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Special Topic Course 28: “What goes in, must come out”: Neonatal Therapy Care for the Premature Infant post Gastrointestinal (GI) Surgery

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Speakers: Holly Schifsky, OTR/L, CNT, NTMTC, CBIS & Danielle Prince, OTD, OTR/L 


Topic: “What Goes In, Must Come Out:”  Neonatal Therapy Care for the Premature Infant Post GI Surgery 

Course Description: Preterm infants are surviving younger gestational ages due to advances in medical care. The risk of necrotizing enterocolitis (NEC) is inversely related to younger premature infants. The development of the gastrointestinal system is interdependent upon cardiac, pulmonary, and immune system maturation. Infants with NEC are at risk for intestinal perforation which requires surgical intervention for creation of a fistula and ostomy.  The neonatal therapist working with these premature infants utilizes their knowledge of gastrointestinal maturation, surgical recovery, gross motor development of the abdominal wall, understanding of GI motility, and feeding skill development to create comprehensive care plans that progress these infants motor and feeding goals. During this presentation, we will review the anatomical changes to the GI system as related to initial surgical correction and re-anastomosis of the small intestine. Clinical education will be provided regarding critical reasoning for pain management, scar assessment/treatment, re-feeding stool to the distal fistula to assist with the development of the rectal anal inhibitory reflex, nutritional factors to reduce weight loss, risk factors for dumping syndrome, oral feeding strategies, assessing the infant for complex oral feeding co-morbidities associated with prolonged NPO status, positioning strategies to support GI motility, and interpretation of perfusion monitoring to the GI system.  We will share the critical reasoning algorithm our neonatal therapy team has created for continuity of care with premature infants’ post-surgical correction for NEC. Upon completion of this session, participants will have a deeper understanding of intestinal correction surgery for premature infants and treatment strategies to address the positioning, handling, developmental, and oral feeding goals for the infant. 

Speaker Bios: 

Holly Schifsky, OTR/L, CNT, NTMTC, CBIS is an Occupational Therapist who has worked in pediatrics for the past 23 years with the past 15 years in a level IV NICU.  She is a Certified Neonatal Therapist, Certified Neonatal Touch and Massage Therapist, Certified Brain Injury therapist, an active member of National Association of Neonatal Therapists, and has completed 6-month mentorship in infant/child NDT.  She has worked within the NICU and NICU follow-up clinic to maximize patient and family outcomes for the most complex premature and medically-fragile term infants.  Holly received her bachelor’s degree in Occupational therapy from the University of North Dakota in 1997.  She has dedicated her career to clinical care and advancing developmental care practice patterns for all multidisciplinary team members.  She has presented at many regional and national conferences including NANT, Audrey Harris Vision NICU conference, and the University of Minnesota NICU conference.  She provides frequent Developmental Care, Feeding Intervention, and NICU education throughout the country.  She is a faculty member for the Neonatal Touch and Massage certification.  She is the recipient of the National Association of Neonatal Therapists Clinical Excellence award in 2018, due to her clinical expertise and dedication to premature infants with cardiopulmonary conditions. 

Danielle Prince, OTD, OTR/L is a 2019 graduate of Washington University School of Medicine Occupational Therapy program and a 2016 graduate of Virginia Commonwealth University with her bachelor of science degree in exercise science and kinesiology.  During her time at Washington University, she was an active member in Dr. Roberta Pineda PhD, OTR/L NICU research lab and completed her capstone professional OT rotation, with a focus on cardiopulmonary interventions for medically fragile neonates, under Holly Schifsky, OTR/L at the University of Minnesota level IV NICU.  She works full-time as a neonatal therapist at the University of Minnesota NICU providing assessment, intervention, family training, and multidisciplinary education to care providers of the infants in the neonatal intensive care unit.  She has been actively involved in program implementation of the SENSE program at the University of MN and has provided education to team members regarding her research interests as referenced on her curriculum vitae.  She provides developmental and feeding interventions to infants in the University of Minnesota NICU follow-up clinic. 


