Am J Perinatol
DOI: 10.1055/a-1678-0002
Original Article

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
2   Department of Pediatrics, Keck School of Medicine, Los Angeles, California
3   Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
4   Program in Occupational Therapy, Washington University, St. Louis, Missouri
Julia Lisle
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
Louisa Ferrara
5   Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, New York
6   Department of Communication Sciences and Disorders, Molloy College, Rockville Centre, New York
Kati Knudsen
7   Neonatal Intensive Care Unit, Women's and Children's Division, Providence St. Vincent Medical Center, Portland, Oregon
Ramya Kumar
8   Department of Rehabilitation Services, Banner Thunderbird Medical Center, Glendale, Arizona
9   Physical Therapy Department, Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, Florida
10   Neonatal Intensive Care Unit, Rehabilitation Department, South Miami Hospital, Miami, Florida
› Author Affiliations
Funding None.


Objectives This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors.

Study Design This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States.

Results We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT).

Conclusion Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families.

Key Points

  • We estimated that there are 4,232 neonatal therapists working in NICUs in the United States.

  • Dedicated therapy teams for the NICU are more common in large, high acuity NICUs.

  • An average of 17 beds per neonatal therapy FTE was observed.

  • In 2020, 22% of NICUs had CNTs, and CNTs were more common in large and high acuity NICUs.

  • Benchmarking neonatal therapy staffing can aid in expanding NICU therapy services where needed.

Publication History

Received: 04 June 2021

Accepted: 20 October 2021

Publication Date:
25 October 2021 (online)

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