Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial

BACKGROUND

Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure.

METHODS

This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs).

RESULTS

between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03).

CONCLUSIONS

early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.

PEP mask therapy for the rehabilitation of a pre-term infant with respiratory distress syndrome: a case report

BACKGROUND

Preterm infants can develop many complications related to organs underdevelopment. Respiratory distress syndrome (RDS) is considered the most important cause of morbidity and mortality in these patients. Traditional therapies for severe RDS, such as mechanical ventilation, come with a potential risk for pneumothorax and bronchopulmonary dysplasia while evidence on chest physiotherapy in preterm infants are controversial in terms of feasibility, tolerability and safety. The use of the positive expiratory pressure (PEP) mask is known in the pediatric field especially in cystic fibrosis for the removal of secretions and lung re-expansion. However, no literature exists on the application and effectiveness of this treatment modality for the respiratory rehabilitation of preterm infants. In this study, we aimed to assess the efficacy of a respiratory rehabilitation protocol based on PEP mask in a preterm infant with respiratory distress syndrome.

CASE REPORT

A Caucasian girl born at 26 + 5 weeks of gestational age with respiratory distress syndrome was treated with mechanical ventilation, oxygen therapy and PEP-mask.

CLINICAL REHABILITATION IMPACT

Three weeks of PEP mask led to a significant clinical and radiological improvement of the lung's function with progressive reduction of the oxygen supplement and mechanical ventilation until complete weaning off. Given the absence of literature on this subject, further studies should be conducted to confirm these preliminary observations.

Effects of early respiratory physiotherapy on spontaneous respiratory activity of preterm infants: study protocol for a randomized controlled trial

Background

Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in neonatal intensive care unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation.

Methods

Preterm infants with gestational age < 31 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: (1) the study group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved; thus, no respiratory support is required; (2) the control group infants will take part exclusively in the individualized postural care program. They will perform the technique of respiratory facilitation and autogenous drainage.

Objective

To evaluate the efficacy of early respiratory physiotherapy in reducing the incidence of intubation and mechanical ventilation in the first week of life (primary outcome).

Discussion

The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a “trigger point” of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support.

Trial registration

UMIN-CTR Clinical Trial UMIN000036066. Registered on March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr

Effects of Lycra suits in children with cerebral palsy

Lycra garments have recently been used for children with cerebral palsy (CP), with favorable effects on alignment, biomechanics and neuromuscular activity. The aim of the present study is to determine the efficacy of a Lycra suit in improving motor function and static balance in children with CP. Five children with CP wore the Lycra suit for more than 4 h per day for 6 months. They were all assessed at baseline and 6 months after with an evaluation of static balance, using a "seated stabilometry exam", and a motor function assessment, using the Gross Motor Function Measure and Gross Motor function Classification System. The assessment of static balance was performed with and without the suit. Another 5 children with CP performed the same assessments and were used as a control group. An immediate improvement of static balance was observed at baseline, with the first use of the Lycra suit. Further improvement was observed at the 6 month follow up, with a statistical significance for the parameters assessing the antero-posterior axis. Both parents and children also reported functional benefits. Further studies are needed on long-term functional effects in a large cohort of children.