Dimitrios

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?

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

Thank you, @Stefan Johansson — very interesting, and I would certainly appreciate the more extended version when you have time. Just to clarify one point: when you say that PT follow-up is the rule for infants enrolled in the extended follow-up programme, does this mean that all of these infants are routinely assessed by a physiotherapist at the specified time points, or that they are also routinely enrolled in physiotherapy intervention/treatment? In other words, is physiotherapy treatment provided to all high-risk infants, or only when the assessment identifies a specific indication or developmental concern?

I would be very interested to learn how follow-up and physiotherapy referral are organized in different NICUs after discharge. Are all preterm infants routinely referred to or enrolled in physiotherapy follow-up programmes, or does your team first perform a developmental assessment and refer only those infants who demonstrate specific risk factors, abnormal findings, or emerging developmental concerns? If referral is selective, what criteria do you use, who makes the decision, and which developmental assessment tools are part of your follow-up pathway? I would be grateful to hear what you actually do in your everyday clinical practice.

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?

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?