Chest physiotherapy may be associated with brain damage in extremely premature infants,☆☆,

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Abstract

Objectives: To determine whether a characteristic form of brain damage (encephaloclastic porencephaly) was associated with chest physiotherapy treatment in preterm babies. Methods: A retrospective case-control study was undertaken among 454 infants of birth weight less than 1500 gm cared for during the 3-year period of 1992 to 1994. Thirteen babies of 24 to 27 weeks of gestation who weighed 680 to 1090 gm at birth had encephaloclastic porencephaly. Twenty-six control subjects were matched for birth weight and gestation. Results: The patients received two to three times as many treatments with chest physiotherapy in the second, third, and fourth weeks of life as did control infants (median 79 vs 19 treatments in the first 4 weeks, p < 0.001). Patients also had more prolonged and severe hypotension in the first week than did control subjects (median duration of hypotension 4 vs 0.5 days, p < 0.01), and were less likely to have a cephalic presentation (31% vs 81%, p < 0.01). Since December 1994 no very low birth weight baby has received chest physiotherapy treatment in the first month of life in our nursery, and no further cases have occurred. Conclusions: Encephaloclastic porencephaly may be a previously unrecognized complication of chest physiotherapy in vulnerable extremely preterm infants. (J Pediatr 1998;132:440-4)

Section snippets

Methods

Cases were identified by retrospective review of reports of all cranial ultrasonography performed on all 454 babies with birth weights less than 1500 gm who were cared for at National Women's Hospital, Auckland, during the 3-year period 1992 to 1994. For reports indicating any intracerebral lesion, the original films were reviewed by a single radiologist (B.A.), who was unaware of the hypothesis under investigation. Thirteen patients were identified; each was matched with two control subjects

Radiologic Appearances

Our patients were infants whose cerebral ultrasound results showed rapidly progressing cerebral destruction involving cortical and subcortical structures. In seven infants, the initial appearances were consistent with hemorrhagic infarction. These lesions then became cystic with variable degrees of cortical and subcortical destruction (Fig. 1).

. Coronal cerebral ultrasound scan through midbrain of a baby who had a normal scan on day 13 of life. By day 45 there is a large, cortically based

Discussion

In this study the development of cerebral destruction was associated with the number of chest physiotherapy treatments in the first month of life, hypotension in the first week, and breech presentation. Since we first suspected the association with chest physiotherapy in December 1994, no VLBW baby has received chest physiotherapy treatment in the first month of life at our hospital, and no further cases have been seen. The incidence of hypotension and breech presentation has not changed.

The

Acknowledgements

We thank Ian Rushton and Geoff Durbin from the Birmingham Maternity Hospital for sharing their experience and leading us to look at the role of chest physiotherapy. We would also like to thank John Newman for his help with the literature search, Yeun Chan for allowing us to review the pathologic material, and Joanna Stewart for statistical advice. The staff of National Women's Hospital and the families of the babies involved have been a source of support and inspiration to us throughout.

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From the Department of Pediatrics, National Women's Hospital, Auckland, New Zealand.

☆☆

Reprint requests: Jane E. Harding, FRACP, DPhil, Department of Pediatrics, National Women's Hospital, Claude Road, Epsom, Auckland 3, New Zealand.

0022-3476/98/$5.00 + 0  9/21/84067

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