高危險性新生兒之物理治療

Physical Therapy for High Risk Neonates

臺灣近年周產期與新生兒醫療的進步已大幅提昇早產兒的存活率，可是早產兒仍有高比例會罹患神經發展問題。文獻資料顯示早期發展性介入可改善其神經發展預後，國外新生兒加護病房之常規性新生兒物理治療發展性介入已行之有年，國內目前也有多所醫學中心推動新生兒物理治療服務。新生兒物理治療師需要接受進階的臨床訓練，以執行早期介入計畫，教導家長照護知識與技巧、提供心理支持、協助取得或轉介療育資源以幫助高危險性新生兒及其家庭。本文主要介紹新生兒物理治療發展歷史、介入理論基礎、新生兒神經發展評估與實務工作內容，並討論物理治療師在新生兒加護病房中的角色與責任，期能分享物理治療在新生兒照護上的經驗，讓醫療人員更進一步了解其服務範疇，以促進醫療團隊合作，共同幫助提昇早產兒的照護品質。本文並回顧新生兒時期治療介入的療效實證，以提供介入的參考，最後提出國內新生兒物理治療發展的需求，期待更多有志的治療師投身其中。

Recent advancement of perinatal and neonatal technologic in Taiwan has significantly improved the survival rate of preterm infants. However, the risk of neurodevelopmental disorders in preterm infants remains high. Accumulating data in Western countries showed that early developmental intervention is effective to enhance short-term developmental outcomes in preterm infants. Neonatal physical therapists have provided usual care in the neonatal intensive care unit (NICU) for several decades in developed countries. In Taiwan, some medical centers have implemented neonatal physical therapy for infants at risk of developmental disorders. Neonatal physical therapists require advanced clinical training in developmental assessment and intervention, provision of family education and caring skills, provision of parental support, and acquisition of social resources to help preterm infants and their families. This article delineates the history of neonatal physical therapy, the theoretical foundation of early intervention, the neonatal neurodevelopmental evaluation, and the content of intervention services. The purpose of this article is to share experience and to increase awareness of the role and competency of neonatal physical therapists in the NICU to promote collaborative team work. This paper reviews the evidence-based data of previous intervention studies for preterm infants that provide the references for clinical practice. While there is an urgent need of neonatal physical therapists to provide early intervention to high risk infants, more graduates are encouraged to participate in this work.