Category Archives: Infant

The Efficacy of Massage on Preterm Infants

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Objective 
To determine whether massage could help preterm infants improve weight gain, discharge from the hospital earlier, and promote the neurobehavioral development, a meta-analysis was conducted.

Study Design 
MEDLINE, Embase, CINAHL, Dissertation Abstracts, and the Cochrane Library were searched up to January 2012. There were no language restrictions.

Results 
In all, 611 articles were retrieved and 17 studies were eligible. Massage intervention improved daily weight gain by 5.32 g (95% confidence interval [CI] 4.15, 6.49, p < 0.00001) and reduced length of stay by 4.41 days (95% CI 2.81, 6.02, p < 0.00001). No significant differences yielded on the scores of Neonatal Behavioral Assessment Scale.

Conclusion 
Massage therapy may be a safe and cost-effective practice to improve weight gain and decrease the hospital stay of clinically stable preterm infants. However, the association between massage and neurobehavioral development is still elusive. Future investigations with a larger sample size and strict protocol are required to confirm the effects of massage on the preterm infants.

Am J Perinatol. 2013 Jan 15. [Epub ahead of print]
The Efficacy of Massage on Preterm Infants: A Meta-Analysis.
Wang L, He JL, Zhang XH.

Massage Improves Growth Quality by Decreasing Body Fat Deposition in Male Preterm Infants

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Researchers from Department of Pediatrics, University of Utah, conducted experiments to assess the effect of massage on weight gain and body fat deposition in preterm infants. The research was recently published in Journal of Pediatrics

Preterm infants (29-32 weeks) were randomized to the massage group (12 girls, 10 boys) or the control group (12 girls, 10 boys). Treatment was masked with massage or control care administered twice-daily by licensed massage therapists (6 d/wk for 4 weeks). Body weight, length, Ponderal Index (PI), body circumferences, and skinfold thickness (triceps, mid-thigh, and subscapular [SSF]) were measured. Circulating insulin-like growth factor I, leptin, and adiponectin levels were determined by enzyme-linked immunosorbent assay. Daily dietary intake was collected.

The results showed that energy and protein intake as well as increase in weight, length, and body circumferences were similar. Male infants in the massage group had smaller PI, triceps skinfold thickness, mid-thigh skinfold thickness, and SSF and increases over time compared with control male infants. Female infants in the massage group had larger SSF increases than control female infants. Circulating adiponectin increased over time in control group male infants.

The authors concluded that twice-daily massage did not promote greater weight gain in preterm infants. Massage did, however, limit body fat deposition in male preterm infants. Massage decreased circulating adiponectin over time in male infants with higher adiponectin concentrations associated with increased body fat. These findings suggest that massage may improve body fat deposition and, in turn, growth quality of preterm infants in a sex-specific manner.

J Pediatr. 2012 Oct 11.doi: 10.1016/j.jpeds.2012.08.033.
Massage Improves Growth Quality by Decreasing Body Fat Deposition in Male Preterm Infants.
Moyer-Mileur LJ, Haley S, Slater H, Beachy J, Smith SL.

A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants

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Pediatrics. 2012 Dec;130(6):e1549-58. doi: 10.1542/peds.2012-0196. Epub 2012 Nov 12.

A randomized placebo-controlled trial of massage therapy on the immune system of preterm infants.

Source

Division of Infectious Diseases, Carman and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201. jang@med.wayne.edu.

Abstract

OBJECTIVES:

The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers.

METHODS:

A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated.

RESULTS:

The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 consecutive days of study intervention compared with control (13.79 vs 10 lytic units, respectively; P = .04). Infants in the massage group were heavier at end of study and had greater daily weight gain compared with those in the control group; other immunologic parameters, number of infections, and length of stay were not different between the 2 groups.

CONCLUSIONS:

In this study, MT administered to stable preterm infants was associated with higher NK cytotoxicity and more daily weight gain. MT may improve the overall outcome of these infants. Larger studies are needed.

 

The effect of massage on heart rate variability in preterm infants

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J Perinatol. 2012 Apr 26. doi: 10.1038/jp.2012.47. [Epub ahead of print]

The effect of massage on heart rate variability in preterm infants.
Smith SL, Lux R, Haley S, Slater H, Beechy J, Moyer-Mileur LJ.
School of Nursing, University of Louisville, Louisville, KY, USA.

Abstract
Objective:To test the hypothesis that massage would improve autonomic nervous system (ANS) function as measured by heart rate variability (HRV) in preterm infants.
Study Design:Medically stable, 29- to 32-week preterm infants (17 massage, 20 control) were enrolled in a masked, randomized longitudinal study. Licensed massage therapists provided the massage or control condition twice a day for 4 weeks. Weekly HRV, a measure of ANS development and function, was analyzed using SPSS generalized estimating equations.
Results:Infant characteristics were similar between groups. HRV improved in massaged infants but not in the control infants (P<0.05). Massaged males had a greater improvement in HRV than females (P<0.05). HRV in massaged infants was on a trajectory comparable to term-born infants by study completion.
Conclusion:Massage-improved HRV in a homogeneous sample of hospitalized, medically stable, preterm male infants and may improve infant response to exogenous stressors. We speculate that massage improves ANS function in these infants.
Journal of Perinatology advance online publication, 26 April 2012; doi:10.1038/jp.2012.47.

