Table 1.

Knowledge areas for evaluation and intervention in the neonatal intensive care unit.

Knowledge area	Evaluation/intervention
Environment (micro-, macro)- including equipment	NTa identifies how the environment affects the infant, determines if environment appropriately matches each infant’s age-specific/risk-adjusted/individual needs, and modifies/adapts environmental affordances according to age-appropriate abilities.
Neurodevelopment-immaturity secondary to preterm or late preterm birth and iatrogenic risks/impact affecting	NT uses assessments and implements interventions that match each infant’s neurodevelopmental needs and sensory input/motor output thresholds from birth through discharge as indicated.
• Neurobehavioral system	NT interprets quality of neurobehavioral output as it relates to environmental input. Generates or formulates an intervention plan that supports the infant’s capacity/skill development in: • autonomic, • motor, • state, • attention, and • self-regulation.
• Neuromotor system	NT interprets quality of neuromotor system as influenced by environmental affordances. Generates or formulates an intervention plan that supports each of the following with age-appropriate interventions: • Neurodevelopmental positioning and handling for caregiving, rest, and recovery • Movement pattern development • Reflex development • Muscle tone development/changes • Compromise following insult (e.g., hypoxic ischemic encephalopathy, IVH, PVL, dysgenesis of corpus callosum)
• Musculoskeletal system	NT interprets quality of musculoskeletal system support and function as it relates to environmental input. Generates or formulates an intervention plan that supports the infant’s development of: • Posture and alignment development • Antigravity movements and symmetric strength development, • Physiological tolerance of activity • Management of orthopedic anomalies (e.g., brachial plexus injury, club foot, spina bifida, etc.) • Prevention of iatrogenic deformities
• Sensory system  ○ Tactile  ○ Proprioceptive  ○ Vestibular  ○ Gustatory  ○ Olfactory  ○ Auditory  ○ Visual	NT Interprets quality of sensory input as it relates to environmental input. Generates or formulates an intervention plan that supports sensory system development at micro- and macro level and promotes protection of sensory system components during age-appropriate activities: • Sensory integration capabilities, and • Progression of sequential sensory system development.
• Aerodigestive system	Feeding assessment must be in the scope of practice of the individual discipline.
Successful transition to oral feeding requires the infant integrate skills from multiple systems and adjust for existing comorbidities	Although not all NT’s may have specialization in oral feeding and/or swallowing, the NT must be able to assess a number of skills that are foundational in order to support oral feeding acquisition. NT promotes protection of aerodigestive system components during age-appropriate activities: • Sensory oral and gustatory integration, • Pre-feeding and safe transition to oral feeding, including breast and bottle feeding, • Autonomic system dysregulation/compromise, • Structural anomalies affecting development or oral feeding/swallowing (e.g., cleft palate, tracheoesophageal fistula, etc.), and Assessment may include clinical bedside and instrumental (e.g., graphic assessment, VFSS, FEES, etc.).
• Pain management	Nonpharmacological pain management interventions.
Family/psychosocial: individual family needs: culture, socioeconomic, language, financial, etc. (in coordination with nursing and other mental-healthcare providers)	Assess confidence and competence in the following • Bonding and attachment • Psychological support • Cognitive abilities and/or challenges • Early caregiving activities • Transition to home Intervention includes unit-wide and family-specific education and support, and strategies to guide families in early parenting skills by improving confidence and competence in noted assessment areas.

^aNeonatal therapist.