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Exploring clinical rehabilitation practices for bronchopulmonary dysplasia in neonatal intensive care unit: A
1Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Rehabilitation for premature infants with bronchopulmonary dysplasia (BPD) in China lacks standardization, with inconsistent practices and limited collaboration. Enhancing multidisciplinary teams and parental involvement is crucial for improving outcomes in the Neonatal Intensive Care Unit (NICU).
Area of Science:
- Neonatal care
- Pediatric rehabilitation
- Respiratory medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a common complication in extremely preterm infants, increasing the risk of neurodevelopmental impairment.
- Rehabilitation therapy can improve pulmonary and neurological functions in infants with BPD.
- Current rehabilitation practices in China lack consensus on optimal timing, type, frequency, and follow-up.
Purpose of the Study:
- To investigate current clinical rehabilitation practices for BPD in Neonatal Intensive Care Units (NICUs).
Main Methods:
- Qualitative descriptive study.
- Involved 12 informants.
Main Results:
- Identified five major themes: non-standardized practices, lack of consensus/collaboration, limited parental involvement, restricted nurses' role, and inadequate environment.
- Rehabilitation frequency, intensity, initiation, and follow-up were inconsistent.
- Interdisciplinary communication and parental engagement (e.g., kangaroo care) were minimal.
Conclusions:
- Current BPD rehabilitation in NICUs is inconsistent, lacking interdisciplinary collaboration and optimal parental involvement.
- There is a need for multidisciplinary teams and evidence-based, culturally tailored rehabilitation protocols.
- Improving parental participation, rehabilitation spaces, environmental factors, and nurses' training is essential for infant recovery.
Background:
Bronchopulmonary dysplasia (BPD) is a common complication in premature infants, particularly those born extremely preterm, and is a significant risk factor for neurodevelopmental impairment. Rehabilitation therapy has been shown to improve both pulmonary and neurological functions in infants with BPD. However, in China, there is no consensus on the optimal timing, type, frequency or follow-up of rehabilitation exercises for these infants. Understanding the current clinical practices, challenges and areas for improvement is essential to enhancing outcomes.
Aim:
To investigate current clinical rehabilitation practices for BPD in the Neonatal Intensive Care Unit (NICU).
Study Design:
Qualitative descriptive study.
Results:
A total of 12 informants participated in this study. Four major themes were identified: (1) Non-standardized rehabilitation practices: Inconsistent frequency and intensity of rehabilitation therapy, delayed initiation and lack of follow-up. (2) Lack of consensus and collaboration: Absence of expert consensus on rehabilitation practices and insufficient interdisciplinary communication. (3) Limited parental involvement in rehabilitation: Minimal kangaroo care, low engagement in caregiver training and limited support for family participation in rehabilitation. (4) Nurses' involvement in rehabilitation therapy is limited, with issues including unstandardized positioning management, minimal participation in rehabilitation coordination and a lack of proactive feedback on BPD infants' rehabilitation tolerance. (5) Inadequate rehabilitation environment: Constraints such as limited space, lack of family-centred wards, insufficient equipment and environmental issues with noise and lighting.
Conclusions:
Rehabilitation practices for BPD in the NICU are inconsistent, with limited interdisciplinary collaboration and suboptimal parental involvement. The study underscores the need for establishing a multidisciplinary team and developing evidence-based, culturally tailored rehabilitation protocols. Improving parental participation, creating appropriate rehabilitation spaces, managing environmental factors like noise and lighting, nurses should participate in training on positioning management and assist with rehabilitation therapy, actively providing feedback to the medical team on the tolerance of BPD infants and enhancing equipment availability will contribute to the early recovery of infants with BPD.
Relevance To Clinical Practice:
This study highlights critical gaps in current rehabilitation practices for BPD in NICUs, suggesting that a standardized, evidence-based approach is needed to optimize care. Clinicians should focus on fostering multidisciplinary collaboration, enhancing parental involvement and improving the physical environment of NICUs to support the rehabilitation process for premature infants with BPD. Nurses in the NICU play a pivotal role in the rehabilitation of children with BPD. Their key responsibilities include assessing the infants' condition to determine their ability to tolerate rehabilitation and providing hands-on support throughout the treatment process.
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