Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study

Gianfranco Pizzolorusso, Patrizia Turi, Gina Barlafante, Francesco Cerritelli, Cinzia Renzetti, Vincenzo Cozzolino, Marianna D'Orazio, Paola Fusilli, Fabrizio Carinci, Carmine D'Incecco, Gianfranco Pizzolorusso, Patrizia Turi, Gina Barlafante, Francesco Cerritelli, Cinzia Renzetti, Vincenzo Cozzolino, Marianna D'Orazio, Paola Fusilli, Fabrizio Carinci, Carmine D'Incecco

Abstract

Background: Organizational improvement of neonatal intensive care units requires strict monitoring of preterm infants, including routine assessment of physiological functions of the gastrointestinal system and optimized procedures for the definition of appropriate discharge timing.

Methods: We conducted a prospective study on the effect of osteopathic manipulative treatment in a cohort of N = 350 consecutive premature infants admitted to a neonatal intensive care unit without any major complication between 2005 and 2008. In addition to ordinary care, N = 162 subjects received osteopathic treatment. Endpoints of the study were differences between study and control groups in terms of excessive length of stay and gastrointestinal symptoms, defined as the upper quartiles in the distribution of the overall population. Statistical analysis was based on crude and adjusted odds ratios from multivariate logistic regression.

Results: Baseline characteristics were evenly distributed across treated/control groups, except for the rate of infants unable to be oral fed at admission, significantly higher among those undergoing osteopathic care (p = .03). Osteopathic treatment was significantly associated with a reduced risk of an average daily occurrence of gut symptoms per subject above .44 (OR = 0.45; 0.26-0.74). Gestational age lower or equal to 32 weeks, birth weight lower or equal to 1700 grams and no milk consumption at admission were associated with higher rates of length of stay in the unit of at least 28 days, while osteopathic treatment significantly reduced such risk (OR = 0.22;0.09-0.51).

Conclusions: In a population of premature infants, osteopathic manipulative treatment showed to reduce a high occurrence of gastrointestinal symptoms and an excessive length of stay in the NICU. Randomized control studies are needed to generalize these results to a broad population of high risk newborns.

References

    1. Owens PL, Thompson J, Elixhauser A, Ryan K. In: Care of Children and Adolescents in U.S. Hospitals. Rockville, MD, editor. Agency for Healthcare Research and Quality; 2003. Report HCUP Fact Book No. 4; AHRQ Publication 04-0004.
    1. Clements KM, Barfield WD, Ayadi MF, Wilber N. Preterm birth-associated cost of early intervention services: an analysis by gestational age. Pediatrics. 2007;119(4):e866–74. doi: 10.1542/peds.2006-1729. Epub 2007 Mar 5.
    1. Russell RB, Green NS, Steiner CA, Meikle S, Howse JL, Poschman K, Dias T, Potetz L, Davidoff MJ, Damus K, Petrini JR. Cost of hospitalization for preterm and low birth weight infants in the United States. Pediatrics. 2007;120(1):e1–9. doi: 10.1542/peds.2006-2386.
    1. Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, Silber JH, Lorch SA. Infant functional status: the timing of physiologic maturation of premature infants. Pediatrics. 2009;123(5):e878–86. doi: 10.1542/peds.2008-2568.
    1. Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics. 2001;108(4):928–33. doi: 10.1542/peds.108.4.928.
    1. American Academy of Pediatrics. Hospital discharge of the high-risk neonate--proposed guidelines. Pediatrics. 1998;102:411–7.
    1. Mezzacappa MA, Rosa AC. Clinical predictors of abnormal esophageal pH monitoring in preterm infants. Arq Gastroenterol. 2008;45(3):234–8.
    1. Mihatsch WA, von Schoenaich P, Fahnenstich H, Dehne N, Ebbecke H, Plath C, von Stockhausen HB, Muche R, Franz A, Pohlandt F. The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants. Pediatrics. 2002;109(3):457–9. doi: 10.1542/peds.109.3.457.
    1. Bertino E, Giuliani F, Prandi G, Coscia A, Martano C, Fabris C. Necrotizing enterocolitis: risk factor analysis and role of gastric residuals in very low birth weight infants. J Pediatr Gastroenterol Nutr. 2009;48(4):437–42. doi: 10.1097/MPG.0b013e31817b6dbe.
    1. Mäki M, Ruuska T, Kuusela AL, Karikoski-Leo R, Ikonen RS. High prevalence of asymptomatic esophageal and gastric lesions in preterm infants in intensive care. Crit Care Med. 1993;21(12):1863–7. doi: 10.1097/00003246-199312000-00013.
    1. Kuusela AL, Mäki M, Ruuska T, Laippala P. Stress-induced gastric findings in critically ill newborn infants: frequency and risk factors. Intensive Care Med. 2000;26(10):1501–6. doi: 10.1007/s001340051346.
    1. Duman N, Utkutan S, Ozkan H, Ozdoğan S. Are the stool characteristics of preterm infants affected by infant formulas? Turk J Pediatr. 2000;42(2):138–44.
    1. Mihatsch WA, Franz AR, Högel J, Pohlandt F. Hydrolyzed protein accelerates feeding advancement in very low birth weight infants. Pediatrics. 2002;110(6):1199–203. doi: 10.1542/peds.110.6.1199.
    1. Magoun HI. In: Osteopathy in the Cranial Field. 3. Kirksville, Mo, editor. Journal Printing Co; 1976.
    1. Nutrition Toolkit. 2008. Accessed June 24th 2010.
    1. The R Development Core Team, R. A Language and Environment for Statistical Computing. Accessed June 24th 2010.
    1. Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complement Ther Clin Pract. 2006;12(2):83–90. doi: 10.1016/j.ctcp.2005.12.005.
    1. Vandenplas Y, Denayer E, Vandenbossche T, Vermet L, Hauser B, Deschepper J, Engelen A. Osteopathy may decrease obstructive apnea in infants: a pilot study. Osteopath Med Prim Care. 2008;19(2):8.
    1. Philippi H, Faldum A, Schleupen A, Pabst B, Jung T, Bergmann H, Bieber I, Kaemmerer C, Dijs P, Reitter B. Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol. 2006;48(1):5–9.
    1. Massaro AN, Hammad TA, Jazzo B, Aly H. Massage with kinesthetic stimulation improves weight gain in preterm infants. J Perinatol. 2009;29(5):352–7. doi: 10.1038/jp.2008.230.
    1. Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database Syst Rev. 2004. p. CD000390. Review.
    1. Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008;5(2):7.
    1. Meltzer KR, Standley PR. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. 2007;107(12):527–36.
    1. Degenhardt BF, Darmani NA, Johnson JC, Towns LC, Rhodes DC, Trinh C, McClanahan B, DiMarzo V. Role of osteopathic manipulative treatment in altering pain biomarkers: a pilot study. J Am Osteopath Assoc. 2007;107(9):387–400.
    1. Kirchner L, Jeitler V, Waldhör T, Pollak A, Wald M. Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies. Acta Paediatr. 2009;98:981–984. doi: 10.1111/j.1651-2227.2009.01248.x.
    1. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2002. p. CD003517.

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