SIGNIFICANCE: Preterm infants are at significant risk of reduced bone mineralization and resultant osteopenia of prematurity (bone deficiency) compared with term infants. It is highly probable that an occupational therapist in the neonatal intensive care unit (NICU) will provide intervention for preterm infants with osteopenia. Currently, no universal protocols with implications for occupational therapy practitioners exist in providing care for preterm infants.

INNOVATION: Nutritional supplementation was traditionally regarded as the only effective treatment for osteopenia of prematurity. As practice in the NICU encompasses a developmental care model, more appropriate interdisciplinary approaches are indicated. Current evidence suggests that preterm infants with osteopenia benefit from daily physical activity performed by skilled professionals. Occupational therapy practitioners are highly qualified to provide the specialized care needed for this unique population.

APPROACH: The purpose of this review was to appraise the evidence for the effectiveness of nonnutritional interventions in treating osteopenia of prematurity. Studies denote that 30% of very low birth weight infants have osteopenia, with fracture rates of 2% to 10%. Despite improvements in nutritional and standard neonatal care, these approaches alone have been unsuccessful in preventing declines in bone mineralization in preterm infants. Physical activity programs have been found to improve bone quality in this population.

METHOD: A systematic review of the literature was performed. Studies were considered if they were published from 1994 to 2014, recruited preterm infants, and contained the following key terms: bone diseases, metabolic/rehabilitation/risk factors/therapy, infants, and newborn. Additionally, reference lists from identified studies were examined for potential articles, and a clinical trial registry was searched for ongoing trials. Studies meeting the criteria were assessed by two authors for eligibility and methodological quality, and data were extracted into a critical appraisal chart. Twelve randomized controlled trials incorporating 562 preterm infants met inclusion criteria for the review. All studies followed a standard physical activity protocol that included daily range of motion (ROM) exercises and compression, with some studies varying the duration of intervention or adding massage.

RESULTS AND CONCLUSION: Physical activity was found to increase or attenuate the rate of decrease in bone mineralization when compared with standard nursing care. Specific improvements were found in bone area, bone mineral content, bone mineral density, bone strength, and biochemical markers of bone turnover. Additionally, improvements in bone quality are explained by the biomechanical model of postnatal bone formation. The results of this review indicate that physical activity does improve bone quality in the preterm infant compared with standard nutritional care. Larger sample sizes and longitudinal studies are needed to determine long-term outcomes of physical activity on fracture reduction and bone health in the preterm infant. It is hoped the results of this review will assist occupational therapists in establishing universal protocols for caring for preterm infants.