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

Authors

  • A Vickers,

    Assistant Attending Research Methodologist, Corresponding author
    1. Memorial Sloan-Kettering Cancer Center, Integrative Medicine, New York, New York, USA
    • A Vickers, Assistant Attending Research Methodologist, Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA. vickersa@mskcc.org.

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  • A Ohlsson,

  • JB 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

Databases were searched using the term 'massage', 'touch' or 'tactile stimulation' with 'infant - newborn', 'infant - premature' and 'infant - low birth weight'. The main databases searched were those of the Cochrane Collaboration Field in Complementary Medicine and the Neonatal Collaborative Review Group.

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 5g (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 -2.4, 1.9g). Massage interventions also appeared to reduce length of stay by 4.6 days (95% CI 2.6, 6.6) 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.

Reviewer's 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

Synopsis

Insufficiently strong evidence from trials to show that massage improves growth and development in premature and low birth weight babies.

Babies in neonatal intensive care units are subject to noise, bright light and a reduced amount of touch they would normally get from their mother. Massage has been recommended to promote growth and development of preterm (born before 34 weeks) and low birth weight babies. Massage can be combined with rocking, talking and eye contact and given by non-medical care givers, including parents. The review found several trials that seemed to show a positive effect of massage on weight gain, but these trials had scientific flaws. Massage seems safe for medically stable infants