Bridging the gap

Baby Bridge program clinicians provide early intervention to preterm babies

by Michele Berhorst  •  October 29, 2020

Katie Bogan, OTD, OTR/L, with a preterm baby in the NICU at St. Louis Children's Hospital.

A preterm birth is defined as a baby being born before 37 weeks of pregnancy are completed. According to the Centers for Disease Control and Prevention (CDC), 1 of every 10 infants born in the United States in 2018 was preterm. Babies born too early (before 32 weeks) have higher rates of death and disability. Infants that survive can have issues with breathing, feeding, hearing and vision. They are also at higher risk for having developmental delays that can cause the child to lag all the way into adulthood.

Developed by Bobbi Pineda, PhD, OTR/L, Baby Bridge began as a collaboration between the Program in Occupational Therapy’s research division, clinical practice and St. Louis Children’s Hospital newborn intensive care unit (NICU). Today, it has evolved into a community-based transition program where Washington University Occupational Therapy, St. Louis Children’s Hospital and First Steps work together to ensure that the baby continues to receive needed therapy services without interruption. Katie Bogan, OTD, OTR/L, and colleague Sarah Cheatham Oberle, OTD, OTR/L, currently comprise the Baby Bridge team. Both pediatric therapists specialize in early intervention and have experience working with NICU babies in acute care and home settings.

First Steps is Missouri’s early intervention system that provides services and support to children aged 0–3 with disabilities or developmental delays. Bogan explains what can happen during the “gap” between a preterm baby being discharged from the hospital and receiving services from First Steps.

“Babies in the NICU receive therapy services every day. Parents are also supported during that time. When they take the baby home, they are on their own until First Steps can step in,” Bogan says. “There can be, on average, a 45-day delay between NICU discharge and First Steps. Baby Bridge ‘bridges’ that gap in services so that the child is followed up at home therapeutically during that time.” “The developmental progression of these babies looks different than babies who are born at full term. Parents may not recognize the signs that their preterm baby needs support,” Oberle explains. “Just leaving the NICU environment and entering a home with external stimuli such as other kids, cigarette smoke or loud noises can be stressful for a preterm baby, especially if they aren’t managing their own internal stimuli, such as body temperature, hunger or sleepiness very well.”

“Something as simple as a yawn can be a sign the baby is under stress. While we are there to see the baby, a lot of what we do is parent education,” Bogan says. “Feeding is an area we tend to focus on with parents because preterm babies will only eat under very specific parameters. They have to be positioned a certain way, need a particular nipple size or volume of milk/formula. At home, multiple people may be feeding the baby and may not know what those parameters are. We coach parents on what to do and what to look for that might signal the baby is stressed. Ultimately, the parents need to do the task, whether it’s feeding, bathing or tummy time. It doesn’t matter if I can do it if they can’t.”

Bogan and Oberle also see preterm and full-term infants who are withdrawing from drugs and experiencing neonatal abstinence syndrome. “Those babies will typically present differently; they can have a lot of sensitivities to their environment. They may not like the bath or being held or looking at mom’s face. They might be crying a lot or eating all the time,” Oberle says. “We educate parents on what those withdrawal symptoms look like, what medications baby may be on to ease withdrawal and how to help baby desensitize to various stimuli. For example, I had a parent who was bathing her baby every day in his baby sling in a tub of water, and he did not like it one bit. We looked at ways of introducing him to bathing slowly in steps instead of all at once.”

Oberle is also concerned that families with a history of trauma don’t get lost in the process. “Trauma can pass to a child even before they are born. It can be hard to get in touch and stay in contact with these families,” Oberle says. “It’s important we make a connection with the parents in the first week after discharge and provide support to the family. Even if we are not dealing with the trauma itself, we are supporting the family as care providers.”

“Worst case scenario is we reach out to the parents, never make contact and the child isn’t doing well. We never want to lose eyes on the family if possible,” Bogan adds.

That smooth transition to First Steps is key to ensuring families continue to receive early intervention services during a child’s first three years. First Steps providers can help the baby acquire important developmental skills such as crawling, playing, talking and eating during their first three years. They continue to provide support to parents as they learn to encourage and support their child’s development within their daily activities.

The Baby Bridge program is the only one of its kind in the St. Louis region, and Bogan and Oberle feel privileged to be a part of it. “We are able help a parent be a parent. We may only see our families for 45 days, but that is a long time in the life of a preterm baby. It’s special to be invited into a home and be able do something that will really help a child and their family,” Bogan says.

To learn more about this program, please visit otservices.wustl.edu.