Efecto de la fisioterapia respiratoria sobre el desarrollo de niños/as prematurosestudio longitudinal

Resumo

Objective: To evaluate the effect of chest physiotherapy through Vojta's pectoral point stimulate and increased expiratory flow, compared to the control group, on the respiratory system, feeding and growth, hospitalization time, and gross motor development in preterm infants under 32 weeks of gestational age with Respiratory Distress Syndrome (RDS). Methodology: A multicenter randomized clinical trial was conducted with two intervention groups and one control group, with a final sample of 48 preterm infants of less than 32 weeks of gestation. The sample was drawn from the Neonatal Intensive Care Units of the Hospital General Universitario de Elche, the Hospital Universitario Virgen de la Arrixaca de Murcia, and the Hospital Torrecárdenas de Almería, between July 2020 and June 2024. The baseline characteristics of the sample were homogeneous between groups, except for sex, the presence of a ductus, and the study start time. Group I received Vojta's pectoral point stimulation, Group II received increased expiratory flow, and the control group received the standard unit intervention. The intervention was carried out over four weeks, five days a week, with two daily sessions. The effect of these two chest physiotherapy techniques was compared with the control group regarding respiratory system immaturity and associated difficulties (ventilatory support, O2 supply, Bronchopulmonary Dysplasia (BPD) incidence, etc.), the time of initiation of autonomous feeding, the time of hospitalization, and the motor development of these preterm infants. The possible presence of pain during these interventions was also evaluated. Various assessments were conducted during the intervention and hospitalization. Motor area follow-up was evaluated at 40 weeks of gestational age and at 3 months of corrected age. This study is registered in ClinicalTrials.gov under registration number NCT04689386. Results: Most of the analyzed variables showed clinical improvement, although not statistically significant. Statistically, it was noted that the group receiving increased expiratory flow had significantly higher SatO2 values at hospital discharge compared to the control group. A reduction in the number of days on O2 supplementation and the number of days until the initiation of autonomous feeding was observed in the Vojta group compared to the control group (p-value 0.050 and 0.052, respectively). Additionally, a prevalence ratio of 0.75 was observed for both intervention groups concerning BPD, with a p-value of 0.014 for the Vojta group and 0.224 for the increased expiratory flow group, compared to the control group. Finally, a 2.1-point increase in the fine motor scale score of the Bayley III scale was observed at 3 months of corrected age in the Vojta group compared to the control group (p-value = 0.058). Conclusion: Given the small sample size, strong and generalizable conclusions for the entire population of preterm infants under 32 weeks of gestation cannot be drawn. Further research in this area is needed. However, based on our results, we conclude that chest physiotherapy in neonatal intensive care units, through Vojta's pectoral point stimulation and increased expiratory flow, may have a positive effect on the population of preterm infants with RDS regarding SatO2, the duration of ventilatory support, hospitalization time, the initiation of autonomous feeding, and short-term motor development. Based on the results obtained in this study, it can be concluded that the positive effects mentioned earlier were generally more evident in the group that received Vojta therapy, although these benefits did not reach statistical significance in many of the analyzed variables. Moreover, based on the results of our study, Vojta therapy may be a protective factor against BPD. No significant differences were observed between both chest physiotherapy groups in pain assessment using the PIPP-R scale