BACKGROUND: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation or other treatments. Physical stimulation is often used to restart breathing and it is possible that repeated stimulation, such as with an oscillating mattress (kinesthetic stimulation), might prevent apnea and its consequences. OBJECTIVES: To determine the effect of prophylactic kinesthetic stimulation on apnea and bradycardia and use of intermittent positive pressure ventilation (IPPV) in preterm infants at risk for apnea? SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, Cochrane Central Register of Controlled Trials (the Cochrane Library, issue 4, 2009), Medline (1966 to October 2009), Embase, CINAHL (1982 to October 2009), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal hand searching mainly in the English language. SELECTION CRITERIA: All trials in preterm infants at risk of developing clinical apnea which utilized random or quasi-random allocation to treatment with an oscillating mattress (or other forms of repetitive kinesthetic stimulation) or control, were eligible. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality and data extraction by each author and synthesis of the data using relative risk. MAIN RESULTS: Three trials enrolling a total of 154 babies were included in this review. There was no evidence of effect on short-term outcomes (apnea /bradycardia, IVH, use of IPPV, sleep/wake cycles and neurological status at discharge) or long-term outcomes (in one trial -- growth and development to one year). AUTHORS' CONCLUSIONS: IMPLICATIONS FOR PRACTICE -- Prophylactic use of kinesthetic stimulation cannot be recommended to reduce apnea/bradycardia in preterm infants. IMPLICATIONS FOR RESEARCH -- There are currently no clear research questions regarding prophylactic use of kinesthetic stimulation to prevent apnea in preterm infants.

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