The results of the present study are difficult to interpret given the absence of additional data on the population under study and the lack of studies evaluating preterm or term newborns during hospitalization. The present study was, to our knowledge, the first to examine somatic dysfunction and cranial strain pattern in newborns who were admitted to a single NICU. Frymann (1966)
13 and Carreiro (1994)
14 were, to our knowledge, the only researchers who explored the prevalence of osteopathic findings in newborns, but their data do not compare readily with ours due to the lack of published results by Carreiro and different characteristics (ie, Frymann did not evaluate preterm newborns) of the samples under study. In the present report, sphenobasilar synchondrosis compression and lateral-vertical strain patterns were diagnosed in 36.8% and 36.8% of preterm newborns, respectively, as opposed to 17% and 7% diagnosed by Frymann, suggesting that severe cranial restrictions may be secondary to unstable clinical conditions of newborns in the NICU.
Findings from the present study also showed that somatic dysfunction at the level of the pelvis and spine occurred frequently. Moreover, the segment of the spine with the highest prevalence of somatic dysfunction was the middle thoracic area (18.7%), in line with the osteopathic observations on 1600 newborns by Carreiro.
13 Additionally, dysfunctions of the rib cage were shown to be in relation to dysfunctions of the diaphragm (16.8%), ribs, and sternum.
We can speculate on clinical interpretation of these results. Licciardone et al
10 demonstrated that tissue changes at the T11-L2 levels were a consistent osteopathic palpatory finding in patients affected by type 2 diabetes mellitus. Evidence from 2 longitudinal studies by Johnston et al
18,19 confirms the association between upper thoracic somatic dysfunction and hypertension. Sergueef et al
11 found that cranial strain pattern and somatic dysfunction at the level of the cervical spine can predispose a newborn to assume a preferential head position, leading to plagiocephaly.
Building on the data from these studies, the pathogenesis of somatic dysfunction and cranial strain pattern in newborns may occur on the basis of several factors. These factors include maternal age and body mass index, parity, pregnancies obtained via assisted reproductive technologies, ovulation induction therapy, gestational diabetes, hypertension, preterm labor, preterm uterine contractions, use of tocolytic drugs, use of oxytocin, duration of labor, route of delivery, and immaturity of the preterm newborn systems. Such speculations, however, cannot be verified within the framework of the current study, as more ad hoc studies looking at specific clinical conditions and osteopathic findings are needed.
Several limitations of the present study need to be addressed. Grades of severity for somatic dysfunction and cranial strain pattern were not reported and lack of data of the study population did not allow for further association with clinical symptoms. Because of the limited sample size, it was not possible to perform subgroup analysis of somatic dysfunction and cranial strain pattern occurrence in different classes of gestational ages and to compare the preterm and term newborn groups. Moreover, the absence of data regarding route of delivery prevented a more detailed analysis for correlation. Finally, these findings lack in reliability because neither interoperator nor intraoperator agreement was evaluated.