related to infant, family or other caregiver. Infant factors to be considered are the ability to tolerate social approaches without physiological stability. Analyzing an infant alert time. Family factors to be considered: how often the mother visits, her availability for KMC and learning developments interventions at home.
A contextual approach that incorporates direct observation with information from a variety of sources allows the therapist to obtain the most comprehensive view of infant’s ability and availability to participate in developmental appropriate intervention
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