Chest physiotherapy may be associated with brain damage in extremely premature infants☆,☆☆,★
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).
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.
References (20)
- et al.
Postextubation atelectasis: a retrospective review and a prospective controlled study
J Pediatr
(1979) - et al.
Pulmonary physiotherapy in neonates: physiological changes and respiratory management
J Pediatr
(1978) - et al.
Postnatal encephaloclastic porencephaly—A new lesion?
Arch Dis Child
(1992) Neurology of the newborn
(1994)- et al.
Craniocerebral trauma in the child abuse syndrome
Pediatr Ann
(1983) - et al.
Cerebral contusional tears as a marker of child abuse—detection by cranial sonography
Pediatr Radiol
(1992) - et al.
Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects
Dev Med Child Neurol
(1993) Shaken baby syndrome: inflicted cerebral trauma
Pediatrics
(1993)- et al.
Development of cerebrovascular architecture and its relationship to periventricular leukomalacia
Arch Neurol
(1978) Anatomical features of the developing brain implicated in pathogenesis of hypoxic-ischemic injury
Brain Pathol
(1992)
Cited by (52)
Respiratory physiotherapy in pediatric practice
2022, Revue des Maladies RespiratoiresRespiratory care of the newborn
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionRespiratory Care of the Newborn
2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth EditionCerebral blood flow assessment of preterm infants during respiratory therapy with the expiratory flow increase technique
2016, Revista Paulista de PediatriaCitation Excerpt :However, to date, we are unaware of the existence of studies that evaluated CBF velocity parameters in preterm newborns before, during and after some type of respiratory physiotherapy maneuver. In the late 1990s, Harding et al.15 observed a significant occurrence of encephaloclastic porencephaly in extremely-low birth weight newborns and identified respiratory physiotherapy as one of the predisposing factors. At the time, these results generated great controversy and, after that, further studies on this subject were performed, which showed no association between respiratory physiotherapy maneuvers and brain damage in preterm newborns.12–14,21
Chest physiotherapy using the expiratory flow increase procedure in ventilated newborns: a pilot study
2007, PhysiotherapyCitation Excerpt :The relative values of each technique have never been established conclusively, partially because neonates present a spectrum of age-specific physiological differences that change with growth and development. Several reports have recently raised doubts about the benefits of chest physiotherapy and emphasized possible adverse effects, particularly on the neonatal brain [8–10]. Some of these methods may have serious adverse effects, such as encephaloclastic porencephaly, recently suspected to be associated with posturing and percussion in extremely preterm infants [11].
Paediatric intensive care
2007, Physiotherapy for Children
- ☆
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