I would be very interested to hear what actually happens in your NICU:
Do you use chest/respiratory physiotherapy in preterm infants? If so, for which specific indications, which techniques are used, and who performs them? Do you have a written protocol?

We have daily physiotherapy in all preterms to facilitate breathing, position to prevent contructures and neck disorders related to uncomfortable position, joints movement and inhancing suckling activity

Chest physiotherapy, as in thumping/vibration to mobilize lung secretions has scarce scientific support. As Nasser mentioned, positioning and flexing is most likely a better option.

No the nurses stopped, since the mid 90s. When there was association of brain injury and death. Now it’s individuality assessed and we very rarely, if at all give chest physio.

Jane E. Harding et al., 1988. Chest physiotherapy may be associated with brain damage in extremely premature. The Journal of Pediatrics. Volume 132, Issue 3, March 1998, Pages 440-444

Thank you all for your replies — very interesting to hear your different perspectives.

@Fiona Dineen, I share many of your concerns. My main concern is whether, particularly in extremely preterm infants, we may sometimes be intervening without clear evidence of benefit while potentially adding unnecessary handling and risk. This is really what prompted my “to benefit, or at least, not to harm” question.

When you say that chest physiotherapy is now very rarely used, could you share in which specific clinical situations your team would still consider it indicated?

There is currently a lack of concrete evidence supporting the use of chest physiotherapy to aid secretion clearance and improve breathing in preterm infants, including those with BPD. This issue mirrors the ongoing debate surrounding NJT feeding in BPD. Furthermore, alongside the known risks of IVH, there are significant concerns regarding the potential for rib fractures, particularly in infants with metabolic bone disease.

Thank you @Mo7 — very interesting points.

May I ask what you actually do in everyday clinical practice in your NICU?

Do you avoid chest physiotherapy altogether in preterm infants, including those with BPD, or are there specific situations in which you would still consider it — for example, significant secretion retention or radiological atelectasis?

best regards from Athens, Greece

I’m afraid practice varies between units and even within the same one. However, I can say that most premature babies won’t receive physiotherapy but babies with evolving or established BPD are more likely to.  People get frustrated especially if there’s been no improvement in respiratory support like maintaining high oxygen levels or weaning PEEP.  We’re a pretty impatient bunch in the NICU.

Thank you again for the reply @Mo7 — this is very interesting and probably reflects what happens in many NICUs.

This is actually one of my main concerns: when a preterm infant with evolving or established BPD remains on high oxygen or PEEP, chest physiotherapy may sometimes be requested simply because respiratory progress has stalled, rather than because there is a specific physiotherapy-responsive problem.

In your experience, what findings would make you consider chest physiotherapy genuinely indicated in these infants — for example, clear secretion retention or radiological atelectasis?