Preemie Exercise
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Comment| Wednesday, December 3rd, 2008 | | CWK Producer |
“I had never thought about exercising my baby… they look so fragile.”
– Eve Gadzikwa, mother of premature infant
Dr. Ann Critz grabs the tiny arm of Larry, born prematurely at 28 weeks. She gently pulls, then pushes, then pulls again. This activity, which Larry doesn’t seem to mind, goes on for 10 to 15 minutes. “And he’s pushing against me,” says Dr. Critz.
The exercises, done on all four limbs, give Larry some much-needed human contact, and something else: “Increased bone growth,” Dr. Critz says, “and increased mineral content.”
That’s the conclusion of a study from Tel Aviv University. Exercise in preemies not only strengthens muscles, it may increase bone mass too, which is often a problem for pre-term infants.
Preemies often have low bone mass. Critz says that’s in part because preemies are denied the nutrition they would have gotten in the womb, “Not even modern technology can fully duplicate what nature provides.”
It’s also because premature babies spend their first several weeks in a crib, often attached to monitors, which limits natural motion and exercise.
Even adults who don’t exercise show reduced bone mass. The same problem occurs with preemies.
Larry’s mom says it will take her a little time to get used to the idea of exercising her child. “Let me put it this way, I had never thought about exercising my baby, I mean, they’re so little when you look at them… they look so fragile,” says Eve Gadzikwa.
But Dr. Critz says parents can exercise their infant’s arms and legs with light pulling and pushing motions, as long as the baby does not cry, or seem uncomfortable.
She adds that preemie exercise provides another important benefit, a sense of bonding between parent and child. “I think the best thing about it would be teaching the parent something that they can learn to do with their babies.”
Eve says she’s convinced of the benefits of preemie exercise, but with one condition. “I would feel comfortable doing it myself. I don’t think I’d feel comfortable with somebody else doing it.”
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In a study published in the journal Pediatrics, researchers found that a program of daily physical activity in combination with adequate nutritional intake can result in increased bone mineralization and growth in premature low birth weight infants. The significance of this study relates to the fact that infants born prematurely are at risk of developing osteopenia and rickets shortly after birth. These problems are thought to be related to a number of factors including a failure of the infant to develop enough bone mass while gestating, a greater need for bone nutrients than in infants delivered at term, and decreased calcium retention once the child has been born.
Unfortunately, the preterm children often do not have as significant an increase in bone mineralization once they are born as compare to when they are in utero, despite apparently normal weigh gain along with the use of nutritional supplements. Bone mineralization in preterm infants does not approach normal ranges until after the first year of life and may continue to be inadequate into childhood, further increasing the risk of bone fractures for these children.
Previous studies have shown mechanical loading or weight-bearing activity increases bone mass in children, young adults, and older individuals. Scientists believe that the strenuous activity triggers osteoblasts, the cells responsible for bone formation, increase activity in response to mechanical loading. On the other hand, the absence of mechanical loading, as seen in space flight and bedridden adults, can cause bone resorption and decreases bone mass. Unfortunately, the standard care of hospitalized, preterm infants has typically included swaddling or nesting, along with decreased sensory and physical stimulation. Thus, according to researchers, hospitalized, preterm infants are often placed into a vicious cycle where the protective nature of their limited physical activity may actually have the unintended consequence of causing bone development problems later in life.
According to the researchers, the results of this study support the hypothesis that daily physical activity enhances bone growth and development in preterm very low birth weight (VLBW) infants. Specifically, the infants in this controlled study infants had much greater gains in forearm length, bone area, bone mineral content, and fat-free mass. They further suggest that that physical activity maintains bone growth and development, while the routine care typically delivered in NICUs, which limits movement, slows the rate of bone formation in preterm VLBW infants.
While the study does suffer from certain experimental limitations, and further research is definitely indicated, the researchers conclude that a daily activity program for healthy preterm infants promotes increased forearm length and bone area.
References
- Pediatrics
- Tel Aviv University
