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. 2025 Aug 7:61:171-181.
doi: 10.29390/001c.142452. eCollection 2025.

Effect of bucket hydrotherapy on clinical parameters in infants with bronchopulmonary dysplasia: A pilot randomized clinical trial

Vanessa S Probst  1   2 , Darllyana S Soares  2   3 , Victoria C Escobar  2   4 , Marcia L C Camargo  2 , Walter Sepulveda-Loyola  2   5 , Josiane M Felcar  1   2 , Lígia S L Ferrari  6
Affiliations

Effect of bucket hydrotherapy on clinical parameters in infants with bronchopulmonary dysplasia: A pilot randomized clinical trial

Vanessa S Probst et al. Can J Respir Ther. .

Abstract

Introduction: It is unknown whether bucket hydrotherapy is beneficial to premature newborns with bronchopulmonary dysplasia (BPD).

Objective: To evaluate the effects of bucket hydrotherapy on physiological and behavioural parameters and the oxygen need in preterm infants with BPD during hospitalization.

Methods: Twenty infants with BPD were randomized into a control (conventional physiotherapy - PG) or an intervention group (conventional physiotherapy plus bucket hydrotherapy - BHG). All infants underwent twelve days of intervention, and data from the first (D1), sixth (D6) and twelfth (D12) days were analyzed. Respiratory rate (RR), heart rate (HR), peripheral oxygen saturation (SpO2), inspired oxygen fraction (FiO2), pain, respiratory effort, sleep, and wakefulness status were measured before, immediately after, and at 15, 30, and 60 minutes after the intervention.

Results: In the BHG, intragroup analysis showed lower values for FiO2 on D1 (30': p = 0.03, 60': p = 0.02), HR on D6 (p = 0.004) and RR on D12 (p < 0.03), and higher values for SpO2 on D12 (p = 0.0003). Intergroup comparisons favored BHG for SpO2 (p = 0.03; effect size [ES] =0.99) and FiO2 (p < 0.02; ES > 0.47) on D1, HR changes on D6 (p < 0.04; ES > 0.9) and D12 (p = 0.009; ES = 0.61). No significant intra- or intergroup differences were found in pain, respiratory effort, sleep, or wakefulness (p > 0.05 for all).

Discussion: Given the persistent gas exchange abnormalities in BPD, bucket hydrotherapy appears to be a feasible and beneficial non-pharmacological method for reducing oxygen requirements.

Conclusion: The present pilot study demonstrates that bucket hydrotherapy is a therapeutic intervention that reduces HR, RR and oxygen requirements in premature infants with BPD without inducing changes in behavioural parameters.

Keywords: Brochopulmonary dysplasia; hydrotherapy; neonatal intensive care unit; oxygen; premature.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.. Flowchart of premature infants included in the study
BPD: bronchopulmonary dysplasia; g: grams; W: weeks
Figure 2.
Figure 2.. FiO2 Before and after bucket hydrotherapy and conventional physiotherapy on D1.
*Significant difference versus Pre (p < 0.05). FiO2: oxygen inspired fraction; D1: first day of intervention; BHG: bucket hydrotherapy group; PG: conventional physical therapy group; Pre: immediately before the intervention; Post: immediately after the intervention; 15’: 15 minutes after the intervention; 30’: 30 minutes after the intervention; 60’: 60 minutes after the intervention.
Figure 3.
Figure 3.. Intra and intergroup changes in physiological parameters and oxygen requirements in the BHG and PG on D1.
A: HR: heart rate; B: SpO2: peripheral oxygen saturation C: FiO2: oxygen inspired fraction; BHG: bucket hydrotherapy group; PG: conventional physiotherapy group. D1: first day of intervention; *Intragroup analyzes before and after intervention. aStatistically significant between-group differences at post-pre (BHG) vs post-pre (PG) (p = 0.03); Effect Size=0.99; bStatistically significant between-group differences at 30’-pre (BHG) vs 30’-pre (PG) (p = 0.02); Effect Size=0.47; cStatistically significant between-group differences at 60’-pre (BHG) vs 60’-pre (PG) (p = 0.009); Effect Size= 0.54; dStatistically significant intragroup difference (∆60’-Pre vs Post-Pre)
Figure 4.
Figure 4.. Intra and intergroup changes in physiological parameters and oxygen requirements in the BHG and PG on D6.
A: HR: heart rate; B: SpO2: peripheral oxygen saturation; C: FiO2: oxygen inspired fraction; BHG: bucket hydrotherapy group; PG: conventional physiotherapy group. D6: sixth day of intervention; *Intragroup analyzes before and after intervention. eStatistically significant between-group differences at post-pre (BHG) vs post-pre (PG) (p = 0.04); Effect Size= 0.9; fStatistically significant between-group differences at 15’-pre (BHG) vs 15’-pre (PG) (p = 0.01); Effect Size=1.17; gStatistically significant between-group differences at 30’-pre (BHG) vs 30’-pre (PG) (p = 0.03); Effect Size=0.99. hStatistically significant between-group differences at 60’-pre (BHG) vs 60’-pre (PG) (p = 0.01); Effect Size=1.19; iStatistically significant intragroup difference (∆60’-Pre vs Post-Pre).
Figure 5.
Figure 5.. Intra and intergroup changes in physiological parameters and oxygen requirements in the BHG and PG on D12.
A: HR: heart rate; B: SpO2: peripheral oxygen saturation; C: FiO2: oxygen inspired fraction; BHG: bucket hydrotherapy group; PG: conventional physiotherapy group. D12: twelfth day of intervention; *Intragroup analyzes of before and after intervention. jStatistically significant between-group differences at 15-pre (BHG) vs 15-pre (PG) (p = 0.009); Effect Size=0.61; kStatistically significant intragroup difference (∆60’-Pre vs Post-Pre).
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