An Evolving Role in the NICU: A Study of the Tasks, Knowledge, Skills, and Practice Demographics of the Neonatal Therapist

Alicia Fernandez-Fernandez^1,2*Deanna Gibbs³Margaret Miller⁴Kati Knudsen⁵Louisa Ferrara-Gonzalez^6,7Roberta Pineda^10,11,8,9

• ¹Physical Therapy Department, Nova Southeastern University, Fort Lauderdale, United States
• ²South Miami Hospital, South Miami, United States
• ³Barts Health NHS Trust, London, United Kingdom
• ⁴Providence Sacred Heart Medical Center, Spokane, WA, United States
• ⁵Providence St Vincent Medical Center, Portland, United States
• ⁶Infant Feeding Specialists, Inc, Garden City, NY, United States
• ⁷NYU Langone Hospital - Long Island, Mineola, United States
• ⁸University of Southern California Chan Division of Occupational Science and Occupational Therapy, Los Angeles, United States
• ⁹Keck School of Medicine, Department of Pediatrics, Los Angeles, CA,, United States
• ¹⁰Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, United States
• ¹¹Program in Occupational Therapy, Washington University in St Louis, St. Louis, United States

Objectives: To describe current practice and roles of the neonatal therapist. Study Design: A Neonatal Therapy Practice Analysis was distributed to neonatal therapists (physical therapists, occupational therapists, and speech-language pathologists) in 2019-2020 via social media, email, newsletters, and conference materials. Results: There were 1313 respondents from 1110 different hospitals. 41.7% (n=277) were occupational therapists, 29.3% (n=195) were physical therapists, and 29.0% (n=193) were speech-language pathologists. 760 (59.1%) worked in level III NICUs, while 248 (19.3%) worked in level II NICUs and 273 (21.2%) in level IV NICUs. 166 (28.1%) of respondents were Certified Neonatal Therapists (CNTs), which was related to higher number of full-time equivalents (FTEs) per beds (β=1.066, SE=0.478, p=0.026) and higher percentage of infants served in the NICU (β=-3.2, SE=0.589, p<0.001). We observed a median of one therapy FTE per 17 NICU beds (range of 1 FTE per 10 to 200 beds). Higher acuity NICU levels (β=2.23, SE=0.197, p< 0.001) and NICUs with higher number of beds (β=2.497, SE=0.285, p< 0.001) had more neonatal therapy FTEs. Survey respondents reported working with a median of 76.0% of infants in their respective NICUs (IQR 25%, range 1-100%). There was a higher percentage of infants served in higher acuity NICUs (β=4.358, SE=1.517, p=0.004), in NICUs with a higher number of beds (β=0.058, SE=0.029, p=0.047), when there was a productivity standard (β=11.47, SE=1.9, p<0.001), and where there was a higher number of neonatal therapy FTEs (β=1.0, SE=0.239, p<0.001). 294 (46%) of respondents reported having standing orders, which was related to a higher percentage of infants served in the NICU (β=-1.109, SE=0.393, p<0.001) and to having a productivity standard (β=-0.467, SE=0.139, p<0.001). 65.3% (n=415) of respondents reported having productivity standards to meet each day, ranging from 50-80%. Conclusion: This practice analysis provides insights into the changing landscape of neonatal therapy.