Hidrocinesioterapia em balde nos movimentos generalizados e desfechos clínicos de recém-nascidos pré-termo: Ensaio clínico randomizado

Abstract

Objective: To examine the effects of hydrokinesiotherapy in a bucket on the general movements (GMs) and clinical outcomes of hospitalized preterm newborns. Methods: In this randomized controlled trial (REBEC registry no. 5n82tv), 34 preterm newborns with ≤ 34 weeks of gestation and low birth weight were randomly allocated into experimental (EG) or control (CG) groups. Only newborns with poor repertoire according to the Prechtl General Movements Assessment (GMA) were included. Intervention protocol consisted of 6 sessions of hydrokinesiotherapy in a bucket for 10 min followed by diaper change (EG) or diaper change only (CG). The quality of GMs in the writing and fidgety movements phase and body weight gain were the primary outcomes. Behavioral state, physiological parameters and respiratory distress were secondary outcomes. All infants had their GMs assessed 4 times: being three evaluations, in the writing movements phase, a) one day before the start of the intervention, b) one day after the end of the intervention, c) at 40-42 weeks post-term, and one evaluation in the fidgety movements phase d) at 50-52 weeks corrected age. Body weight gain was assessed in the first and last days of the protocol. Secondary outcomes were assessed at each day of the protocol as follows: pre-intervention, post-intervention, 15 min after the intervention, and 30 min after the post-intervention. All analyzes were calculated using only the randomization number of newborns. A p value lower than 0.05 was considered. The difference between the groups (treatment effects) and the 95% confidence interval (CI) was calculated using the mixed linear model (GLM), using the interaction terms: group versus intervention days. To test differences between groups for categorical variables, the chi-square test was applied. Results: In both groups most newborns remained with poor repertoire at 36 and 40 weeks and presented fidgety movements at 50-52 weeks corrected age. Both groups gained weight over the protocol. Physiological parameters presented transitory one-off differences between groups within normal ranges. The EG presented higher frequency of alert state than the CG in the post-intervention assessment in all days of the protocol. This was maintained in the 15th minute follow-up assessment in the 1st, 3rd and 4rd days of the protocol. Conclusion: Six sessions of 10-minute hydrokinesiotherapy in a bucket did not affect the newborns’ clinical conditions. We recommend the technique if the therapy goal is to increase alertness in the studied population, but it is not advantageous if the goal is improving GMs and body weight gain.