Massage for promoting growth and development of preterm and/or low birth-weight infants

A Vickers, A Ohlsson, J B Lacy, A Horsley, A Vickers, A Ohlsson, J B Lacy, A Horsley

Abstract

Background: It has been argued that infants in Neonatal Intensive Care Units are subject both to a highly stressful environment - continuous, high-intensity noise and bright light - and to a lack of the tactile stimulation that they would otherwise experience in the womb or in general mothering care. As massage seems to both decrease stress and provide tactile stimulation, it has been recommended as an intervention to promote growth and development of preterm and low-birth weight infants.

Objectives: To determine whether preterm and/or low birth-weight infants exposed to massage experience improved weight gain and earlier discharge compared to infants receiving standard care; to determine whether massage has any other beneficial or harmful effects on this population.

Search strategy: The following databases were searched: the specialized register of the Cochrane Neonatal Review Group and that of the Cochrane Complementary Medicine Field. Searches were also undertaken of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2003), MEDLINE, EMBASE, Psychlit, CINAHL and Dissertation Abstracts International (up to July 1, 2003). Further references were obtained by citation tracking, checking personal files and by correspondence with appropriate experts. Data provided in published reports was supplemented by information obtained by correspondence with authors. There were no language restrictions.

Selection criteria: Randomised trials in which infants with gestational age at birth <37 weeks or weight at birth <2500g received systematic tactile stimulation by human hands. At least one outcome assessing weight gain, length of stay, behaviour or development must be reported.

Data collection and analysis: Data extracted from each trial were baseline characteristics of sample, weight gain, length of stay and behavioural and developmental outcomes. Physiological and biochemical outcomes were not recorded. Data were extracted by three reviewers independently. Statistical analysis was conducted using the standard Cochrane Collaboration methods.

Main results: Massage interventions improved daily weight gain by 5.1g (95% CI 3.5, 6.7g). There is no evidence that gentle, still touch is of benefit (increase in daily weight gain 0.2g; 95% CI -1.2, 1.6g). Massage interventions also appeared to reduce length of stay by 4.5 days (95% CI 2.4, 6.5) though there are methodological concerns about the blinding of this outcome. There was also some evidence that massage interventions have a slight, positive effect on postnatal complications and weight at 4 - 6 months. However, serious concerns about the methodological quality of the included studies, particularly with respect to selective reporting of outcomes, weaken credibility in these findings.

Reviewers' conclusions: Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage. Where massage is currently provided by nurses, consideration should be given as to whether this is a cost-effective use of time. Future research should assess the effects of massage interventions on clinical outcome measures, such as medical complications or length of stay, and on process-of-care outcomes, such as care-giver or parental satisfaction.

