De volta ao meio líquido: efeitos da intervenção de fisioterapia aquática realizada em prematuros

Abstract

At birth, preterm newborns (PTNB) often require Neonatal-ICU hospitalization, which, despite being a care setting, also causes stress such as pain, sleep disturbances and wakefulness, and alterations of physiological parameters. The aim of this study was to analyze the effects of aquatic physiotherapy on pain, sleep disturbances and wakefulness, and physiological variables of PTNB in Neonatal-ICU. Pain, sleep disturbances and wakefulness, and alterations of physiological parameters were evaluated at three moments: 5 minutes before intervention, immediately after and 10 minutes after intervention. At intervention, participants were wrapped in soft fabric and immersed at shoulder level in warm water (36 °C to 37.5 °C). Sideways, forward, backward and rotational movements were performed. Twenty-two newborns participated in the study. The results obtained in relation to pain, sleep state and wakefulness showed significant improvements in reevaluations after intervention. Physiological variables also underwent significant changes and remained within normality parameters. The results indicate that aquatic physiotherapy is effective in reducing pain, improving sleep and wakefulness and physiological variables of PTNB in Neonatal-ICU.

Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review

“…As reported in Table 4 , a significant increase in body weight was observed in newborns exposed to aquatic therapy when compared to non-intervention infants [ 44 ]. Benefits in the sleep–wake cycle and reduction of pain signals in preterm newborns that were exposed to aquatic therapy were also observed [ 45 , 46 ].…”

“…Although the intervention was applied twice on alternating days, we only considered between pre-, post-, and follow-up results; between-session results were not considered in this review once no control group was available to confirm the results. Two other studies also reported that newborn heart rates (HRs) reduced 10 to 30 min after aquatic therapy [ 45 , 46 ]. No changes in arterial pressure were observed after aquatic therapy interventions [ 45 ].…”

“…While two studies pointed toward a significant increase in blood oxygenation after aquatic therapy sessions [ 45 , 46 ], a third study found no significant effect from intervention [ 47 ]. Conflicting results were also observed for the effect of aquatic therapy on infants’ body temperature and respiratory rate (RR): one study reported no significant changes in the RR [ 47 ], while another study found a decrease in the RR after aquatic therapy intervention [ 45 ]; one study reported no changes between pre- and post-exposure in body temperature [ 45 ], while another found a decrease in body temperature after aquatic therapy sessions [ 46 ].…”

“…In the aquatic therapy context, research has largely focused on the benefits for infants and, in many cases, newborns and premature babies. Since results in the physiological domain indicate that this practice is safe for kids [ 44 , 45 , 46 , 47 ], aquatic therapy can be regarded as a facilitative means to achieve newborn discharge criteria and a preventative measure against neonatal jaundice [ 44 ]. According to Mitra and Rennie [ 52 ], jaundice is a yellow discoloration of the skin and sclera in infants associated with the accumulation of bilirubin in the tissues.…”

“…In most term babies, jaundice will remain harmless, but high levels of bilirubin in the brain, can lead to a state of toxicity, called ‘kernicterus’, that could result in the infant’s death. Aquatic therapy was also linked to the well-being of premature infants, stimulating pain reduction and better sleep–wakefulness cycles [ 45 , 46 ]. In therapy, the adoption of pharmacologic and nonpharmacologic interventions to reduce pain is crucial due to neonate hypersensitivity to painful stimuli [ 53 ].…”