Massage and touch therapy in neonates: The current evidence

A narrative review of research linking non-sexual social touch to sleep quality

This narrative review describes the current state of the literature that has examined associations between non-sexual social touch (i.e., affectionate touch, touch therapies, touch with animals and inanimate objects that mimic social touch) and sleep quality. It also highlights areas for future research to clarify the links and to identify underlying mechanisms. Most existing studies have focussed on and shown positive effects of touch therapies (e.g., massage, therapeutic touch) on sleep quality in clinical populations. Although there are fewer studies examining how other forms of social touch are linked with sleep quality, the existing research provides preliminary evidence supporting affectionate touch (e.g., hugging, skin-to-skin contact) and tactile contact with animals (e.g., dogs) and objects that mimic social touch (e.g., robots, weighted blankets) as predictors of better sleep quality, while touch deprivation and touch aversion are associated with worse sleep quality. Informed by the existing literature, we additionally reviewed potential relational-cognitive (e.g., felt-security) and neurobiological (e.g., oxytocin) mechanisms likely to underlie associations between social touch and sleep quality. Overall, current research supports associations between non-sexual social touch and sleep quality. However, future research is needed to establish these links for specific forms of social touch (and in various populations), to test explanatory mechanisms, and to identify boundary conditions. Understanding associations between non-sexual social touch and sleep quality can inform the development of touch-based interventions to improve sleep quality and health.

The effect of M technique massage on behavioral state and weight gain in preterm neonates: A randomized controlled trial

This study aimed to investigate the effect of M technique massage on behavioral state and weight gain in preterm neonates admitted to neonatal intensive care unit (NICU). This was a randomized controlled trial study in which a total of 64 preterm neonates were randomly allocated to intervention and control group. Intervention group received M technique massage and control group received routine care. Neonatal weight and behavioral state were measured for two weeks. After intervention, no statistically significant difference was found between groups in terms of neonatal weight (mean difference: 44.03, 95% CI [-180.66, 268.74]). At baseline, the mean score for behavioral state response was 5.84 ± 2.20 (mean ± SD) in control group and 5.68 ± 2.15 (mean ± SD) in intervention group and the difference was not significant (mean difference: 0.16, 95% CI [-1.21, 1.52]), but 2 weeks later, and also, after intervention, a statistically significant difference was found between groups (mean difference: 2.16, 95% CI [1.19, 3.17]) and (mean difference: 3.03, 95% CI [2.15, 3.91]), respectively, meaning that it was significantly lower in intervention group compared with control group. According to the findings, massage with M technique in premature neonates can have a positive effect on behavioral state, but no effect on their weight gain.

The efficacy of massage as a nightly bedtime routine on infant sleep condition and mother sleep quality: A randomized controlled trial

BACKGROUND AND PURPOSE

Infants' sleep disorders and parents' insufficient sleep are common problems in the infant care. The current study was conducted to assess the effectiveness of infant massage on infants' night-time sleep condition and mothers' sleep quality.

PROCEDURES

140 infants were randomly put into two different groups, experimental group with fifteen-minute bedtime messages for two weeks and the control group with normal infant routine care. The Brief Infant Sleep Questionnaire, a personal information submission form, and Pittsburgh Sleep Quality Index for the mothers were the tools used to gather data in this study.

RESULTS

Infants in experimental group showed meaningful differences in variables such as, sleep latency (P <  0001, eta = 0.099), number of night waking (P = 0.03, eta = 0.027) and longest continuous sleep period (P = 0.03, eta = 0.026). As for other variables no meaningful differences were observed. There wasn't meaningful difference in the mother's overall night-time sleep quality between the two groups (P = 0.184, eta = 0.012) except for the duration of the mother's night-time sleep (P = 0.028, eta = 0.026) and the reduction of maternal sleep disorder (P = 0.020 eta = 0.029).

CONCLUSION

The findings indicated that infants' bedtime massages would improve some of the sleep markers of mothers and infants, and therefore, can be suggested as a practical, harmless, and cost-free method to improve sleep.

