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The purpose of this systematic review is to compare the effects hydrokinesiotherapy and immersion bathing on the physiological factors that influence stress on preterm newborns in the NICU. Therapeutic interventions minimize the negative effects of prematurity on physiological parameters. Preterm newborns undergo different immersion bathing techniques such as conventional bathing and swaddle bathing to stabilize vital signs. Hydrokinesiotherapy is an alternative intervention that uses submersion in water to promote positive physiological effects while also incorporating muscle strengthening and relaxation.
A review of literature was conducted using CINAHL Complete, Academic Search Ultimate, PubMed, PEDro, and Google Scholar. Search terms included neonatal hydrotherapy, NICU hydrotherapy, water therapy, preterm, hydrokinesiotherapy, and physical therapy. A hand search was also conducted.
Inclusion criteria consisted of articles published within the last 12 years, premature infants less than 34 weeks gestation, and infants with no underlying medical diagnoses.
Sixteen articles met the inclusion criteria with five articles on hydrokinesiotherapy and 11 articles on conventional bathing. Each article was analyzed for quality using the hierarchy of evidence scale to assess the methodological quality. There were four level two, 11 level three, and one level four included in the study.
Hydrokinesiotherapy, swaddle bathing and tub bathing decreased RR, HR, crying, salivary cortisol levels and increased SO2, and sleep. Hydrokinesiotherapy was superior to all types of bathing, swaddle bathing was superior to conventional bathing, and conventional bathing was superior to sponge bathing. Hydrokinesiotherapy can be provided simultaneously while maintaining body temperature, calming atypical physiological responses to movement, and decreasing overall stress.
Conventional bathing, swaddle bathing, and hydrokinesiotherapy decrease RR, HR, crying, and salivary cortisol levels and improve SO2, and sleep in preterm infants. Hydrokinesotherapy can provide neurodevelopmental techniques such as light and slow movements aimed at tactile-kinesthetic stimulation. It facilitates the flexed posture of body organization via the effect of the thrusting motion, allows for passive mobilizations of the upper and lower limbs, global stretching, trunk rotation, and tactile, proprioceptive, and vestibular stimulation.
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