Impact of Aquatic Therapy in the NICU on diaphragmatic mobility assessed by ultrasound: clinical trial
DOI:
https://doi.org/10.17267/2238-2704rpf.2024.e5423Keywords:
Hydrotherapy, Aquatic Therapy, Ultrasonography, Diaphragm, NewbornAbstract
INTRODUCTION: Aquatic physiotherapy is a modality of hydrotherapy performed on newborn babies (NB) in the Neonatal Intensive Care Unit (NICU). The effects on pain levels, behavior, and respiratory function are already known; however, little has been said about the effects on diaphragmatic function in the preterm newborn population. OBJECTIVE: To evaluate the effect of aquatic physiotherapy on diaphragmatic amplitude using diaphragmatic kinesiologic ultrasound (DKUS) in NBs admitted to a NICU, as well as the safety regarding the clinical stability of the NBs, behavioral state, pain, and respiratory distress. METHODS: Cross-sectional before-and-after clinical trial. The NBs participating in the study received a single intervention with aquatic physiotherapy for 10 minutes. An assessment was performed using the USCD before and after the session, and heart and respiratory rates, behavioral state, pain, and respiratory discomfort were recorded. RESULTS: Twenty-six NBs participated. There was a significant increase in diaphragmatic amplitude (p= 0.02) and peripheral oxygen saturation (p= 0.05); physiological parameters remained within normal limits, and the intervention did not cause behavioral disorganization, pain, or respiratory discomfort in NBs. CONCLUSION: Aquatic physiotherapy promoted an increase in diaphragmatic amplitude, suggesting that this technique can be used as a way to stimulate the contraction of the respiratory muscles in NB, in addition to being a safe technique, as it did not generate clinical instability, behavioral disorganization, pain, or respiratory discomfort to the participants.
Downloads
References
(1) Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas e Estratégicas. Atenção humanizada ao recém-nascido: método canguru – manual técnico [Internet]. 3a ed. Brasília: Ministério da Saúde; 2017. 342 p. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/atencao_humanizada_metodo_canguru_manual_3ed.pdf
(2) Waitzman KA. The Importance of Positioning the Near-term Infant for Sleep, Play, and Development. Newborn Infant Nurs Rev. 2007;7(2):76-81. https://doi.org/10.1053/j.nainr.2007.05.004
(3) Silva HA, Silva KC, Reco MON, Costa AS, Soares-Marangoni DA, Merey LSF. Physiological effects of bucket hydrotherapy for premature newborns. Rev Ter Ocup da Univ São Paulo [Internet]. 2017;28(3):309-15. Available from: https://www.researchgate.net/publication/323612728_Efeitos_fisiologicos_da_hidroterapia_em_balde_em_recem-nascidos_prematuros_Physiological_effects_of_bucket_hydrotherapy_for_premature_newborns
(4) Anjos FR, Nakato AM, Hembecker PK, Nohama P, Sarquis ALF. Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit. J Pediatr. 2022;98(2):155-60. https://doi.org/10.1016/j.jped.2021.04.011
(5) Ghedini RG, Kaminski DM. Fisiologia muscular ventilatória do recém-nascido: implicações para a prática clínica. PROFISIO – Programa Atualização em Fisioterapia Pediátrica e Neonatal Cardiorrespiratória e Terapia Intensiva. 2019;35-60.
(6) Dassios T, Vervenioti A, Dimitriou G. Respiratory muscle function in the newborn: a narrative review. Pediatr Res. 2022;91(4):795-803. https://doi.org/10.1038/s41390-021-01529-z
(7) Brüggemann AKV, Leal BE, Gonçalves MA, Lisboa L, Tavares MGS, Paulin E. Mobility of right and left hemidiaphragms in healthy individuals and in individuals with chronic obstructive pulmonary disease. Fisioter Pesqui. 2018;25(2):126-33. https://doi.org/10.1590/1809-2950/16155925022018
(8) El-Halaby H, Abdel-Hady H, Alsawah G, Abdelrahman A, El-Tahan H. Sonographic Evaluation of Diaphragmatic Excursion and Thickness in Healthy Infants and Children. J Ultrasound Med. 2016;35(1):167-75. http://doi.wiley.com/10.7863/ultra.15.01082
(9) Dres M, Demoule A. Monitoring diaphragm function in the ICU. Curr Opin Crit Care. 2020;26(1):18-25. https://doi.org/10.1097/mcc.0000000000000682
(10) Kreling JC, Rosa TR. Hidroterapia em Unidade Neonatal. ASSOBRAFIR Ciência [Internet]. 2016;7(2):7-9. Available from: https://assobrafirciencia.org/article/5dd5374d0e8825c82dc8fca6
(11) Sandi NEF, Silva LD. Comparative analysis of respiratory muscle strength in healthy individualsin soil and in the pool. Fisioter Pesqui. 2018;25(2):182-7. https://doi.org/10.1590/1809-2950/17761325022018
(12) Tuinman PR, Jonkman AH, Dres M, Shi Z-H, Goligher EC, Goffi A, et al. Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients-a narrative review. Intensive Care Med. 2020;46(4):594-605. https://doi.org/10.1007/s00134-019-05892-8
(13) Neindre AL, Mongodi S, Philippart F, Bouhemad B. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care. 2016;31(1):101-9. https://doi.org/10.1016/j.jcrc.2015.10.014
(14) Doorduin J, Hees HWH, Hoeven JG, Heunks LMA. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med. 2013;187(1):20-7. https://doi.org/10.1164/rccm.201206-1117cp
(15) United Medical Education. PALS Algorithms 2020 – Pediatric Advanced Life Support [Internet]. [s.d.]. Available from: https://www.acls-pals-bls.com/algorithms/pals/
(16) Motta GCP, Schardosim JM, Cunha, MLC. Neonatal Infant Pain Scale: Cross-Cultural Adaptation and Validation in Brazil. J Pain Symptom Manage. 2015;50(3):394-401. https://doi.org/10.1016/j.jpainsymman.2015.03.019
(17) Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics. 1956;17(1):1-10. Citado em: PMID: 13353856.
