Vestibular stimulation for promoting development and preventing morbidity in preterm infants.

rationaleThe vestibular system is a sensory system within the inner ear and the brain that controls balance and physical coordination. Vestibular stimulation may have an impact on various physiological processes, including breathing, reducing apnea episodes and the need for respiratory support. It has been suggested that targeted vestibular stimulation in premature infants may improve neurodevelopmental outcomes and neuromotor function.

objectivesTo evaluate the benefits and harms of vestibular stimulation for reducing morbidity and promoting development in hospitalized preterm infants. SEARCH

methodsWe conducted searches in October 2025 using the following databases: CENTRAL, MEDLINE, Embase, CINAHL, Emcare, Epistemonikos, Directory of Open Access Journals (DOAJ), and three trials registries. We conducted manual searches of conference abstracts, checked the references of systematic reviews and included studies, and searched for errata or retractions related to the included studies. ELIGIBILITY CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated vestibular stimulation in preterm infants compared with no intervention or with other forms of vestibular stimulation. We excluded studies that combined vestibular stimulation with other types of sensory stimulation. OUTCOMES: Our outcomes of interest were major neurodevelopmental disability at 18 to 24 months' corrected age (cerebral palsy, developmental delay, intellectual impairment, blindness, and sensorineural deafness), death during initial hospitalization, and weight gain (g). We also analyzed additional clinical outcomes reported by the included studies, including intraventricular hemorrhage, duration of hospital stay, number of days until full enteral feeding and number of apnea episodes during exposure to the intervention, which we synthesized where sufficient data were available. RISK OF BIAS: We used the Cochrane risk of bias tool, RoB 2. SYNTHESIS

methodsWe conducted a meta-analysis using fixed-effect models to calculate risk ratios (RR) with their 95% confidence intervals (CI) for one outcome with dichotomous data - intraventricular hemorrhage (grades 1-4). Heterogeneity calculation was not applicable as we included only one study in each analysis. For other outcomes (weight gain, apnea, number of days until full oral feeding), we were unable to pool the results in meta-analyses because the trials presented data in different ways and at varying time points, or provided only limited data, which we were unable to recalculate for analyses. We synthesized them using synthesis without meta-analysis. We evaluated the certainty of the evidence for all outcomes using the GRADE approach. INCLUDED STUDIES: We included three RCTs and one quasi-RCT, that enrolled a total of 196 infants. One study evaluated vestibular stimulation using an oscillating air mattress; another study evaluated vestibular stimulation with an oscillating waterbed; a third study evaluated rocking; and the final study evaluated stimulation with VestibuGlide (a rocking chair). The comparisons were standard care, standard infant stimulation, and the use of a regular mattress. No studies compared different vestibular stimulation interventions. All four studies included only preterm infants. However, the range of gestational age used as an inclusion criterion varied across the studies. Three studies aimed to assess the effects of vestibular stimulation on neuromuscular develop-ment. Two of these studies also aimed to assess the effects of vestibular stimulation on body weight gain. Two studies aimed to assess the effects of vestibular stimulation on the respiratory system, and one study aimed to evaluate the role of vestibular stimulation on oral feeding functions. We identified three ongoing trials. SYNTHESIS OF

resultsVestibular stimulation compared to no intervention No studies reported on major neurodevelopmental disability outcomes (cerebral palsy, developmental delay, intellectual impairment, blindness, or sensorineural deafness). The evidence is very uncertain about the effect of vestibular stimulation on death during initial hospitalization (no events were observed in either the intervention or control groups; 1 study, 122 participants; very low-certainty evidence). The evidence is very uncertain about the effect of vestibular stimulation on intraventricular hemorrhage compared with no intervention (RR 1.33, 95% CI 0.38 to 4.73; 1 study, 122 participants; very low-certainty evidence). No studies reported weight gain as prespecified in the review, however, narrative synthesis of three studies that reported weight gain using different definitions and time points suggested little to no difference between vestibular stimulation and control groups (3 studies, 169 participants, low-certainty evidence). We downgraded the overall certainty of the evidence for these outcomes due to risk of bias and imprecision. No studies reported on the duration of hospital stay, time to full oral feeding, or apnea as defined in our protocol. One vestibular intervention compared to another We found no studies that compared different types of vestibular stimulation. Therefore, it is unclear whether one approach is more effective than another. AUTHORS'

conclusionsThe evidence is very uncertain about the effect of vestibular stimulation compared to no intervention on death. The evidence suggests that any vestibular stimulation may result in little to no difference in weight gain. No studies reported major neurodevelopmental disability, a critical outcome in this review. Future studies of vestibular stimulation in preterm infants should use adequately powered, parallel‑group randomized controlled designs with clearly defined outcomes and transparent intervention reporting.

fundingOne review author, ML, received stipends to conduct this review from the Childhood Foundation of the Swedish Order of Freemasons, and the Sällskapet Barnavård, Department of Women's and Children's Health, Karolinska Institute. REGISTRATION: Protocol available via DOI10.1002/14651858.CD016072.