Pediatric Physical Therapy - Pediatric Physical Therapy Podcast

The Pediatric Physical Therapy Podcast March, 2024 Edition:

AN INTERVIEW WITH:

Eilish M Byrne PT, DSc, PCS, CNT, Assistant Professor, Camino Hospital and Stanford Children's Hospital, California, Visiting Professor University of St Augustine, San Marcos, California. In conversation with Peter Goodwin, Editor, The Pediatric Physical Therapy Podcast (March, 2024 Edition)

DESCRIPTION: Dr. Byrne discusses the research her ream has published in Pediatric Physical Therapy, Volume 36, Number 2, 2024 on: “Introducing the i-Rainbow- An evidence-based, parent-friendly care pathway designed for even the most critically ill infant in the Neonatal Intensive Care setting.”

AUTHORS: Eilish M. Byrne, Katherine Hunt and Melissa Scala

SUMMARY: This study investigated the feasibility and effectiveness of a novel, evidence-based developmental care pathway to be used by healthcare providers and parents in the neonatal intensive care setting.

PURPOSE: This study investigated the feasibility and effectiveness of a novel, evidence-based developmental care pathway to be used by healthcare providers and parents in the neonatal intensive care setting (NICU). The iRainbow is based on current evidence and responds to individual infant health status. It is not base on infant age.

METHODS: After development and implementation of the iRainbow, pre-and post- implementation nurse and parent survey data were collected, and pre- and post-developmental care rates were compared.

RESULTS: After iRainbow implementation, disagreement among providers on appropriate developmental care interventions significantly decreased, total minutes of daily developmental care and swaddled holding increased significantly, and parents reported that they would recommend the tool.

CONCLUSION: The iRainbow is a unique, parent-friendly, infant-based tool that guides sensory interventions in the NICU by staging infants based on cardiorespiratory status and physiologic maturity, not age. The iRainbow improved the delivery of developmental care activities in our unit and was well received by parents and nurses.

KEYWORDS: iRainbow, Neonatal Intensive Care Unit, Neonatal Therapy, Developmental Care, Neonatal Sensory Interventions, Neonatal Care Path, Family Education

WHAT THIS EVIDENCE ADDS: Current evidence: There are many studies and programs demonstrating the benefits of providing evidence-based developmental interventions for both neonates and caregivers.1-4 Gap in the evidence: There is less agreement regarding the safety and timing of developmental interventions7-9, and what does exist tends to rely on gestational age, while recommending performing activities per infant tolerance.5,6 However, this approach can be problematic because preterm infants progress at variable rates, and infant tolerance is not objectively defined. How does this study fill this gap? This study provides objective clinical criteria to define neonate tolerance for intervention guided by the cardiorespiratory stability of the infant, and in later stages, behavior cues of the infant, not gestational age. Implication of all the evidence: Optimal timing of and tolerance to evidence-based developmental interventions in the NICU is still being described. Relying solely on gestational ages may not be ideal for many infants. The iRainbow serves as a valuable tool to objectively identify an infant’s readiness to participate in a developmental care program.