S.V. Mannava1, E. Turk2, A. Engel1, A. Vogler3, A. Crook2, M. McQuay4, T.A. Markel1 1Indiana University School Of Medicine, Division Of Pediatric Surgery, Indianapolis, IN, USA 2Indiana University Health Physicians, Indianapolis, IN, USA 3Riley Hospital for Children at Indiana University Health, Pediatric Inpatient Physical Therapy Rehabilitation Services, Indianapolis, IN, USA 4Community Health Network, Indianapolis, IN, USA
Introduction: Postoperative mobilization in neonates is a critical component of the enhanced recovery pathway. There is limited data on physical (PT) and occupational (OT) therapy utilization in this cohort. We hypothesized that neonates who underwent major abdominal surgical procedures (operative neonates, ONs) will experience increased barriers to receiving therapies compared to neonates who did not undergo such procedures (nonoperative neonates, NNs).
Methods: We retrospectively analyzed neonates admitted to our institution from January 2020 to December 2021. We compared baseline characteristics, therapy type and timing, and clinical outcomes between ONs and NNs.
Results: We assessed 210 neonates (92 ONs, 118 NNs). ONs had lower median [Q1, Q3] gestational age (GA) at birth (33 [26, 37] weeks vs. 36 [28, 39] weeks, p=0.002) and birthweight (1722 [782.5, 2842] grams vs. 2328 [113, 3093] grams, p=0.013] compared to NNs. Therapy type varied between ONs and NNs as follows: PT only (19.6% vs. 28%), OT only (32.6% vs. 33.1%), neither (30.4% vs. 33.1%), and both (17.4% vs. 5.9%) (p=0.054). ONs experienced significantly greater median [Q1, Q3] time from admission to first PT session (28 [12.8, 94.3] days vs. 11 [5, 24.8] days, p=0.001) and first OT session (27 [13.8, 61.3] days vs. 13 [6, 34] days, p<0.001). The median time from index operation to first PT session was 25 days and to first OT session was 22 days for ONs. While ONs had a significantly higher mean [SD] corrected GA (41 [5.7] vs 37.9 [4.0] weeks, p=0.008) and median [Q1, Q3] weight (3260 [2103, 5415] grams vs. 2680 [1908, 3260] grams, p=0.046) compared to NNs at time of first PT session, this was not observed for OT. The ratio of active and missed PT and OT sessions to length of stay (LOS) was not significantly different between groups. ONs more frequently missed PT (38.2% vs. 7.5%, p=0.002) and OT sessions (32.6% vs. 2.2%, p=0.001) due to out-of-unit procedures or imaging studies when compared to NNs. Postoperative pain was cited as a reason for missed PT sessions in 32.4% of cases and missed OT sessions in 23.9% of cases. ONs had significantly longer LOS, more frequent need for parenteral nutrition, and decreased survival during admission when compared to NNs.
Conclusion: Compared to NNs, ONs experienced significantly longer time from admission to first therapy sessions. After accounting for LOS, there was no significant difference between groups in terms of active and missed PT and OT sessions. However, ONs were more likely to miss a PT or OT session due to out-of-unit procedure or imaging study as compared to NNs. Our data highlights a need for mitigation of barriers to mobilization among ONs, particularly in the first few weeks after abdominal surgery. Prospective studies are needed to explore the impact of earlier postoperative therapy and tactile stimulation among ONs and investigate the potential for improved postoperative outcomes in this population.