Use of Elastic Adhesive Tapes for Diastasis Recti in a Preterm Infant with Respiratory Distress: A Case Report

Diastasis recti (DRA) is defined as a separation of the rectus abdominis muscles along the line of the abdominal wall. This phenomenon is most often observed in women after childbirth [1,2], but it can also be observed in newborns [3]. In newborns, especially those with muscle hypotonia or congenital anomalies, the weakened abdominal wall resulting from DRA further complicates breathing, as the abdominal muscles, in addition to the diaphragm, play an important role in supporting breathing [4].

Fetal hydrops is a fetal disease characterized by the accumulation of fluid in body cavities or the appearance of edema. The disease is often accompanied by genetic disorders and high perinatal mortality [5]. Immediately after birth, the condition manifests as severe respiratory distress [6]. Signs and symptoms of respiratory distress may be exacerbated by the presence of DRA, which impairs respiratory function due to the lack of stability provided by the abdominal wall. Elastic adhesive tapes are a therapeutic method that is noninvasive and nonpharmacological and is commonly used in adults, including postpartum women, to support muscles, improve posture, and reduce diastasis. The use of tapes in premature infants has not yet been documented. In this article, we present a case study of the use of elastic adhesive tapes in a premature infant with DRA and concomitant conditions that cause respiratory distress.

Patient description

A premature male infant was born at 34 weeks and 3 days of gestation. The delivery was completed by cesarean section. At birth, the infant was not breathing spontaneously, requiring immediate intubation and initiation of mechanical ventilation. The clinical picture and imaging findings confirmed the diagnosis of fetal hydrops with extensive pleural effusion. A diagnosis of trisomy 21 was suspected, which was later confirmed by genetic analysis. In addition to respiratory problems, the infant had marked muscle hypotonia and clearly visible DRA. Separation of the rectus abdominis muscles and muscle hypotonia significantly impaired abdominal wall stability, which could have impeded diaphragmatic movement and contributed to ineffective breathing.

Physiotherapy intervention

Respiratory distress and the presence of DRA persisted on the 24^th day after birth, so after consulting with the medical team, which also includes physiotherapists, we decided to apply elastic adhesive (kinesiology) tapes over the abdominal wall, targeting the DRA. The tapes were placed along the rectus abdominis muscles, over the linea alba, with a mild approximation effect, i.e. a mild stretch of the tape during application.

On the 24^th day after birth, a physiotherapy intervention using ETT was performed in order to improve trunk stability and support diaphragmatic function. The tapes were placed along the rectus abdominis muscles, over the linea alba, with a mild approximation effect.

The procedure was performed by a qualified physiotherapist trained in the use of tapes in pediatric patients. The tapes were changed every 3 days, and any skin reaction was also monitored, which was not observed. The premature baby responded well to the therapy.

In the first 24 hours after the application of elastic adhesive tapes, the premature baby’s breathing stabilized. He began to breathe spontaneously without the help of machines. This was followed by an improvement in the results of gas analysis, which showed normal values of partial pressure and carbon dioxide and pH.

The need for mechanical ventilation therefore gradually decreased, and the child showed a calmer breathing pattern. There was no visible skin damage or discomfort due to the tapes. The tapes remained in place for a total of 7 days. Upon removal, improved muscle symmetry and a reduction in the gap between the muscles were visible. Better results and calmer breathing indicate the appropriateness and positive effect of the application of elastic adhesive tapes via DRA, which contributed to the biomechanical support of the respiratory system and facilitated the spontaneous breathing of the premature baby, and consequently reduced his dependence on mechanical assistance.

To our knowledge, this case is the first and only documented case of the use of elastic adhesive tapes in a premature infant, not adults diagnosed with DRA and concomitant respiratory distress. Existing literature indicates positive effects of tape application in adults, especially in postpartum women, where they help reduce the distance of the rectus abdominis muscles and strengthen the muscles [2,1]. The application of elastic adhesive tapes has proven successful in postpartum women [7]. Based on biomechanical principles that are established and confirmed in the adult population, we can assume that similar effects would also occur in newborns, despite significant anatomical differences.

The clinical improvements described in the case are consistent with findings from early physiotherapy interventions in neonates with neurological disorders, where it has been demonstrated that such interventions can improve muscle tone and consequently respiratory synergy [8]. In this context, the use of elastic adhesive tapes contributed to strengthening the abdominal wall, improved proprioceptive input and increased efficiency. Such a case may open avenues for further research into the safety, efficacy and long-term benefits of the application of elastic adhesive tapes in neonates (Figure 1 and 2).

Figure 1: Diastasis recti abdominis.

Figure 2: Applied elastic adhesive tapes.

Limitations of the case include the lack of objective measurements of DRA width (e.g., by ultrasound) before and after the intervention and the short-term follow-up. Nevertheless, the immediate clinical improvement suggests a positive effect of the intervention.

The described case provides evidence of the successful use of elastic adhesive tapes in a preterm infant with DRA. It has been shown to provide a safe, feasible and clinically effective physiotherapy intervention. The positive results observed, including reduced respiratory effort, transition to spontaneous breathing and reduced dependence on mechanical ventilatory support, suggest that the application of elastic adhesive tapes may have a positive effect on respiratory function in the preterm infant, due to the formation of support and integrity of the abdominal wall and the consequent improvement of diaphragmatic function. The use of this method in neonatal physiotherapy is promising, but further research is needed to confirm its effectiveness.

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