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

doi:10.1016/j.infbeh.2007.04.002

Infant Behavior and Development

Volume 30, Issue 4, December 2007, Pages 557-561

https://doi.org/10.1016/j.infbeh.2007.04.002 Get rights and content

Abstract

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.

Section snippets

Consent and screening process

Attending physicians at a large urban university Neonatal Intensive Care Unit (NICU) referred medically stable preterm infants who met the study criteria, which included (a) gestational age between 28 and 32 weeks, (b) birthweight between 800 and 1400 g and (c) NICU hospitalization between 15 and 60 days. These criteria follow those of other preterm infant massage studies (see Field et al., 1986). Mothers of the preterm infants were approached about the study when they visited their infants at

Results

The background and demographic data were examined using ANOVA and Chi-square analyses to assess equivalence between the groups. The two groups did not differ on any variable (see Table 1).

Discussion

Preterm infants are exposed daily to numerous stressors while being treated in the Neonatal Intensive Care Unit (NICU), resulting in their display of heightened motor activity and stress behaviors (Anand et al., 2005). Attenuation of these stress behaviors is desirable since chronic exposure to stress has been associated with medical and neurodevelopmental problems in the neonate (Grunau et al., 2001; Mitchell & Boss, 2002). The current study examined the cumulative effects of massage therapy

Acknowledgements

We thank the parents and their infants for participating in this study. We also thank the attending physicians and the nurses at Jackson Memorial Hospital and the researchers and massage therapists who assisted with the project. This research was supported by an NIH/NCCAM award (AT 00370) to Maria Hernandez-Reif, an NIH/NCCAM Senior Research Scientist award (#AT 01585) and an NIH/NIMH Merit award (MH #46586) to Tiffany Field, in addition to funding from the Johnson & Johnson Pediatric Institute

