Introduction

Preterm birth and low birth weight (LBW) continue to be among the great public health problems worldwide. UNICEF and the World Health Organization (WHO) estimate that in 2020, 19.8 million babies were born with LBW (14.7% of all live births) [1]. Preterm LBW infants are a highly vulnerable population and are at high risk for adverse neurodevelopmental outcomes due to immature neurological systems, medical comorbidities, and prolonged exposure to the stressful NICU environment [2]. Most preterm infants spend their time in the NICU, while the most rapid period of human brain development is between 22 and 40 weeks of gestation [3]. Interventions during this time of brain malleability can have a significant impact on later developmental outcomes. Despite advances in neonatal care, NICU environments induce excess sensory stimulation, painful procedures, and prolonged separation from caregivers, which are all linked to dysregulated responses of cortisol (the stress hormone) and a decrease in oxytocin (the bonding hormone), as well as altered brain maturation [4].

Kangaroo Mother Care (KMC) is defined as prolonged skin-to-skin contact (SSC) between the baby and a caregiver, with exclusive breastfeeding promotion and early discharge; it is recognized by the WHO as an essential intervention for all preterm and LBW babies [5]. KMC has been consistently linked to decreased neonatal mortality, improved thermoregulation, physiologic stability, and better mother-infant bonding. The results of a large meta-analysis indicated that KMC can reduce neonatal death by 36% in LBW infants [6]. Neurophysiologically, SSC stimulates C-tactile afferent fibers, leading to the release of oxytocin and endogenous opioids and inducing an autonomic regulation and a calming neuroregulatory state that facilitates sensory-motor integration [7].

Neonatal physiotherapy has become a key component of developmental care in NICUs, using positioning, passive range of motion, tactile stimulation, and sensory-motor activities to promote the development of the neuromotor system [8]. Structured tactile-kinesthetic stimulation in the neonatal period has been demonstrated to enhance motor organization, autonomic stability, and reflex maturation in preterm neonates [9]. Although there is an increasing number of evidence-based studies supporting KMC and neonatal physiotherapy as separate interventions, there are limited studies examining the implementation of a structured physiotherapy protocol within the KMC framework, especially when assessing the outcomes of the physiotherapy intervention in terms of neurobehavioral development as the primary outcomes [10].

A recent randomized controlled trial protocol by Reco and Soares-Marangoni [10] outlined a similar combined sensory-motor physiotherapy and KMC intervention in preterm infants of comparable postmenstrual age, using general movements as the primary outcome, though results from this trial are not yet available.

This is a case report of a seven-day structured physiotherapy program administered through KMC sessions and its outcome measured by Prechtl's General Movements Assessment (GMA) and Neonatal Behavioural Assessment Scale (NBAS) in one LBW preterm infant. The purpose of the report is to demonstrate the feasibility, safety, and potential benefit of this integrated approach and to help build the clinical evidence base for combined developmental interventions in the NICU. The parents of the infant gave written informed consent for the presentation of this case report and clinical data.