Effects of Tummy Time Associated With Therapeutic Positioning in Premature Newborns With Cranial Asymmetry

Deformational plagiocephaly (DP) specifically refers to cranial asymmetry due to external compression. These deformational changes are believed to originate in utero and are exacerbated by sleeping in the supine position. In the first weeks of a baby's life, it generally becomes more severe due to active head positioning, with a peak prevalence at 4 months of age. Prematurity is frequently cited as a risk factor, as are patients who remain hospitalized for extended periods in the intensive or semi-intensive care unit, in the supine position for prolonged periods, contributing to accelerated head deformation. Similarly, the use of non-invasive ventilatory support devices with a hood is also associated with an increase in DP cases. Therefore, the objective of this study is to verify the effects of a physiotherapy protocol in premature newborns with cranial asymmetry. This is a randomized, controlled clinical trial composed of premature newborns under 37 weeks of gestation diagnosed with cranial asymmetry of both sexes who are hospitalized in the NICU and PICU of the Hospital de Clínicas de Porto Alegre, for a period of 15 days. Patients will be randomized into an intervention group consisting of a daily tummy time and positioning protocol, and a control group that will maintain the unit's usual physiotherapy routine.

Inclusion criteria

• Newborns with suspected cranial asymmetry.
• Newborns of both sexes.
• Gestational age of less than 37 weeks.
• Admission to the HCPA Neonatal ICU or Neonatal Intermediate Care Unit.
• Breathing without invasive ventilatory support and clinically stable, or breathing room air.
• No expected hospital discharge within the next 15 days.

Exclusion criteria

• Patients with congenital cranial malformations (e.g., hydrocephalus).
• Patients with chronic diseases that could compromise the assessment of cranial asymmetry.
• Patients with clinical conditions that prevent or compromise the performance of the procedures proposed in the study.
• Patients with prolonged hospital stays requiring transfer to the Pediatric Intensive Care Unit (PICU) or the Pediatric Inpatient Unit (PIU).