| Sumario: | Background: Bucket hydrokinesiotherapy, a supportive aquatic intervention for newborns, has been widely applied, although it lacks robust evidence regarding its clinical and neuromotor effects. While the General Movements Assessment (GMA) sensitively detects early neurological risk, the influence of therapeutic interventions on general movements (GMs) remains unclear. Objective: This study aimed to examine the effect of hydrokinesiotherapy on the GMs of hospitalized preterm infants and their clinical outcomes. Methods: Parallel-arm randomized controlled trial in which newborns were randomly assigned to two balanced groups and assessed at 34 (baseline), 36, 40–42, and 50–52 weeks postmenstrual age. Main inclusion criteria were: poor repertoire-GMs, admitted to a Neonatal Intermediate Care Unit, clinically stable. Assessors of main outcomes were blinded to group allocation. Interventions consisted of 10-minute bucket hydrokinesiotherapy followed by diaper change over 6 sessions on alternate days, or a diaper change only (control). Body weight and GMA were primary outcomes. Behavioral state was a secondary outcome; physiological parameters and respiratory distress were monitoring outcomes. Results: Thirty-four infants were included. Body weight (p = 0.43; d = 0.28) and global quality of GMs (p's > 0.25; d's < 0.39) were not affected by the intervention. Controls presented higher total (95%CI: 3.28–19.71; p <.001), upper (95%CI: 1.74–9.36; p < 0.001), and lower limb (95%CI: 0.79–8.14; p = 0.02) movement scores in the detailed GMA after the diaper changes protocol, at 36 weeks. The hydrokinesiotherapy group was more alert than controls after each session (p's < 0.01; V's > 0.53). Physiological parameters showed transient between-group differences within normal ranges (p's < 0.05). Adverse effects were not found. Conclusion: Bucket hydrokinesiotherapy was safe for the newborns. The technique was not effective in improving the global quality or detailed aspects of GMs after the two-week protocol. The intervention may be recommended to increase alertness, potentially supporting readiness for active feeding and engagement during care; however, caution is warranted given its acute effects on detailed aspects of GMs. Trial registrations: Trial registered in the Brazilian Clinical Trials Registry (ReBec). ReBec is a Primary Registry in the WHO Registry Network. Trial nº. RBR-5n82tv.
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