Effect of Assisted Exercise on Musculoskeletal System and Growth in Preterm Infants
Authors: Awad H A , Elganzoury M M , Emam S S , Gad G I , Elfarrash R A H , Ibrahim B A 
Published: May 2020

Abstract

Background
osteopenia of prematurity, also known as bone metabolic disorder, is one of the common diseases in very low birth weight (VLBW) prematurity.

Aim of the Work
the primary aim of this study was to assess whether physical activity programs in preterm infants improve bone mineralization as well as growth and reduce the risk of fractures. The secondary aim was to include other potential benefits in terms of length of hospital stay, weaning from mechanical ventilation, feeding tolerance and adverse events.

Patients and Methods
this study was conducted on 36 neonate, Preterm infants (gestational age &lt;33 completed weeks), body size appropriate for gestational age according to the growth curve, Postnatal age of ≥ 1 week with medically stable condition and favorable evolution that is presenting no associated diseases besides prematurity, tolerating enteral feeds of preterm formula at or above 100 kcal/kg/d.

Methods
the studied neonates were randomized into the physical exercise (n = 18) and control (n = 18) groups. Randomization was made by birth order. The studied neonates were subjected to full history taking, complete clinical assessment together with complete blood picture, C-reactive protein, serum Ca, Serum phosphorous concentration, Serum magnesium concentration. Serum alkaline phosphatase concentration, Serum Alanine Aminotransferase (ALT), Urinary calcium/phosphorous ratio. Babies admitted to NICU bathed, placed in incubator, attached to monitor. Infants in treatment and control groups received well defined interventions for the exercise group, systematic physical activity programs consisting of range-of-motion exercises with gentle compression, extension and flexion of all joints of both bilateral upper extremities; including the shoulder, elbow, and wrist and lower extremities; including the hip, knee and ankle, with a total of 12 joints Each activity was about 10 min a day and was carried out 5 times per week for 4 weeks. This program was started after 1 week of birth. Physical activity continued until discharge from hospital.

Results
the study demonstrated non significant difference in weight at enrollment (p = 0.516) which was turned into significant difference at end of the study as being higher among exercise group (p &lt; 0.001). In our study although there was increase in the length and head circumference (p &lt; 0.001) in the 2 groups no significant difference detected comparing them together. The control group had significantly lower serum phosphorus (p &lt; 0.001), higher urinary Ca/Po4 ratio (p &lt; 0.035) and higher ALP (p &lt; 0.005) compared to excerise group at the end of the exercising protocol.

Conclusion
our study has demonstrated that regular physical activity programs (range-of-motion exercises), after an initial period of stabilization, might provide a simple intervention for improving musculoskeletal system and skeletal growth in preterm infants. They may also promote general growth in preterm infants.