File
Esposito E.1, Bembich S.1, Cont G.1, Travan L.1, Sanesi C.1, Demarini S.1
1Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
Background: Preterm infants may be at higher risk of metabolic bone disease, partly due to insufficient physical activity compared to intrauterine life. Physical Exercise program, consisting of passive superior and inferior limbs' mobilization, has been proposed for promoting bone mineralization and growth. No study has so far evaluated if Physical Exercise may cause distress in preterm infants.
Purpose: To evaluate possible stressful effects of Physical Exercise on physiological and behavioral stability in clinically stable preterm infants. Additionally, cerebral blood flow was measured during interventions.
Methods: This was a pilot study involving 10 preterm newborns (6 male, 4 female) with gestational age 34 weeks. Duration of the Physical Exercise program was three weeks, for a total of 15 sessions (five sessions per week). Each session consisted of passive mobilization in flexion and extension of the four limbs for 15 minutes a day. The assessment of physiological and behavioral responses, by an observational sheet specifically designed for this study purpose, was performed at seven time points: 10 minutes before the intervention (baseline), at 5, 10 and 15 minutes during the intervention, and at 10, 20 and 30 minutes after its conclusion. Statistical analysis was performed by repeated measure ANOVA (physiological variables) and non-parametric Friedman test (behavioral variables). Behavioral states, according to Brazelton, were similarly assessed, at the same time points, throughout the Physical Exercise program. Their frequency distribution before, during and after the intervention was compared by Chi2. Cerebral oxy-haemoglobin (HbO2) variation, estimating cerebral blood flow, was assessed during Physical Exercise execution by near-infrared spectroscopy (NIRS) on the 1th , the 8th and the 15th intervention session. HbO2 data was analyzed by repeated measure ANOVA.
Results: 1) Physiological variables: heart rate increased (F(6) = 3.620; p = 0.004), while peripheral oxygen saturation (F(6) = 2.561; p = 0.030) and respiratory rate (F(6) = 2.888; p = 0.016) decreased, during the intervention.
2) Behavioral variables: tremors/startles/clones increased after the intervention
(Chi2(6) = 28.188; p = 0.0005), and stretching/extending trunk increased during and after the intervention
(Chi2(6) = 15.345; p = 0.018).
3) Newborns exhibited also a lower frequency of sleep and a higher frequency of crying during the intervention than either before (Chi2(20) = 55.129; p = 0.0005) or after (Chi2(25) = 41.713; p = 0.019) its execution.
4) Cerebral blood flow, after an initial increase during the first third of the intervention, decreased below the baseline level at the end of Physical Exercise (F(4,36) = 4.564; p = 0.004).
Conclusion(s): Physical exercise appeared to distress preterm newborns in many ways. It increased heart rate and tremors and decreased peripheral oxygen saturation. Moreover, it interfered with sleep state and was associated with decreased cerebral blood flow throughout the intervention.
Implications: Physical therapy may be beneficial for bone mineralization, but it is not devoid of side effects. Clinicians should carefully evaluate the pros and cons of such intervention in preterm infants.
Funding acknowledgements: None
Topic: Paediatrics
Ethics approval: Independent Committee for Bioethics of Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" (Trieste, Italy) approved the reserch
All authors, affiliations and abstracts have been published as submitted.
