Multiple Rib Fractures Due to Physiotherapy in a Neonate With Hyaline Membrane Disease

Abstract

ceed the elite and British groups. In short, these apparently plump arms contained not only fat but fluid not otherwise obvious on clinical exami¬ nation. The implications of this find¬ ing in terms of bodily growth, intel¬ lectual alertness, and, above all, resistance to infection are only too obvious and are manifested in the high incidence, morbidity, and mor¬ tality from infections and the rapid¬ ity with which these children can be triggered off into clinical malnutri¬ tion syndromes.There is, then, a growing realisa¬ tion of the complex interaction be¬ tween the many factors leading to PCM. Low intake of important food factors-yes; but of itself not a suffi¬ cient explanation. Others include low general standards of living, and taboos, on feeding eggs to young chil¬ dren for instance, alleged to have de¬ veloped to ensure that the father-the worker-gets what he needs in order to do his farming. In this connection one study of rural family food con¬ sumption showed a rise in the inci¬ dence of malnutrition in the children that coincided with a sudden increase in the family total calorie intake oc¬ curring with the return to intense farming activity in anticipation of the coming rains. And then, constant infections, with the accompanying loss of appetite, poor digestion, and diminished absorption of food, are now accepted as vital factors contrib¬ uting to undernourishment and pre¬ cipitating malnutrition. Gastroenter¬ itis is undoubtedly the biggest contributor to marasmus and to in¬ fant mortality, and measles, the great villain occurs in epidemics of great severity and high mortality, and can be seen to be followed by sudden on¬ set of kwashiokor a few weeks later.Severe diarrhoea often accompanies the acute phase, and it is easy to un¬ derstand that the rash, so evident as Koplik spots in the mouth, extends down into the gut and gives rise to mucosal damage and malabsorptionand so it is. Disaccharide intolerance has been shown to be present and sometimes persists and is associated with other malabsorptions. Further¬ more, some interesting recent work at Ahmadu Bello University Hospital in Zaria, Nigeria, has pinpointed an actual positive protein-losing enteropathy of up to 4 to 5 gm daily, suffi¬ cient to give rise to oedema even in well-fed subjects with nephrotic syn¬ drome.So, in summary the concept now ac¬ cepted is that malnutrition does notwill not-occur solely from inadequate protein or calorie intake in a healthy child, even in rural Africa, but results from the constant ill health, infec¬ tions, malabsorption, and so on that are the normal lot of mankind during the first few years of life, until some degree of immunity to a host of infec¬ tions has been achieved. But adequate immunity fails to develop in the un¬ dernourished, and infections flourish; and so the wheel goes round and round and the end result is the sur¬ vival of the toughest and luckiest 55% to 65% of those born into the African world-natural selection.It follows, of course, that the plump, well-nourished children of the African el...

Evaluation of a new chest physiotherapy technique in dogs with airway fluid accumulation hospitalized in an intensive care unit

“…Coupage has been associated with pulmonary atelectasis in dogs and gastroesophageal reflux, multiple rib fractures, and brain lesions in infants . In the present study, PSE and AC showed no adverse events, even in dogs with coagulation disorders, although the number of enrolled dogs was relatively small and further evaluation will be needed to fully determine the potential adverse effects of these techniques.…”

“…Numerous studies have also demonstrated the potential adverse effects of various CP maneuvers, mostly in very small and fragile patients. In human infants, there is an increased risk of gastroesophageal reflux and hemoglobin desaturation, potentially severe hypoxemia, rib fractures, and brain damage . However, most of these studies are based on percussion and vibration techniques …”

Structure and Function of the Mucus Clearance System of the Lung

“…Percussion has been shown to cause an increase in hypoxemia (Falk et al 1984), but, when combined with thoracic expansion exercises, no fall was seen in oxygen saturation (Pryor et al 1990). Rib fractures were reported in a neonate (Purohit et al 1975). Vibration augments the expiratory flow and may help mobilize mucus (McCarren and Alison 2006).…”

Physiotherapy for airway clearance in paediatrics

“…Clinical experience suggests that these interventions are hardly effective on the big and stiff chest of the adult, whereas the compliant chest of the newborn and infant seems to provide for a high effectiveness of conventional CPT. The disadvantage of this difference is that this small chest can also be damaged more easily as suggested by reports on physiotherapy inflicted rib fractures in newborn infants [76].…”