Effect of aquatic physical therapy on pain and state of sleep and wakefulness among stable preterm newborns in neonatal intensive care units

Abstract

Objectives: To evaluate the effects of aquatic physical therapy on pain and on the cycle of sleep and wakefulness among stable hospitalized premature infants.

Methods: This study was characterized as an uncontrolled clinical trial on a time series and included 12 clinically stable newborns of gestational age less than 36 weeks who were hospitalized in a neonatal intensive care unit (NICU). After selection, the newborns were placed in a liquid medium for aquatic physical therapy lasting 10 minutes. Movements to stimulate flexor posture and postural organization were performed. The sleep-wakefulness cycle was assessed using the adapted Brazelton (1973)* scale and pain was assessed by the occurrence of signs of pain according to the Neonatal Facial Coding System (NFCS) scale; and physiological parameters.

Results: In relation to states of sleep and wakefulness, before the physical therapy, the newborns' behavior varied from fully awake with vigorous body movements to crying. After the physical therapy, the states of sleep ranged from light sleep with closed eyes to some body movement. These values presented statistically significant differences (p<0.001). The score on the pain assessment scale also decreased from 5.38+/-0.91 to 0.25+/-0.46, with p<0.001 after the intervention. The vital signs remained stable.

Conclusions: It is suggested that aquatic physical therapy can be a simple and effective method for reducing pain and improving sleep quality among preterm infants in NICUs. Controlled studies with larger numbers of subjects are needed in order to generalize the results. Article registered of the Clinical Trials under the NCT00785837.