Prenatal tactile stimulation attenuates drug-induced behavioral sensitization, modifies behavior, and alters brain architecture

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Brain Research Volume 1400, 11 July 2011, Pages 53-65
DOI: 10.1016/j.brainres.2011.05.038

Prenatal tactile stimulation attenuates drug-induced behavioral sensitization, modifies behavior, and alters brain architecture

Abstract

Based on the findings of postnatal tactile stimulation (TS), a favorable experience in rats, the present study examined the influence of prenatal TS on juvenile behavior, adult amphetamine (AMPH) sensitization, and structural alteration in the prefrontal cortex (PFC) and the striatum. Female rats received TS through a baby hair brush throughout pregnancy, and the pups born were tested for open field locomotion, elevated plus maze (EPM), novel object recognition (NOR), and play fighting behaviors. Development and persistence of drug-induced behavioral sensitization in adults were tested by repeated AMPH administration and a challenge, respectively. Structural plasticity in the brain was assessed from the prefrontal cortical thickness and striatum size from serial coronal sections. The results indicate that TS females showed enhanced exploration in the open field. TS decreased the frequency of playful attacks whereas the response to face or evade an attack was not affected. Anxiety-like behavior and cognitive performance were not influenced by TS. AMPH administration resulted in gradual increase in locomotor activity (i.e.; behavioral sensitization) that persisted at least for 2 weeks. However, both male and female TS rats exhibited attenuated AMPH sensitization compared to sex-matched controls. Furthermore, the drug-associated alteration in the prefrontal cortical thickness and striatum size observed in controls were prevented by TS experience.

In summary, TS during prenatal development modified juvenile behavior, attenuated drug-induced behavioral sensitization in adulthood, and reorganized brain regions implicated in drug addiction.

Baby massage ameliorates neonatal jaundice in full-term newborn infants

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Baby massage ameliorates neonatal jaundice in full-term newborn infants
Chen, J., Sadakata, M. , Ishida, M. , Sekizuka, N. , Sayama, M.

Neonatal jaundice is a common physiological problem affecting over half of all full term and most preterm infants. Thus, newborn infants must be monitored for signs of hyperbilirubinemia to prevent acute bilirubin encephalopathy or kernicterus. Evidence exists supporting the benefits of baby massage as a form of mild hand to skin contact, to increase neonatal physical and mental development. In the present study, the effects of gentle baby massage on neonatal jaundice in full term newborn infants were evaluated by a controlled clinical trial. The inclusion criteria of newborn neonates were as follows: (1) gestational age of 37 ~ 41 weeks, (2) birth weight of 2,800 ~ 3,600 g, (3) Apgar score at birth of 8 ~ 10, and (4) being a healthy neonate without neonatal asphyxia and hemolytic condition. Breastfed newborns without phototherapy were included: 20 in the massage group and 22 in the control group. We found the mean stool frequency of the massaged infants on day 1 and day 2 (4.6 and 4.3) was significantly higher than that of the control group (3.3 and 2.6) (p < 0.05). The transcutaneous bilirubin levels on the second to fifth day and serum total bilirubin levels on fourth day were significantly decreased in the massage group, compared to the control group. In conclusion, baby massage at an early stage after birth could reduce neonatal bilirubin levels. We suggest baby massage is beneficial for ameliorating neonatal jaundice.

Tactile stimulation in physically healthy infants

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Tactile stimulation in physically healthy infants: Results of a systematic review
Underdown, A., Barlow, J., Stewart-Brown, S. 2010 Journal of Reproductive and Infant Psychology 28 (1), pp. 11-29

Touch establishes powerful physical and emotional connections between infants and their caregivers, and plays an essential role in development. The objective of this systematic review was to identify published research to ascertain whether tactile stimulation is an effective intervention to support mental and physical health in physically healthy infants.

Twenty-two studies of healthy infants with a median age of six months or less met our inclusion criteria. The limited evidence suggests that infant massage may have beneficial effects on sleeping and crying patterns, infants’ physiological responses to stress (including reductions in serum levels of norepinephrine and epinephrine, and urinary cortisol levels), establishing circadian rhythms through an increase in the secretion of melatonin, improving interaction between mother-infant dyads in which the mother is postnatally depressed, and promoting growth and reducing illness for limited populations (i.e. infants in an orphanage where routine tactile stimulation is low).

The only other evidence of a significant impact of massage on growth in infants living in families was obtained from a group of studies regarded to be at high risk of bias which we have reported separately. There is no evidence of a beneficial effect on infant temperament, attachment or cognitive development. There is, therefore, some evidence of benefits on mother-infant interaction, sleeping and crying, and on hormones influencing stress levels.

In the absence of evidence of harm, these findings support the use of infant massage in the community, particularly in contexts where infant stimulation is poor. Further research is needed, however, before it will be possible to recommend universal provision.

