REPERCUSSÕES DE UM PROTOCOLO DE INTERVENÇÃO FISIOTERAPÊUTICA ASSOCIADO AO POSICIONAMENTO CANGURU EM RECÉM-NASCIDOS PRÉ-TERMO: ENSAIO CLÍNICO CONTROLADO RANDOMIZADO

Abstract

Objective: To examine the effects of a physiotherapeutic intervention protocol combined with kangaroo positioning over fifteen days in stable preterm newborns. Methods: This is a randomized controlled trial with parallel and balanced groups (REBEC no. 4wx7wp-2019). Thirty-four preterm newborns with ≤34 weeks of gestation and low birth weight were randomly allocated into experimental (GE) or control (GC) groups. Only newborns considered with poor repertoire according to the Prechtl General Movements Assessment (GMA) were included. The intervention consisted of 10 sessions of 15-minute sensory-motor physiotherapy followed by kangaroo positioning (GE) or only kangaroo positioning (GC). The primary outcome was the quality of general movements (GMs) assessed by the GMA in the writing movements (WM) and fidgety movements (FM) phases. Secondary outcomes included weight gain, muscle tone and posture assessed by the Neonatal Neuromotor Screening, behavioral state assessed by the Brazelton Behavioral Assessment Scale, length of hospital stay, and establishment and maintenance of breastfeeding. Physiological parameters and signs of respiratory distress were monitoring outcomes. All preterm newborns had their GMs assessed 4 times: three assessments during the WM phase: a) one day before the intervention started, at 34-35 weeks postmenstrual age, b) one day after the intervention ended, at 36-37 weeks postmenstrual age, c) at 2-4 weeks post-term; and one assessment during the FM phase d) at 12-15 weeks post-term. GMs film assessments were conducted blind by two Prechtl-certified evaluators. Posture and tone assessment and weight gain were evaluated on the first and last days of the intervention. Breastfeeding was assessed daily, at hospital discharge, and its maintenance at 2-4 weeks and 12-15 weeks post-term. Monitoring outcomes and behavioral state were evaluated at each intervention day: initially (pre-intervention), at the end (post-intervention), and 30 minutes after the intervention. Treatment effects were obtained by comparing groups using t-tests, chi-square tests, Mann-Whitney tests, and mixed linear models. Results: Newborns gained weight, showed no signs of respiratory distress, and maintained stable vital signs during the protocol. Regarding GMs, newborns in both groups showed similar proportions of normal and abnormal GMs at both assessment times (in WM and FM phases). There was no difference between groups in hospital stay duration. There were no differences between groups in the establishment and maintenance of breastfeeding. The GE group showed better flexor posture and higher physiological tone after the protocol compared to the GC group. The GE group showed higher alertness at 30 minutes after the intervention on half of the days of the protocol, compared to the GC group. Conclusions: Ten 15-minute physiotherapy sessions followed by kangaroo positioning was a clinically safe technique for stable preterm newborns. We recommend the technique if the objective is to increase alertness in newborns or promote greater tone and physiological flexor posture, but it does not seem advantageous if the objective is to improve the quality of GMs.