Intervention Review

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

  1. Andrew Vickers1,*,
  2. Arne Ohlsson2,
  3. Janet Lacy3,
  4. Angela Horsley4

Editorial Group: Cochrane Neonatal Group

Published Online: 19 APR 2004

Assessed as up-to-date: 7 JAN 2004

DOI: 10.1002/14651858.CD000390.pub2

How to Cite

Vickers A, Ohlsson A, Lacy J, 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.

Author Information

  1. 1

    Memorial Sloan-Kettering Cancer Center, Integrative Medicine Service, New York, NY, USA

  2. 2

    University of Toronto, Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, Warkworh, Ontario, Canada

  3. 3

    Paediatrics, Scarborough, Ontario, Canada

  4. 4

    Chilwell, Nottingham, UK

*Andrew Vickers, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA. vickersa@mskcc.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2004

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

背景

按摩對早產兒和低體重嬰兒促進生長和發展的影響

嬰兒在新生兒加護病房(Neonatal Intensive Care Units)是處於高度壓力的環境,這個環境有持續且高強度的噪音和明亮的光線。他們也同樣處於缺乏觸覺刺激的環境下。在子宮內和母親的照顧下卻可以有觸覺的刺激。上述的論點是有爭議性的。由於按摩似乎可以減輕壓力和提供觸覺刺激,對於早產兒和低體重嬰兒而言,按摩被視為促進生長和發展的方法。

目標

本文的目的有二:(1)有接受按摩刺激的早產兒和低體重兒,是否比接受一般照顧的嬰兒,在體重增加上有改善,而且出院時間較早。(2)按摩對於這個族群是否有其他益處或害處。

搜尋策略

搜尋的資料庫如下:專業上註冊的Cochrane Neonatal Review Group和Cochrane Complementary Medicine Field。搜尋也試圖從以下著手:Cochrane Central Register of Controlled Trials(CENTRAL, The Cochrane Library, Issue 3, 2003),MEDLINE,EMBASE,Psychlit,CINAHL和Dissertation Abstracts International(July 1, 2003)。進一步的參考資料是由索引查詢,個人檔案檢視,和合適的專家們通信討論而獲得。經由與通信作者連繫,取得已發表文獻資料的補充訊息。沒有語言的限制。

選擇標準

Randomised trials包含了懷孕週數小於37週或出生體重小於2500克的嬰兒,而有接受手的全身觸覺刺激。需要描述至少一個結果關於評估體重增加,住院天數,行為或發展。

資料收集與分析

從每個試驗取得的資料包括樣本的基本特性、體重增加、住院天數和行為及發展的結果。生理或生化上的結果沒有被記錄。分別由三個評論者去擷取資料。統計分析使用標準的Cochrane Collaboration methods。

主要結論

按摩的介入改善每天體重的增加有5.1克(95% CI 3.5, 6.7g)。沒有證據顯示輕微、靜止的撫摸是有益處的(每天增加的體重有0.2g;95% CI −1.2, 1.6g)。按摩的介入也顯示減少住院天數4.5天(95% CI 2.4, 6.5),雖然在方法上對於結果的盲性處置有一些顧慮。有其他證據顯示,按摩的介入對於產後併發症及4 – 6個月的體重有輕微正向的影響。然而,受到矚目的關注對於這些研究使用的方法品質,特別是選擇性的使用結果資料,降低了這些發現的可信性。

作者結論

只有微弱的證據顯示按摩對於早產兒的發展是有益處,而且也不鼓勵廣泛推行早產兒的按摩。按摩目前是由護士在實行,這種作法應該注意於是否符合時間的成本效益的。更進一步的研究應該評估按摩介入對於臨床結果的影響,例如醫療上的併發症、住院天數、照顧過程的結果(例如看護人或父母親的滿足)。

翻譯人

本摘要由馬偕醫院林佳瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

按摩對於促進早產兒和低體重嬰兒的生長和發展。在出生前的胎兒期,嬰兒是受到身體刺激的。因此有個問題被提出:對於懷孕小於37週或體重小於2500克(5.5磅)的嬰兒,是否輕柔的按摩會促進出生後的發展,以及行為上的改善呢?這篇回顧只包含randomized controlled trials,這些試驗是比較有接受按摩和另一群沒有接受按摩的相似族群。作者搜尋醫學文獻和專家的意見,找到14篇研究。在多數的研究中,嬰兒被按摩和拍打15分鐘,每天三到四次,通常持續五到十天。有些研究也提到靜止、輕柔的撫摸,其方法為護士將他們的手放在嬰兒身上,但沒有用力的按摩或拍打。一般而言,接受按摩及拍打的嬰兒比那些沒有被撫摸的嬰兒,他們每天的體重增加較多(大約5克)。這些嬰兒住院天數較短,在發展的測驗中有稍微好一點的分數,有稍微較少的產後併發症,問題是這些發現到底是否值得信賴就不得而知。這些研究也沒有顯示任何按摩的副作用。按摩由護士來實行是消耗時間的,但父母親可以不用廣泛訓練,就可以執行按摩。

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Plain language summary

Masaža za poticanje rasta i razvoja nedonoščadi i novorođenčadi s niskom porođajnom težinom

Masaža za poticanje rasta i razvoja nedonoščadi i novorođenčadi s niskom porođajnom težinom

Djeca su u maternici izložena fizičkoj stimulaciji zbog čega se postavlja pitanje može li nježna masaža pomoći djeci rođenoj prije 37. tjedna trudnoće ili s težinom manjom od 2500 grama da se razviju nakon poroda te može li poboljšati njihove reakcije. Cochrane sustavni pregledni članak je uključio samo randomizirane kontrolirane pokuse, studije u kojima je jedna skupina djece bila masirana te je bila uspoređena sa sličnom skupinom koja nije bila masirana. Autori su pretražili medicinsku literaturu, kontaktirali stručnjake i pronašli 14 studija. U većini ovih studija djecu su lagano trljali ili milovali oko 15 minuta, tri do četiri puta dnevno, obično pet do deset dana. Neke studije su također uključivale „nepomični, lagani dodir“ u kojima su medicinske sestre stavljale svoje ruke na djecu, ali ih nisu trljale ili milovale. U prosjeku, rezultat studija je bio da su, u usporedbi s djecom koja nisu dodirivana, masirana djeca, ali ne i ona koje su bila „nepomično, lagano dodirivana“, dobivala više na težini svakoga dana (oko 5 grama). Provela su manje vremena u bolnici, imala nešto bolje rezultate na razvojnim testovima i nešto manje postnatalnih komplikacija, iako su postojali problemi vezani za pouzdanost ovih rezultata. Studije nisu pokazale nikakve negativne učinke masaže. Obzirom da medicinske sestre nemaju dovoljno vremena da bi izvodile masaže, roditelji mogu izvoditi masažu djece bez opsežne obuke.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports