Kinesthetic stimulation for preventing apnea in preterm infants.
BACKGROUND
Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences.


OBJECTIVE
In preterm infants at risk for apnea, does prophylactic use of kinesthetic stimulation lead to a clinically important reduction in apnea and bradycardia, and use of intermittent positive pressure ventilation (IPPV).


METHODS
The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2001), MEDLINE (1966-January 2002), EMBASE, CINAHL (1982-January 2002), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal hand searching mainly in the English language.


METHODS
All trials in preterm infants at risk of developing clinical apnea which utilized random or quasi-random allocation to treatment with an oscillating mattress (or other forms of repetitive kinesthetic stimulation) or control, were eligible.


METHODS
Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk.


RESULTS
Three trials enrolling a total of 154 babies were included in this review. There was no evidence of effect on short term outcomes (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or long term outcomes (in one trial - growth and development to one year).


CONCLUSIONS
Implications for practice. Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. Implications for research. There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.
Henderson-Smart
D J
DJ
NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, Australia, 2006. dhs@perinatal.usyd.edu.au
Osborn
D A
DA
D001049:Apnea / Q000517:prevention & control*; D001513:Beds; D006801:Humans; D015370:Infant Equipment; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D018953:Kinesiology, Applied; D010812:Physical Stimulation / Q000295:instrumentation*