Conflict of interest statement

None

Figures

1.1
1.1
Comparison 1 Massage vs. routine care, Outcome 1 Daily weight gain (g/day).
1.2
1.2
Comparison 1 Massage vs. routine care, Outcome 2 Length of stay (days).
1.3
1.3
Comparison 1 Massage vs. routine care, Outcome 3 Brazleton scale: habituation.
1.4
1.4
Comparison 1 Massage vs. routine care, Outcome 4 Brazleton scale: orientation.
1.5
1.5
Comparison 1 Massage vs. routine care, Outcome 5 Brazleton scale: range of state.
1.6
1.6
Comparison 1 Massage vs. routine care, Outcome 6 Brazleton scale: motor maturity.
1.7
1.7
Comparison 1 Massage vs. routine care, Outcome 7 Brazleton scale: state regulation.
1.8
1.8
Comparison 1 Massage vs. routine care, Outcome 8 Brazleton scale: autonomic stability.
1.9
1.9
Comparison 1 Massage vs. routine care, Outcome 9 Brazleton scale: number of abnormal reflexes.
1.10
1.10
Comparison 1 Massage vs. routine care, Outcome 10 Stress behaviours.
1.11
1.11
Comparison 1 Massage vs. routine care, Outcome 11 Percentage time awake.
1.12
1.12
Comparison 1 Massage vs. routine care, Outcome 12 Percentage time in movement.
1.13
1.13
Comparison 1 Massage vs. routine care, Outcome 13 Weight at 4‐8 month follow‐up (mixed units).
1.14
1.14
Comparison 1 Massage vs. routine care, Outcome 14 Length at 4‐8 month follow‐up (cm).
1.15
1.15
Comparison 1 Massage vs. routine care, Outcome 15 Head circumference at 4‐8 month follow‐up (cm).
1.16
1.16
Comparison 1 Massage vs. routine care, Outcome 16 Bayley Mental Scale at 6 months.
1.17
1.17
Comparison 1 Massage vs. routine care, Outcome 17 Bayley Motor Scale at 6 months.
1.18
1.18
Comparison 1 Massage vs. routine care, Outcome 18 Postnatal Complications Scale.
1.19
1.19
Comparison 1 Massage vs. routine care, Outcome 19 Brazy postnatal complications scale.
1.20
1.20
Comparison 1 Massage vs. routine care, Outcome 20 Newfoundland postnatal complications scale.
1.21
1.21
Comparison 1 Massage vs. routine care, Outcome 21 NCAFS Infant Feeding Behaviors.
2.1
2.1
Comparison 2 Gentle touch vs. routine care, Outcome 1 Daily weight gain (g/day).
2.2
2.2
Comparison 2 Gentle touch vs. routine care, Outcome 2 Length of stay (days).
2.3
2.3
Comparison 2 Gentle touch vs. routine care, Outcome 3 Neonatal morbidity score.
2.4
2.4
Comparison 2 Gentle touch vs. routine care, Outcome 4 Days on supplemental oxygen.
2.5
2.5
Comparison 2 Gentle touch vs. routine care, Outcome 5 Days of phototherapy.
2.6
2.6
Comparison 2 Gentle touch vs. routine care, Outcome 6 Number of blood transfusions.
2.7
2.7
Comparison 2 Gentle touch vs. routine care, Outcome 7 Change in time in movement.
2.8
2.8
Comparison 2 Gentle touch vs. routine care, Outcome 8 Change in behavioural distress.
2.9
2.9
Comparison 2 Gentle touch vs. routine care, Outcome 9 Brazleton scale: habituation.
2.10
2.10
Comparison 2 Gentle touch vs. routine care, Outcome 10 Brazleton scale: orientation.
2.11
2.11
Comparison 2 Gentle touch vs. routine care, Outcome 11 Brazleton scale: range of state.
2.12
2.12
Comparison 2 Gentle touch vs. routine care, Outcome 12 Brazleton scale: motor maturity.
2.13
2.13
Comparison 2 Gentle touch vs. routine care, Outcome 13 Brazleton scale: state regulation.
2.14
2.14
Comparison 2 Gentle touch vs. routine care, Outcome 14 Brazleton scale: autonomic stability.

