Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy

Preterm infants residing in an NICU were randomly assigned to a massage therapy or to a control group. The preterm infants in the massage therapy group received three 15-min massages each day for 5 consecutive days, with the massages consisting of moderate pressure stroking to the head, shoulders, back, arms and legs and kinesthetic exercises consisting of flexion and extension of the limbs. Infant stress behaviors and activity were recorded on the first and last day of the study. Preterm infants receiving massage therapy showed fewer stress behaviors and less activity from the first to the last day of the study. The findings suggest that massage has pacifying or stress reducing effects on preterm infants, which is noteworthy given that they experience numerous stressors during their hospitalization.     

The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants

ObjectiveThe aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants.MethodsForty-four healthy preterm infants with a corrected gestational age of 30–36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups.ResultsDuring the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly.ConclusionOur findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants’ weight gain and decreases their duration of NICU stay significantly.     

Mothers' depressed mood and anxiety levels are reduced after massaging their preterm infants

Forty mothers whose preterm infants were about to be discharged from the Neonatal Intermediate Care Nursery (NICU) were randomly assigned to two groups: the first group of mothers conducted preterm infant massage and the second group only observed their preterm infants receiving massage. Both groups of mothers had lower depressed mood scores following the session. However, only the group who massaged their infants had lower anxiety scores after the session.     

Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants

Sixty-eight preterm infants (M GA = 30 weeks) were randomly assigned to a moderate or to a light pressure massage therapy group to receive 15 massages three times per day for 5 days. Behavior state, stress behaviors and heart rate were recorded for 15 min before and during the first 15-min therapy session. Weight gain was recorded over the 5-day therapy period. The moderate versus light pressure massage group gained significantly more weight per day. During the behavior observations the moderate versus light pressure massage group showed significantly lower increases from the pre-session to the session recording on: (1) active sleep; (2) fussing; (3) crying; (4) movement; and (5) stress behavior (hiccupping). They also showed a smaller decrease in deep sleep, a greater decrease in heart rate and a greater increase in vagal tone. Thus, the moderate pressure massage therapy group appeared to be more relaxed and less aroused than the light pressure massage group which may have contributed to the greater weight gain of the moderate pressure massage therapy group.     

Massage therapy improves the development of HIV-exposed infants living in a low socio-economic,peri-urban community of South Africa

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother–infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15 min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants’ dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p = 0.002) and mean percentile (p = 0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p < 0.03) and the general quotient percentile (19.3 vs. 7.7) (p = 0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.     

Effects of massage intervention on discharged premature infants’ weight,parental stress,and parent–child attachment: A randomized controlled trial

Infant massage enhances the growth and development of premature infants and promotes parent–child bonding. However, its effects on parental stress and parent–child attachment in premature infants, as well as gender differences thereof, remain unclear. In this randomized controlled trial, we used a repeated-measures design and included 61 premature infants (mean gestational age: 35.1 ± 1.5 weeks). Weight, parental stress, and parent–child attachment were measured at multiple time points: before massage and 1, 4, 8, and 12 weeks after commencing infant massage. The results revealed that the massage group infants had significantly higher weight gain than the control (no massage) group infants at all four time points. Moreover, parents in the massage group reported notably lower levels of stress than those in the control group, particularly in the parental distress and difficult children subscales. No significant between-group differences were observed in parent–child attachment. Furthermore, no significant differences were observed between fathers and mothers in parental stress and parent–child attachment. However, fathers reported higher levels of distress than mothers at 4 and 12 weeks. In conclusion, infant massage led to increased infant weight and reduced parental stress over time, and differences between fathers and mothers were not significant, except fathers exhibiting higher levels of distress than mothers over time. Healthcare professionals should educate and support parents on infant massage before discharge of premature infants.     

Interventions in early infancy

Infants of high-risk pregnancies and deliveries may need early intervention to facilitate attachment both to and from their caregivers. Three early interventions are described: (1) giving high-risk pregnant women video feedback during prenatal ultrasound, which reduced maternal anxiety, obstetric complications, and fetal activity and improved neonatal outcome (increased weight gain, better performance on the Brazelton, and decreased irritability); (2) providing preterm neonates nonnutritive sucking opportunities to reduce stress during heelsticks and gavage feedings; and (3) providing preterm neonates and preterm cocaine-exposed neonates massage therapy, which facilitated weight gain and better performance on the Brazelton scale. Following improved neonatal behavior, infants would be expected to have better interactions with their caregivers.     