00:00-2:00 min: Introduction to topic
02:00-20:00 min: Incidence, types of NEC, anatomy,
20:00-30:00 min: Neonatal Therapy algorithm
30:00-40:00 min: Assessment of Scars, Treatment, Interventions, Oral Feeding considerations,
40:00-50:00 min: Outcomes
50:00-61:00 min: Recorded question and answer session
61:00-65:00 min: Learning assessment


Holly Schifsky, OTR/L, CNT, NTMTC, CBIS  

Financial Disclosures: Speaker is a faculty member for Education Resources Inc and receives a speaking honorarium for continuing education courses that she teaches. 

Nonfinancial Disclosures: Presenter is a volunteer teacher and speaker at professional events. 

Danielle Prince, OTD, OTR/L 

Financial Disclosures: No relevant disclosures 

Nonfinancial Disclosures: No relevant disclosures 

Conflict of Interest: There is no conflict of interest for anyone with the ability to control content for this activity. 

Target Audience:  OT, SLP, PT and neonatal professionals 

Educational Level: Advanced 


    1. Identify the anatomical changes to the premature infant gastrointestinal anatomy post-surgical intervention for necrotizing enterocolitis 
    2. Apply individualized care planning to premature infants with post intestinal surgical correction to positioning, handling, and feeding interventions
    3. Assess the premature infants scar maturation with consideration of the effects to GI motility, gross motor development, and oral feeding outcomes 

Instructional Methods: Recorded webinar, lecture, videos, case studies, and recorded question and answer session. Learning assessment and course evaluation follow course.   

Course Completion Requirements: 

The learner must view the entire webinar, complete the course evaluation and complete the post webinar learning assessment with at least 80% to receive education credit. Login and logout times will be recorded and documented. 

Following completion of this course physical therapists, nurses and other disciplines will receive a certificate of completion and a zip file containing information necessary to submit to their individual state for education credit. Zip file will include course bibliography. Physical therapists are responsible for knowing and adhering to their state’s deadlines, rules and regulations. 

Registration information:

In order to obtain access to the course, click the “Watch now” button at the bottom of the screen. You are required to be a NANT member in good standing to have access to this course. You may also purchase this course as a non-member by clicking the “Buy Now” button at the bottom of the screen.  

For ADA accommodations, please call NANT Customer Service for more information at (866) 999-5524. 

Cancellation Policy: Click HERE to review NANT’s Course Cancellation Policy. 

Continuing Education Information*


National Association of Neonatal Therapists® (NANT) is an AOTA Approved Provider of professional development. Course approval ID# 03642. This Distance Learning-Independent Course is offered at 0.1 CEUs (Advanced level, Occupational Therapy Service Delivery). AOTA does not endorse specific course content, products, or clinical procedures.



Learners must complete the entire course in order to receive ASHA CEUs. No partial credit awarded. ASHA CE Provider approval and use of the Brand Block does not imply endorsement of course content, specific products or clinical procedures. 

ASHA CE Registry users: NANT will submit ASHA CEUs to ASHA on your behalf.  ASHA CEUs may take up to 100 days show on your ASHA Transcript. 

Non-ASHA CE Registry users:  Maintain your course records and please keep your registry status current in your NANT account.  Update your NANT account with your ASHA number if your registry status changes.  NANT is not responsible for tracking your registry status. 

PT CE Credit:

This activity has been approved by the Texas Board of Physical Therapy Examiners for 1.0 CCUs for PTs and PTAs.  

NANT is recognized by the New York State Education Department’s State Board for Physical Therapy as an approved provider of physical therapy and physical therapist assistant continuing education. 

*NANT 11 attendees who previously viewed this educational content may retake this course and receive CE Credit. 

Questions regarding CE credit should be directed to the National Association of Neonatal Therapists at or (866) 999-5524. 

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