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L’objectif principal de cette étude était d’émettre des recommandations sur les différentes techniques choisies et recensées dans la littérature : le massage, l’alimentation et la posture.
Cette revue systématique s’est appuyée sur les recommandations PRISMA 2020. La recherche d’articles a été réalisée de novembre 2020 à décembre 2022 dans les base de données PubMed, Cochrane et Pediatrics selon les mots clés : nouveau-nés prématurés, comparaison à un autre traitement, recevoir l’intervention. La qualité méthodologie des études a été déterminée au moyen de l’échelle PEDro. La douleur était l’unique paramètre étudié.
Quatorze essais contrôlés randomisés ont été inclus dans l’étude parmi les 376 études identifiées. Treize avaient un niveau de preuve 1 (score PEDro ≥ 7), le dernier un niveau de preuve 2 (score PEDro < 7). Le massage, l’alimentation et la posture ont montré un effet significativement positif sur le critère de jugement de la douleur.
Cette revue systématique permet de conclure que ces techniques sont efficaces indépendamment les unes des autres. Les associer lors des soins est donc indispensable. Il est conseillé aux professionnels de santé des unités de soins mère kangourou d’ajouter ces techniques à leur prise en charge afin d’obtenir une moindre douleur lors des actes médicaux. Ces techniques peuvent également être pratiquées par les parents.
NA.
Preterm neonates pain management in kangaroo mother care units is a major part of the management of these patients. Massage, nutrition and the skin-to-skin kangaroo posture are three basic non-pharmacological methods that allow pain management for preterm neonates.
The main objective of this study was to make recommendations on the different techniques chosen and identified in the literature scientific, i.e. massage, nutrition and kangaroo posture.
This systematic review was based on the 2020 PRISMA recommendations. Articles were searched between 2020 November and 2021 November on the search engines PubMed, Cochrane, Pediatrics, according to key words such as preterm infants, comparison to another treatment, receiving the intervention. The methodological quality of the studied was based on the PEDro scale. Pain was the only parameter studied in three non-pharmacological techniques: massage, nutrition and kangaroo posture.
Fourteen randomized controlled trials were included in the study out of the 376 studies identified through the various research equations. Thirteen articles had a level 1 of evidence (PEDro score ≥ 7) and one a level 2 of evidence (PEDro score < 7). Massage, nutrition and the kangaroo posture showed a definitive improvement on pain.
This review concludes that these techniques are effective independently of each other. Associating them during care is thereby essential. It is therefore advisable for health professionals in kangaroo care units to add these techniques to their care in order to decrease the patients’ pain during medical procedures. These techniques can also be practiced by the parents.
NA.
Effects of massage intervention on discharged premature infants’ weight, parental stress, and parent–child attachment: A randomized controlled trial
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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.
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Preterm infants who leave the intrauterine environment early are deprived of tactile stimuli. This affects the physical, emotional and social developments of infants and their physical growth parameters such as weight, height and head circumference negatively.
This research was conducted to determine the effects of massage on the development of preterm infants.
This research was conducted as randomized controlled research with two groups (massage-control). The infants in the intervention group received massage for 30 days. Height, weight and head circumference values of the infants were recorded on days 5, 10, 20 and 30. Amount of feeding was recorded before intervention, on day 15 after intervention and on day 30 after intervention. Discharge times of the infants were recorded according to groups.
A significant difference was found in height and weight of the preterm infants on days 20 and 30 when compared with the control group. Discharge time of the infants in the massage group was found to be 10 days shorter on average when compared with the control group. Significant difference was also found between day 15 and 30 in terms of amount of feeding.
Massage was found to have significant effects on physical growth parameters such as height, weight and head circumference. It was found that massage increased amount of feeding and weight intake in infants and decreased discharge time. In this case, hospital cost per infant may be reduced.
The effects of multisensory stimulation on the length of hospital stay and weight gain in hospitalized preterm infants: A systematic review with meta-analysis
2023, Brazilian Journal of Physical Therapy
Multisensory interventions, such as auditory-tactile-visual-vestibular intervention (ATVV), tactile-kinesthesic stimulation (TKS), and the kangaroo mother care (KMC), have been commonly applied in hospitalized preterm infants.
To investigate the effectiveness of the ATVV, the TKS, and the KMC combined to standard care compared to standard care in the length of hospital stay and weight gain of hospitalized preterm infants.
PubMed, Scopus, Web of Science, Embase, SciELO Citation Index, CINAHL, Cochrane, and LILACS databases were searched from the inception to May 06, 2022 without language restrictions. We included randomized controlled trials. Two independent reviewers selected studies and extracted information about participants, interventions, outcomes, and the risk of bias. The body of evidence was synthesized through GRADE. Data were pooled using a random-effects model.
Sixty-three randomized clinical trials included a range of 20–488 preterm infants (gestational age=25 to <37 weeks). Evidence was low to very low due to risk of bias, inconsistency, and imprecision. Most studies presented some concerns about methodological quality. The ATVV and the KMC increased weight gain. The TKS reduced the number of days at the hospital and increased the daily weight gain and the total weight gain.
Adding ATVV, TKS, or KMC to standard care was more effective than standard care alone to improve weight gain. Only the TKS combined with standard care was more effective than standard care alone to reduce the length of hospital stay.
The effect of sensory stimulation on apnea of prematurity
2022, Journal of Taibah University Medical Sciences
The study aims to assess the effect of sensory stimulation on apnoea among premature newborns.
Thirty preterm newborns that were diagnosed with apnoea of prematurity, had a gestational age between 32 and 34 weeks, had low birth weight, and were appropriate for gestational age from 1200 to 2000 g were included in this prospective randomized study. Subjects were divided into two equivalent groups: a control group that received the standard care including nasal oxygen (one litre per minute) and caffeine citrate, and a study group that received the same care plus sensory stimulation (tactile, proprioceptive, and kinaesthetic). Participants’ heart rate, oxygen saturation, and apnoea frequency were measured by the neonatal intensive care unit team using a pulse-oximeter. The sensory stimulation sessions were 10 min, 3 times per day, totalling 30 min over a 7 day period.
There was a significant decrease in heart rate within both groups after receiving treatment from before treatment (p < 0.05), with no significant differences between the two groups. Furthermore, there was no significant difference in oxygen saturation within the groups after treatment compared with the levels before treatment, with no significant differences between the two groups (p > 0.05). Before treatment, there was a non-significant difference in the apnoea rate between both groups (p = 0.464), whereas there was a significant decrease in the apnoea rate of the study group after treatment compared with the control group (p = 0.031).
Sensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.
Socially-relevant Visual Stimulation Modulates Physiological Response to Affective Touch in Human Infants
2021, Neuroscience
Citation Excerpt :
Because heart-rate and skin conductance both reflect activity in the autonomic nervous system, our and Aguirre et al. (2019) and Fairhurst et al. (2014) results, together, reveal that this system is already tuned to social-like stimulation across different sensory modalities by the age of 4 months. From a clinical perspective, our study corroborates findings that suggest that touch therapy, including massage, kangaroo care and osteopathic manipulative treatment, all may have beneficial effects on the infants’ well-being and developmental outcomes, being associated with decreased stress response and autonomic arousal, improved pain tolerance, enhanced immune-system parameters, and improvements in attentional responses and cognitive and motor development (Feldman et al., 2002; Hernandez-Reif et al., 2007; Manzotti et al., 2019). Most of these studies analysed the effects of tactile stimulation occurring in the context of dyadic interaction with the caregiver, whereas in clinical settings infants are most commonly handled by clinicians or researchers.
The human tactile system is known to discriminate different types of touches, one of these termed ‘affective touch’, is mainly mediated by slow conducting tactile afferents (CT fibres), which are preferentially activated by slow and gentle strokes.
Human infants experience self-generated tactile stimulation during prenatal life, and they receive a large amount of affectionate touches by their caregivers from birth. This early and extended experience with tactile stimulation may likely make infants particularly sensitive to affective touch, and increasing evidence shows that this may indeed be the case. However, infants commonly experience affective touch in the context of social interactions with familiar adults (e.g., while looking at their caregiver), and recent evidence suggests that this helps them assigning affiliative and communicative meaning to the touch they are perceiving. Here we investigated the presence of visual-tactile interactions in 4–5-month-old infants’ physiological (i.e., skin conductance) and behavioural (i.e., visual looking times) responses to visual and tactile stimulation of affective/social nature when the sources of both stimulation are not familiar to the infant. To explore whether the modulation of physiological arousal elicited by the socially-relevant bimodal stimulation is specific to infants or extends into adulthood, we also tested a group of adults. Infants (N = 25) and adults (N = 25) were stimulated on their forearm through slow stroking (i.e. affective touch) or tapping (i.e. non-affective touch) during the observation of dynamic images of socially-relevant (i.e., an unfamiliar face) and non-socially-relevant (i.e., a house) stimuli. We found that the simultaneous presentation of socially-relevant visual-tactile stimuli significantly decreased infants’ – but not the adults’ – electrodermal response, suggesting that infants easily integrate low-level properties of affective touch with socially salient visual information, and that social experience may tune and change sensitivity to affective touch across the life-span.

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

Abstract

Section snippets

Consent and screening process

Results

Discussion

Acknowledgements

Clinical Therapeutics

Developmental Review

Infant Behavior and Development

Infant Behavior and Development

Infant Behavior and Development

Infant Behavior and Development

Changes in plasma cortisol and catecholamine concentrations in response to massage in preterm infants

Archives of Disease in Childhood

The impact of temporarily patterned stimulation on the development of preterm infants

Child Development