• neonatal
• shaken baby syndrome
• brain lesions

Williams and Sunderland,¹ and the accompanying commentary from Rosenbloom and Ryan,² discuss a severe cystic brain lesion associated with chest physiotherapy in very preterm infants. Rosenbloom is correct that the topic lacks topicality, but mainly because neonatal chest physiotherapy is now used very little if at all. I disagree that there is an abundant literature detailing appropriate treatment and the absence of brain damage associated with neonatal chest physiotherapy. Older data suggested benefit,^3–,⁵ but more recent publications demonstrate none.^6–,⁸ The reported benefits were transient improvements in oxygenation and slight increased removal of secretions. The older studies are all too small to adequately address safety. Chest physiotherapy, by whatever method, has little or no place in neonatal intensive care.

There are several lessons to be learned from the experience of the units who found these brain lesions. Firstly, a treatment generally recognised as being beneficial may not be so, especially with other changes in care over the passage of time. Continued reassessment of the usefulness of treatment is needed. Secondly, …