References

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White Traut 1986 {published and unpublished data}
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White Traut 1993 {published data only}
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References to studies excluded from this review Acolet 1993 {published data only}
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Adamson‐Macedo 1993 {published data only}
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Adamson‐Macedo 1991 {published data only}
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Adamson‐Macedo 1994 {published data only}
    1. Adamson Macedo EN, Roiste A, Wilson A, Carvalho F, et al. TAC‐‐TIC therapy with high‐risk, distressed, ventilated preterms. Journal of Reproductive & Infant Psychology 1994;12:249‐52.
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Barnard 1973 / 78 {published and unpublished data}
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Barnard 1983 {published data only}
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Benavides‐Gonzales {published data only}
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Brown 1980 {published data only}
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Casler 1965 {published data only}
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Cody 1995 {published data only}
    1. Cody AL. The effects of infant massage on the attitudes and perceptions of mothers who massage their hospitalized premature infants. Dissertation Abstracts International 1995;56:2858.
Cornell 1976 {published data only}
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Crusco 1990 {published data only}
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de Roiste 1991 {unpublished data only}
    1. de Roiste. Aspects of tactile stimulation with infants in intensive and special care baby units. PhD thesis, University of Glasgow, Scotland. 1991.
de Roiste 1993 {published data only}
    1. Roiste A, Bushnell IW. Tactile stimulation and pre‐term infant performance on an instrumental conditioning task. Special Issue: Prenatal and perinatal behaviour. Journal of Reproductive & Infant Psychology 1993;11:155‐63.
Eidelman 1994 {published data only}
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Ferber 2002 {published and unpublished data}
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Field 1984 {published data only}
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Freedman 1966 {unpublished data only}
    1. Freedman D, Boverman H, Freedman N. Effects of kinesthetic stimulation on certain aspects of development in premature infants. Paper presented at the American Orthopsychiatric Association, San Francisco. 1966.
Freeman 1970 {published data only}
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Gaebler 1996 {published data only}
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Garcia 1993 {published data only}
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Gatts 1995 {published data only}
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Gorski 1990 {published data only}
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Groom / McNichol {published data only}
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Haselmeyer 1963 {published data only}
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Hayes 1980 {published data only}
    1. Hayes J. Premature infant development: The relationship of neonatal stimulation, birth condition and home environment. Pediatric Nursing 1980;6:33‐6.
Helders 1988 {published data only}
    1. Helders PJ, Cats BP, Net J, Debast SB. The effects of a tactile stimulation/range‐finding programme on the development of very low birthweight infants during initial hospitalization. Child: Care, Health and Development 1988;14:341‐54.
Helders 1989 {published data only}
    1. Helders PJ. Cats BP. Debast S. Effects of a tactile stimulation/range‐finding programme on the development of VLBW‐neonates during the first year of life. Child: Care, Health & Development 1989;15:369‐79.
Heller 1991 {published data only}
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Johanson 1992 {published data only}
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Kalscheur 1985 {published data only}
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Kassis 1967 {unpublished data only}
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Kattwinkel 1975 {published data only}
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Kennell 1974 {published data only}
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Kilgo 1986 {published data only}
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Koniak‐Griffin 1988 {published data only}
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Koniak‐Griffin 1995 {published data only}
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Kramer 1975 {published data only}
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Kuhn 1991 {published data only}
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Leib 1980 {published data only}
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Ludington 1978 {published data only}
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Macedo 1984 {unpublished data only}
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Mansy 1967 {unpublished data only}
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Marshall 1990 {published data only}
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Mathai 2001 {published data only (unpublished sought but not used)}
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McCain 1992 {published data only}
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McIntosh 1994 {published data only}
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Millot 1988 {published data only}
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Morrow 1991 {published data only}
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Nelson 1986 {published data only}
    1. Nelson D, Heitman R, Jennings C. Effects of tactile stimulation on premature infant weight gain. Journal of Obstetric, Gynecologic, & Neonatal Nursing 1986;15:262‐7.
Nelson 2001 {published and unpublished data}
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Pardew 1983 {published data only}
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Powell 1974 {published data only}
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Prodromidis 1995 {published data only}
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Rausch 1981 {published data only}
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Rosenfeld 1980 {published data only}
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Saigal 1986 {published data only}
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Sampers 1993 {unpublished data only}
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Scafidi 1996 {published data only}
    1. Scafidi F, Field T. Massage therapy improves behavior in neonates born to HIV‐positive mothers. Journal of Pediatric Psychology 1996;21:889‐97.
Scarr‐Salapatek 1973 {published data only}
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Schaeffer 1982 {published data only}
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Scott 1983 {published data only}
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Siqueland 1973 {published data only}
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Solkoff 1975 {published data only}
    1. Solkoff N, Matuszak D. Tactile stimulation and behavioral development among low‐birthweight infants. Child Psychiatry and Human Development 1975;6:33‐7.
Toney 1983 {published data only}
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Trevathan 1981 {published data only}
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Tribotti 1990 {published data only}
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Uvnas‐Moberg 1987 {published data only}
    1. Uvnas Moberg K, Widstrom AM, Marchini G, Windberg J. Release of GI hormone in mothers infants by sensory stimulation. Acta Paediatrica Scandinavia 1987;76:851‐860.
Weiss 1991 {published data only}
    1. Weiss SJ. Psychophysiologic and behavioral effects of tactile stimulation on infants at‐risk from nervous system arousal. Dissertation Abstracts International 1991;51:4077.
Weiss 1992 {published data only}
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Weiss 1993 {published data only}
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White 1964 {published data only}
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White Traut 1997 {published data only (unpublished sought but not used)}
    1. White Traut RC, Nelson MN, Silvestri JM, Cunningham N, Patel M. Responses of preterm infants to unimodal and multimodal sensory intervention. Pediatric Nursing 1997;23:169‐75.
White Traut 1999 {published data only (unpublished sought but not used)}
    1. White Traut RC, Nelson MN, Silvestri JM, Patel M, Vasan U, Han BK, Cunningham N, Burns K, Kopischke K, Bradford L. Developmental intervention for preterm infants diagnosed with periventricular leukomalacia. Research in Nursing & Health 1999;22:131‐43.
White‐Traut 1998 {published data only}
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White‐Traut 2002 {published data only}
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Wright 1971 {published data only}
    1. Wright L. The theoretical and research base for a program of early stimulation care and training of premature infants. In: Hellmuth J editor(s). The Exceptional Infant: Studies in Abnormalities. Vol. 2, New York: Brunner/Mazel, 1971:276‐304.
References to studies awaiting assessment Dieter 2003 {published data only}
    1. Dieter JN, Field T, Hernandez‐Reif M, Emory EK, Redzepi M. Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology 2003;28:403‐11.
References to ongoing studies Dieter 1998 {unpublished data only}
    1. Dieter J. Replication of Field 1987.
Additional references Barnard 1978
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Bayley 1969
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