Je. Harding et al., CHEST PHYSIOTHERAPY MAY BE ASSOCIATED WITH BRAIN-DAMAGE IN EXTREMELY PREMATURE-INFANTS, The Journal of pediatrics, 132(3), 1998, pp. 440-444
Objectives: To determine whether a characteristic form of brain damage
(encephaloclastic porencephaly) was associated with chest physiothera
py 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 ha
d encephaloclastic porencephaly. Twenty-six control subjects were matc
hed for birth weight and gestation. Results: The patients received two
to three times as many treatments with chest physiotherapy in the sec
ond, 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 contr
ol 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 nurser
y, and no further cases have occurred. Conclusions: Encephaloclastic p
orencephaly may be a previously unrecognized complication of chest phy
siotherapy in vulnerable extremely preterm infants.