(18) Brazelton TB. Neonatal behavioral assessment scale. London: William Heinemann Medical Books; 1973.
(19) World Health Organization, March of Dimes, The Partnership for Maternal, Newborn & Child Health, Save the Children. Born Too Soon: The Global Action Report on Preterm Birth [Internet]. Geneva: World Health Organization; 2012. Available from: https://www.who.int/publications/i/item/9789241503433
(20) Braga HV, Dutra LP, Veiga JM, Pinto Junior EP. Effect of aquatic physiotherapy on the respiratory muscle strength of children and teenagers with down syndrome. Arq Ciências Saúde UNIPAR [Internet]. 2019;23(1):9-13. Available from: https://www.revistas.unipar.br/index.php/saude/article/view/6392
(21) Ho S, Rock K, Addison O, Marchese V. Relationships between diaphragm ultrasound, spirometry, and respiratory mouth pressures in children. Respir Physiol Neurobiol. 2022;305:103950. https://doi.org/10.1016/j.resp.2022.103950
(22) Tedesco NM, Nascimento ALF, Mallmann GS, Merey LSF, Raniero EP, Gonçalves-Ferri WA, et al. Bucket hydrokinesiotherapy in hospitalized preterm newborns: a randomized controlled trial. Physiother Theory Pract. 2022;38(13):2452-61. https://doi.org/10.1080/09593985.2021.1926025
(23) Novakoski KRM, Valderramas SR, Israel VL, Yamaguchi B, Andreazza MG. Back to the liquid environment: effects of aquatic physiotherapy intervention performed on preterm infants. Rev Bras Cineantropom Desempenho Hum. 2018;20(6):566-75. https://doi.org/10.5007/1980-0037.2018v20n6p566
(24) Soares DS. Short-term effects of hydrotherapy on premature with broncopulmonary dysplasia: preliminary results [dissertação] [Internet]. Londrina: Universidade Estadual de Londrina; 2020. Available from: http://www.bibliotecadigital.uel.br/document/?code=vtls000234083
(25) Carregaro RL, Toledo AM. Efeitos Fisiológicos e Evidências Científicas da Eficácia da Fisioterapia Aquática. Movimenta [Internet]. 2008;1(1):23-7. Available from: https://www.revista.ueg.br/index.php/movimenta/article/view/7235
(26) Fonseca Filho GG, Passos JOS, Almeida VA, Ribeiro CMA, Souza JC, Silva GFA, et al. Thermal and cardiorespiratory newborn adaptations during hot tub bath: a randomized clinical trial. Int Arch Med [Internet]. 2017;10(85). Available from: https://www.researchgate.net/publication/315997554_Thermal_and_cardiorespiratory_newborn_adaptations_during_hot_tub_bath
(27) Lemos GC, Almeida TVC, Pinto MM, Medeiros AIC. Ofuro bath effects on relaxation and weight gain of premature newborns in neonatal care units. Rev Pesqui Fisioter. 2020;10(3):393-403. https://doi.org/10.17267/2238-2704rpf.v10i3.2953
(28) Aranha VP, Chahal A, Bhardwaj AK. Neonatal aquatic physiotherapy in neonatal intensive care units: A scoping review. J Neonatal Perinatal Med. 2022;15(2):229-35. https://doi.org/10.3233/npm-210858
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Kely Cristina Liberato, Marimar Goretti Andreazza, Marciane Sanches de Assis, Ana Lucia Figueiredo Sarquis, Demetria Monteiro Kovelis, Evellin de Oliveira Gomes, Monica Nunes Lima, Vera Lúcia Israel
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
