NICU Manual Edema Mobilization: "Opening the Flood Gates: Infant Edema Management"
09-13-2025
Objectives (Educational Content) :
Presentation Date: Saturday 9/13/25 and Sunday 9/14/25.
Participants will identify the role of the lymphatic system and gestational development as related to co-morbidities of prematurity, post-surgical interventions, and wound healing
Participants will distinguish specific NICU/infant edema precautions, contraindications, and limitations to Manual Edema Mobilization
Participants will apply individualized care planning with critical reasoning for the lymphatic flow of fluid regarding positioning, handling, and movement facilitation for premature and medically complex infants.
Participants will assess premature/medically complex infant edema with consideration for type of edema and its influence on oral motor and gross motor movement to support development.
Participants will demonstrate the five key components of MEM and application within the NICU:
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a. Diaphragmatic breathing
b. Light manual lymphatic system stimulation with "Pump Points" and "Clear and Flow"
c. Exercise
d. Adjuncts
e. Home program with caregiver training
Target Audience:
Occupational Therapy and Physical Therapy
Estimated Time to Complete the Educational Activity:
16 hour(s)
Expiration Date for CE/CME Credit:
00-00-0000
Method of Participation in the Learning Process:
The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.
Evaluation Methods:
Labs/hands on practice, post-test, and course evaluation to receive certificate for OT/PT CEUs.
Bibliography:
Akbayrak, T., Citak, I., Demirtuk, F., Kerem, M., & Akarcali, I. (2002). Physiotherapy results in a baby with congenital lymphedema: A follow up study. The Turkish Journal of Pediatrics, 44, 349-353.
Artzberger, Sandra. (2005) Physical Disabilities: Special Interest Section Quarterly, AOTA. A Critical Analysis of Edema Control Techniques. Volume 28, Number 2; June 2005 Baluk P,
Tammela T, Ator E, Lyubynska N, Achen MG, Hicklin DJ, Jeltsch M, Petrova TV, Pytowski B, Stacker SA, et al. Pathogenesis of persistent lymphatic vessel hyperplasia in chronic airway inflammation. J Clin Invest 2005;115:247-257. Bamji,M. et al (1986) Palpable lymph nodes in healthy newborns and infants. Pediatrics, 1986 Oct; 77 (4): 3-5
Bengtsson, B, van Houten, J. 2019. Central edema in critically ill neonates. Case reports in Perinatal Medicine, vol 8, no 2, 2019, pp. 20190037.
Bhardwaj, R., Vaziri, H., Gautam, A., Ballesteros, E., Karimeddini, D., & Wu, G.Y. (2018). Chylous Ascites: A Review of Pathogenesis, Diagnosis and Treatment. Journal of Clinical and Translational Hepatology, 6, 105 - 113.
Butler, M.G., Isogai, S., & Weinstein, B.M. (2009).Lymphatic development. Birth Defects Res C Embryo Today, 87, 222-231.
Damstra, R.J., & Mortimer, P.S. (2008). Diagnosis and therapy in children with lymphedema. Phlebology, 23, 276-286.
Doubblestein, D (2016). Manual Lymphatic Techniques for the Orthopedic Manual Therapist. 2016, Upledger Publications.
Gitomer, S.A., Giannoni, C.M., & Canadas, K.T. (2016). Pediatric lymphedema caused by diffuse cervical lymphadenophy; A case report and review of the literature. International Journald of Pediatric Otorhinolaryngology, 87, 67-70.
Greene AK, Goss JA. Vascular Anomalies: From A Clinicohistologic to a Genetric Framework. Plast Reconstr Surg(2018). 141(5); 709e-717e.
Gurevich A, Nadolski GJ, Itkin M.(2018) Novel lymphatic imaging and percutaneous treatment of chyluria. Cardiovasc Intervent Radiol 2018; 41 (12) 1968-1971
Hanson, C.S., Newsom, J., Singh-Grewal, D., Henschke, N., Patterson, M., & Tong, A. (2018). Children and adolescents' experiences of primary lymphedema: semistructured interview study. Arch Dis Child, 103, 675-682. Huxley VH, Scallan J. (2011). Lymphatic fluid: exchange mechanisms and regulation. J Physiol. 2011 Jun 15;589(Pt 12):2935-43. doi: 10.1113/jphysiol.2011.208298. Epub 2011 Apr 26. PMID: 21521763; PMCID: PMC3139077.