Effects of baby massage on neonatal jaundice in healthy Iranian infants: A pilot study

ObjectiveTo evaluate the effects of baby massage on transcutaneous bilirubin levels and stool frequency of healthy term newborns.MethodsThis Pilot study was conducted on 50 healthy newborns in Valiasr Hospital of IKHC. The infants were randomly allocated to two treatment (massage) and control group. The massage group received massage therapy (according to Touch Therapy) for four days from the first day postnatal while the control group received routine care. Main variable studied were transcutaneous bilirubin level (TCB) and stool frequency which were compared in two groups.ResultsThere were 50 newborns in the study 25 in each group (50%). There was a significant difference in the TCB levels between two groups (p = 0.000) with those in the massage group having lower bilirubin levels. As for the stool frequency there was a significant difference in two groups on the first day showing more defecation in the control group (p = 0.042) which on the consequent days was not significant and the frequencies were almost similar.ConclusionMassage group had a lower transcutaneous billirubin levels compared to the control group, thus, these pilot results indicate that massaging the newborns can be accompanied by a lower bilirubin level in the healthy term newborn.     

Differential effects of massage and heelstick procedures on transcutaneous oxygen tension in preterm neonates

The present study investigated the differential effects of heelsticks and tactile-kinesthetic massage on transcutaneous oxygen tension (TcPO₂) in preterm infants. The sample was comprised of 37 stabilized preterm neonates from the Neonatal Intensive Care Unit. During the heelstick procedure, TcPO₂ significantly declined an average of 14 mmHg. When compared to the tactile-kinesthetic massage, TcPO₂ levels during the heelstick (M = 39.8) were significantly lower than during the stimulation (M = 72.8). Mean TcPO₂ levels remained clinically safe during the four massage sessions evaluated. The TcPO₂ levels during kinesthetic stimulation were somewhat more varied, and movement and pressurization of the TcPO₂ electrode were investigated as possible artifactual explanations for this phenomenon. Overall, the findings indicate that social forms of touch such as tactile-kinesthetic massage do not appear to have a medically compromising effect on TcPO₂ in the preterm neonate. These findings are evaluated in relation to the “minimal touch” policy, and implications for future handling of the stabilized preterm neonate are discussed.     

Regulatory competence and social communication in term and preterm infants at 12 months corrected age. Results from a randomized controlled trial

Temperamental regulatory competence and social communication in term and preterm infants at 12 months corrected age was studied in a randomized controlled intervention trial aimed at enhancing maternal sensitive responsiveness. Surviving infants <2000 g from a geographically defined area were randomized to an intervention (71) or a control group (69), and compared with term infants (74). The intervention was a modified version of the "Mother-Infant Transaction Program". Regulatory competence was measured with the Infant Behavior Questionnaire, and social communication with the Early Social Communication Scales. Preterm intervention infants with low regulatory competence had higher responding to joint attention than preterm control infants. A sensitizing intervention may moderate the association between temperament and social communication, and thus allow an alternative functional outlet for preterm infants low in regulatory competence. The finding may have implications for conceptualizations of the role of early sensitizing interventions in promoting important developmental outcomes for premature infants.     

Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder

In the present study, 30 students between the ages of 7 and 18 years (M = 13 years) diagnosed with attention-deficit/hyperactivity disorder (ADHD) were randomly assigned to a massage group or a wait-list control group. The massage group received massage therapy for 20 minutes twice per week over the course of one month. The results revealed that massage therapy benefited students with ADHD by improving short-term mood state and longer-term classroom behavior.     

Visual attention control differences in 12-month-old preterm infants

There have been few previous attempts to assess the development of early markers of executive function in infants born preterm despite well-established deficits reported for older preterm children that have been closely linked to poorer academic functioning. The present study investigates early attention control development in healthy 12-month-old age-corrected pre-term infants who were born less than 30 weeks and compares their performance to full-term infants. Eye-tracking methodology was used to measure attention control. Preterm Infants spent less time focused on the target and were slower to fixate attention, with lower gestational age associated with poorer target fixation and slower processing speed. There were no significant group differences observed for inhibition of return or interference control. These findings suggest that specific emerging deficits in attention control may be observed using eye tracking methodology in very preterm infants at this early stage of development, despite scores within the average range on the Bayley Scales of Infant Development.     

