Dor em recém-nascidos pré-termo submetidos à fisioterapia em unidade de terapia intensiva neonatal no Amazonas: coorte prospectiva

Abstract

Introduction: Physical Therapy in Neonatal Intensive Care (NICUs) it proposes, among other objectives, to trigger positive repercussions on early experiences capable of influencing the best development of high-risk newborns. However, it is possible that some of the Physical Therapy modalities (PT modalities) in preterm can be painful and stressful. Objective: Describe the clinical characteristics and pain level of premature infants undergoing physical therapy care in the NICU. Methods: In order to identify whether PT modalities cause pain and stress, we conducted a Prospective cohort approved by the ethics committee (CAAE: 70828017.2.0000.5020) who observed for almost two years the care of neonatal physiotherapists. Were used 3 scales to analyze pain and stress: Neonatal Infant Pain Scale, Premature Infant Pain Profile and Neonatal Facial Action Coding System. We also describe the clinical characteristics of the preterms and their relationship with the frequency of the PT modalities. Results: This study observed 153 prematures with an average gestational age of 31.59 ± 2.77 weeks, with low weight and born by cesarean delivery. Most were under invasive mechanical ventilation (IMV) and were discharged. In all, 32 different PT modalities were recorded, the most frequent of which were: aspiration, assessment, positioning and stimulation. The non-pharmacological measure most used to control pain was Facilitated Tucking and the non-pharmacological measure was Fentanyl. Most preterms did not experience pain before or after the PT modalities. Small preterms for gestational age were six times more likely to die than those suitable for gestational age, with the Respiratory Discomfort Syndrome being the main cause of death. Our results demonstrated that the use of IMV and the length of hospital stay increased the frequency of PT modalities, especially aspiration. We also observed that the increase in the frequency of PT modalities was inversely proportional to gestational age and birth weight. Conclusion: It was possible to observe that PT modalities did not cause pain and stress. Physical therapy participated positively in the pain and stress control measures used in the observed NICU.