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To the Editor:Harding et al reported severe neurologic complications caused by chest physiotherapy performed in premature infants admitted to their unit (percussion technique and postural drainage).For 25 years the only method of respiratory physiotherapy used in our unit has been forced expiratory maneuver adapted to the preterm infant. This technique, like the cough reflex, is performed in intubated neonates and also in infants with nasal ventilatory support. Abdominal compression is not used in premature neonates because of the risk of increased venous pressure. It is a maneuver that increases the expiratory time and recruits ejection volumes higher than those mobilized during spontaneous cough, which are very low in the preterm infant. This technique requires meticulous training and should be performed 3 times a day.No adverse effects have been noted except for desaturations, which can be compensated for with a transitory increase in inspired fraction of oxygen with close monitoring by pulse oximeter. Our approach to chest therapy seems to be very helpful because only 1 of 300 infants extubated underwent reintubation because of atelectasis.We have not observed cerebral lesions resulting from chest physiotherapy. Our infants had cranial ultrasound examinations twice a week. In 1997, in 74 infants born between 24 and 27 weeks’ gestation, we observed that 38% (Grade I to IV) had intraventricular hemorrhage, and all cases of intraventricular hemorrhage were diagnosed before chest physiotherpy was initiated.Therefore chest physiotherapy in general should not be blamed for cerebral damage during the treatment of very preterm infants. Techniques such as chest percussion may have adverse effects. To the Editor:Harding et al reported severe neurologic complications caused by chest physiotherapy performed in premature infants admitted to their unit (percussion technique and postural drainage).For 25 years the only method of respiratory physiotherapy used in our unit has been forced expiratory maneuver adapted to the preterm infant. This technique, like the cough reflex, is performed in intubated neonates and also in infants with nasal ventilatory support. Abdominal compression is not used in premature neonates because of the risk of increased venous pressure. It is a maneuver that increases the expiratory time and recruits ejection volumes higher than those mobilized during spontaneous cough, which are very low in the preterm infant. This technique requires meticulous training and should be performed 3 times a day.No adverse effects have been noted except for desaturations, which can be compensated for with a transitory increase in inspired fraction of oxygen with close monitoring by pulse oximeter. Our approach to chest therapy seems to be very helpful because only 1 of 300 infants extubated underwent reintubation because of atelectasis.We have not observed cerebral lesions resulting from chest physiotherapy. Our infants had cranial ultrasound examinations twice a week. In 1997, in 74 infants born between 24 and 27 weeks’ gestation, we observed that 38% (Grade I to IV) had intraventricular hemorrhage, and all cases of intraventricular hemorrhage were diagnosed before chest physiotherpy was initiated.Therefore chest physiotherapy in general should not be blamed for cerebral damage during the treatment of very preterm infants. Techniques such as chest percussion may have adverse effects. Harding et al reported severe neurologic complications caused by chest physiotherapy performed in premature infants admitted to their unit (percussion technique and postural drainage). For 25 years the only method of respiratory physiotherapy used in our unit has been forced expiratory maneuver adapted to the preterm infant. This technique, like the cough reflex, is performed in intubated neonates and also in infants with nasal ventilatory support. Abdominal compression is not used in premature neonates because of the risk of increased venous pressure. It is a maneuver that increases the expiratory time and recruits ejection volumes higher than those mobilized during spontaneous cough, which are very low in the preterm infant. This technique requires meticulous training and should be performed 3 times a day. No adverse effects have been noted except for desaturations, which can be compensated for with a transitory increase in inspired fraction of oxygen with close monitoring by pulse oximeter. Our approach to chest therapy seems to be very helpful because only 1 of 300 infants extubated underwent reintubation because of atelectasis. We have not observed cerebral lesions resulting from chest physiotherapy. Our infants had cranial ultrasound examinations twice a week. In 1997, in 74 infants born between 24 and 27 weeks’ gestation, we observed that 38% (Grade I to IV) had intraventricular hemorrhage, and all cases of intraventricular hemorrhage were diagnosed before chest physiotherpy was initiated. Therefore chest physiotherapy in general should not be blamed for cerebral damage during the treatment of very preterm infants. Techniques such as chest percussion may have adverse effects.