Inoue M, Nakatsuka S, Yashiro H., et al. (2016) Lymphatic intervention for various types of lymphorrhea: access and treatment. Radiographics 2016; 36 (07) 2199-2211
Jakus Z; et al (2014) Lymphatic function is required prenatally for lung inflation at birth. J Exp Med 2014; 211: 815-826
Janer et al (2006). Pulmonary vascular endothelial growth factor-c in development and lung growth in premature infants. American Journal of Respiratory and Critical Care Medicine. August 2006
Kato M, Watanabe S, lida T, Watanabe A. (2019) Flow pattern classification in lymphatic malformations by indocyanine green lymphography. Plast Reconstr Surg 2019; 143 (03) 558e-564e Levick, RJ.; Michel, CC. (2010) Microvascular fluid exchange and the revised Starling principle, Cardiovascular Research, Volume 87, Issue 2, 15 July 2010, Pages 198-210, https://doi.org/10.1093/cvr/cvq062
McNellis, E.M., Mabry, S.M., Taboada, E., & Ekekezie, I.I. (2014). Altered pulmonary lymphatic development in infants with chronic lung disease. BioMed Research International, 2014, 1-11.
Meert, G. (2012) Fluid dynamics in fascial tissues.: In Fascia: The Tensional Network of the Human Body, edited by Alison Taylor, 177-81. New York: Churchill Livingstone Ele
Momose M, Kawakami S, Koizumi T., et al. (2008) Lymphoscintigraphy using technetium-99m HSA-DTPA with SPECT/CT in chylothorax after childbirth. Radiat Med 2008; 26 (08) 508-511
Papendieck, C.M. (2016). Lymphedema in pediatric patients. In EDITORS (Eds.), Lymphedema: Complete Medical and Surgical Management (235-246). New York: Thieme Verlagsgruppe.
Phillips, J.J., & Gordon, S.J. (2014). Conservative management of lymphedema in children: A systematic review. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 7, 361-372.
Reddena, L., Venkatesh, P., Siva Kumar, K., and Saikeshava Reddy, A. 2017. Anasarca: A generalized swelling. PharmaTutor. 5, 8 (Aug. 2017), 41-45.
Schook, C.C., Mulliken, J.B., Fishman, S.J., Grant, F.D., Zurakoski, D., & Greene, A.K. (2011). Primary lymphedema: Clinical features and management in 138 pediatric patients. Plastic and Reconstructive Surgery, 127(6), 2419-2431.
Scallan JP, Zawieja SD, Castorena-Gonzalez JA, Davis MJ. Lymphatic pumping: mechanics, mechanisms and malfunction. J Physiol. 2016 Oct 15;594(20):5749-5768. doi: 10.1113/JP272088. Epub 2016 Aug 2. PMID: 27219461; PMCID: PMC5063934.
Schifsky, H. (2016) "Fluid matters: Integrating manual edema mobilization within the NICU for Optimal neuromotor development. Annual Conference National Association of Neonatal Therapists.
Semo J, Nicenboim J, and Yaniv K. Development of the lymphatic system: new questions and paradigms. Development (2016) 143, 924-935. doi: 10.1242/dev.132431
Shulte-Merker S, Sabine A and Petrova TV. Lymphatic vascular morphogenesis in development, physiology, and disease. J. Cell Biol (2011) 193(4): 607-618.
Stump, B; Cui, C. et al (2016) Lymphatic changes in respiratory diseases: more than just remodeling of the lung? American Journal of Respiratory Cell and Molecular Biology. Volume 57, Issue 3.
Tan, I.C., Balagurau, D., Rasmussen, J.C., Guilliod, R., Bricker, J.T., Douglas, W.l., & Sevick-Muraca, E.M. (2014), Investigational lymphatic imaging at the bedside in a pediatric postoperative chylothorax patient. Pediatric Cardiology, 35, 1295-1300.
Todd, M. (2010). Lymphoedemain children: An overview. British Journal of Nursing, 19(7), 420, 422, 424-427.
Vical, F., Arrault, M., & Vignes, S. (2016). Paediatric primary lymphedema: A cohort of 155 children and newborns. British Journal of Dermatology, 175, 628-631.
Visscher et al. (2015) Newborn infant skin: Physiology, development, and care. Clinics in Dermatology (2015) 33, 271-280.
Warren, AG; Brorson, H; et al. (2007) Lymphedema: a comprehensive review. Ann Plast Surg, 59(4):49-54, 01 Oct 2007. PMID 17901744
Watt, H., Singh-Grewal, D., Wargon, O., & Adams, S. (2017), Paediatric lymphedema: A retrospective chart review of 86 cases. Journal of Paediatrics and Child Health, 53, 38-42.
Williams, A. (2010). Manual lymphatic drainage: exploring the history and evidence base." Britain Journal of Community Nursing. 15 (4): S18-24.
Zoltzer H. Initial Lymphatics-morphology and function of the endothelial cells. Lymphology. 2003;36(1):7-25.
Speakers:
Holly Schifsky, OTR/L, CNT, NTMTC, CBIS