Massage Therapy in Children with Sickle Cell Disease

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A Randomized Controlled Trial of Massage Therapy in Children with Sickle Cell Disease
Kathleen L. Lemanek, PhD, Mark Ranalli, MD and Colleen Lukens, PhD
Ohio State University College of Medicine and Children’s Hospital of Philadelphia

Recurring or chronic pain is the hallmark clinical feature of sickle cell disease (SCD). Children and adolescents with SCD typically report pain occurring in the extremities, hip, or trunk on 7–30% of diary days, with an average duration of 2.5 days and an average pain rating of 5 on a 10-point scale (Dampier, Ely, Brodercki, & O’Neal, 2002Go). Events may occur spontaneously or as a consequence of environmental stress (e.g., excessive cold or heat exposure), physiological stress (e.g., infection), or psychosocial stress (e.g., school demands) (Ballas, 1998Go). Pain has a substantial impact on academic performance (i.e., completing school assignments, school attendance), sleep and social activities (Gil et al., 2000Go).

This randomized controlled trial investigated the short-term effects of massage therapy on youth with SCD and their parents.

Methods Thirty-four children and adolescents, and their parents were assigned to a massage therapy or an attention control group. Parents were trained in massage in their homes once a week for 4 weeks, with instructions to provide nightly massages. Families in the control group were visited weekly by a research assistant. Participants completed measures of depression and anxiety, functional status, pain intensity, medication use, and service utilization.

Results Parents in the massage therapy group reported higher levels of depression and anxiety following the intervention. Youth in this group showed higher levels of functional status, and lower levels of depression, anxiety, and pain. Health service utilization rates were unchanged from pre- to post-intervention.

Conclusions These results offer preliminary support for parent-delivered massage therapy as an intervention for SCD pain.

Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsp015

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

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Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage for promoting growth and development of preterm and/or low birth-weight infants. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD000390. DOI: 10.1002/14651858.CD000390.pub2.

Massage for promoting growth and development of premature and low birth-weight infants

In utero, infants are exposed to physical stimulation. This raises the question whether gentle physical massage helps babies born before 37 weeks gestation or weighing less than 2500 grams (5.5 pounds) to develop after birth, and if it can improve their behaviour. The review only included randomized controlled trials, studies in which a group of babies received massage and was compared with a similar group which did not. The authors searched the medical literature and contacted experts and found 14 studies. In most of these studies babies were rubbed or stroked for about 15 minutes, three or four times a day, usually for five or ten days. Some studies also included “still, gentle touch”, in which nurses put their hands on babies but did not rub or stroke them. On average, the studies found that when compared to babies who were not touched, babies receiving massage, but not “still, gentle touch”, gained more weight each day (about 5 grams). They spent less time in hospital, had slightly better scores on developmental tests and had slightly fewer postnatal complications, although there were problems with how reliable these findings are. The studies did not show any negative effects of massage. Massage is time consuming for nurses to provide, but parents can perform massage without extensive training.

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.

Authors’ 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.

Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic

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Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic.

J Clin Nurs. 2008 Jul ;17 (13):1754-61

Duygu Arikan, Handan Alp, Sebahat Gözüm, Zerrin Orbak, Esra Karaca Cifçi
Department of Child Health Nursing, School of Nursing, Atatürk University, 25240 Erzurum, Turkey.

AIM AND OBJECTIVE: The aim of the study was to evaluate the effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula, each used individually in the treatment of infantile colic. BACKGROUND: The term colic describes a group of symptoms that occur frequently in infants, consisting of paroxysmal abdominal pain and severe crying. Infant colic is of importance for both parents and the community health services that provide families with care, and is therefore an important clinical problem that is amenable to nursing interventions.

DESIGN: This prospective and randomised-controlled study involved 175 infants in Turkey.

METHODS: Data were gathered by using Wessel criteria; parents wrote a daily structured diary, recording the onset and duration of crying. Patients were assigned randomly into four different intervention groups (massage, sucrose solution, herbal tea and hydrolysed formula) and control group. Duration of crying following each intervention was recorded in the diary by parents for a one week period.

RESULTS: There was a significant reduction in crying hours per day in all intervention groups. The difference between mean duration of total crying (hours/day) before and after the intervention infants in hydrolysed formula group was found higher than massage, sucrose and herbal tea group. The difference between mean duration of total crying(hours/day) before and after the intervention infants in massage group was found lower than other intervention groups and all groups.

CONCLUSION: Our findings demonstrated that varied interventions such as administration of massage, sucrose solution, herbal tea and hydrolysed formula are effective in the treatment of colic. The difference between mean duration of total crying (hours/day) before and after the intervention in hydrolysed formula group was found higher than other intervention groups. Hydrolysed formula was the most effective in reducing the duration of crying (hours/day) when compared with the other intervention groups. Massage intervention yielded the least symptomatic improvement among all the interventions.

RELEVANCE TO CLINICAL PRACTICE: Colic treatment models used in this study can be used by nurses in neonatal and primary healthcare settings as an aid to families for the treatment of infantile colic.