Preference for infant-directed speech in preterm infants

The current study explores the effects of exposure to maternal voice on infant sucking in preterm infants. Twenty-four preterm infants averaging 35 weeks gestational age were divided randomly into two groups. A contingency between high-amplitude sucking and presentation of maternal voice was instituted for one group while the other group served as a yoked control. No significant differences were observed in sucking of the two groups, but the degree of pitch modulation of the maternal voice predicted an increase in the rate of infant sucking.     

Maternal ratings of infant regulatory competence from 6 to 12 months: influence of perceived stress, birth-weight, and intervention: a randomized controlled trial

Mothers’ reports of preterm and term infants’ temperament from 6 to 12 months of age were studied, with intervention and stress as predictors. Preterm infants with a birth weight <2000 g were randomized to an intervention (71) or a control (69) group. A control group of healthy term infants (74) was also established. The intervention was a modified version of the “Mother–Infant Transaction Program”, aimed at sensitizing caregivers to the infants’ individual characteristics. Temperament was measured with the Infant Behavior Questionnaire, and stress with the Parenting Stress Index. There were no group differences in temperament at 6 or 12 months or in change during the same period. There was a strong association between stress and negative reactivity in the preterm control group at 12 months. In the preterm intervention group, there were strong negative correlations between stress and regulatory competence at 6 months. The intervention seemed to change the relationship between stress and temperament. The strength of this association indicates that the intervention sensitized mothers to the temperamental regulatory competence of their preterm infants.     

Developmental effects of an intervention for preterm infants of teenage mothers

Since preterm infants and infants born to teenage mothers are noted to be at risk for developmental delays, a group of infants who were both preterm and born to teenage mothers was provided a sensorimotor exercise intervention program for the first year of infancy. The development of these infants was compared to the development of preterm infants without intervention and term infants of teenage mothers as well as term and preterm infants of adult mothers to determine the degree to which developmental delays were prevented. The intervention infants showed more optimal growth, cognitive development, temperament and play behaviors during interactions with their mothers across the first year of development.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

Massage Therapy Facilitates Weight Gain in Preterm Infants

Studies from several labs have documented a 31 to 47% greater weight gain in preterm newborns receiving massage therapy (three 15-min sessions for 5–10 days) compared with standard medical treatment. Although the underlying mechanism for this relationship between massage therapy and weight gain has not yet been established, possibilities that have been explored in studies with both humans and rats include (a) increased protein synthesis, (b) increased vagal activity that releases food-absorption hormones like insulin and enhances gastric motility, and (c) decreased cortisol levels leading to increased oxytocin. In addition, functional magnetic resonance imaging studies are being conducted to assess the effects of touch therapy on brain development. Further behavioral, physiological, and genetic research is needed to understand these effects of massage therapy on growth and development.     

Effects of early hospital-based intervention on mothers and their preterm infants

Mothers of eight Israeli preterm infants were exposed to a standardized but individualized intervention during their stay in the hospital and before their infants were discharged. Mothers and infants in the intervention group were compared to eight control subjects using various outcome measures. While the intervention did not affect maternal personal attitudes and feelings, it positively affected the mother-infant interactions and mothers' perceptions of their infants. The importance of individualized interventions with parents of preterm infants is discussed.     

Potential underlying mechanisms for greater weight gain in massaged preterm infants

In this paper, potential underlying mechanisms for massage therapy effects on preterm infant weight gain are reviewed. Path analyses are presented suggesting that: (1) increased vagal activity was associated with (2) increased gastric motility, which, in turn, was related to (3) greater weight gain; and (4) increased IGF-1 was related to greater weight gain. The change in vagal activity during the massage explained 49% of the variance in the change in gastric activity. And, the change in vagal activity during the massage explained 62% of the variance in the change in insulin. That the change in gastric activity was not related to the change in insulin suggests two parallel pathways via which massage therapy leads to increased weight gain: (1) insulin release via the celiac branch of the vagus; and (2) increased gastric activity via the gastric branch of the vagus.