A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns

BACKGROUND

Approximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods.

METHODS

Our study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain.

RESULTS

A total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection.

CONCLUSIONS

Although sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.

Effect of whole-body massage on growth and neurodevelopment in term healthy newborns: A systematic review

Background

Infant massage is commonly practiced in many parts of the world. However, the effectiveness of this intervention has not been reviewed for term, healthy newborns.

Methods

This systematic review of randomized and quasi-randomized controlled trials assessed the effect of whole-body massage with or without oil, compared to no massage in term healthy newborns. Key outcomes were neonatal mortality, systemic infections, growth, behaviour (crying or fussing time, sleep duration), and neurodevelopment. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021), and clinical trials databases and reference lists of retrieved articles. Two authors separately evaluated the risk of bias, extracted data, and synthesized effect estimates using mean difference (MD) and standardized mean difference (SMD). The GRADE approach was used to assess the certainty of evidence.

Results

We included 31 randomized and quasi-randomized trials involving 3860 participants. Infant massage was performed by different care providers starting in the neonatal period and continuing for 1-2 months in most studies. Thirteen studies reported the use of oil with body massage. No study reported neonatal mortality or systemic infections. Meta-analyses suggested that whole-body massage may increase infant length at the end of the intervention period (median assessment age 6 weeks; mean difference (MD) = 1.6 cm, 95% confidence interval (CI) = 1.4 to 1.7 cm; low certainty evidence), but the effect on weight (MD = 340 g, 95% CI = 240 to 441 g), head circumference (MD = 0.8 cm, 95% CI = 0.6 to 1.1 cm), sleep duration (MD = 0.62 hours/d, 95% CI = 0.12 to 1.12 hours/d) and bilirubin levels (MD = -31.8 mmol/L or -1.8 mg/dL, 95% CI = -23.5 to -40.0 mmol/L) was uncertain. The effect on crying/fussing time at median 3 months of age, sleep duration at 6 months of age, weight, length, and head circumference at 6-12 months follow-up, and neurodevelopment outcomes, both at the end of the intervention period and follow-up was uncertain.

Conclusions

Whole-body massage may improve the infant length at the end of the intervention period (median age 6 weeks, range 1-6 months) but the effect on other short- or long-term outcomes is uncertain. There is a need for further well-designed trials in future.

Registration

Priyadarshi M, Balachander B, Rao S, Gupta S, Sankar MJ. Effect of body massage on growth and neurodevelopment in term healthy newborns: a systematic review. PROSPERO 2020 CRD42020177442.

The effectiveness of massage interventions on procedural pain in neonates: A systematic review and meta-analysis

BACKGROUND

The painful procedures experienced by neonates during hospitalization have short-term or long-term effects on neonates. While the limitations of previous interventions make it imperative to explore effective interventions that are readily available. This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of massage for pain management in neonates.

METHODS

This systematic review was registered in PROSPER. PubMed, Embase, Cochrane Library, and the Clinical Trials Registry were searched to December 2021. Two reviewers independently carried out study selection, data extraction, bias risk assessment. Continuous data were analyzed by mean differences (MD). Dichotomous data were reported using relative risk. If at least two studies reported identical results by the same pain assessment tool, a meta-analysis was conducted using random effect model and inverse variance.

RESULTS

Total 11 included studies involving 755 neonates investigated the effects of massage on neonatal pain response compared to standard care. The meta-analysis showed that massage could effectively improve pain response in neonates compared to standard care no matter whether neonatal infant pain scale (NIPS) or premature infant pain profile (PIPP) was used as an assessment tool. Besides, massage was also effective for crying duration, blood oxygen saturation both during and after the procedure, but non-effective for the variation of respiratory rate after the procedure, and heart rate both during and after the procedure.

CONCLUSIONS

Massage may have a positive effect on pain relief of neonate, and rigorous trials are needed in the future to determine the most effective massage method.

Adapting Clofazimine for Treatment of Cutaneous Tuberculosis by Using Self-Double-Emulsifying Drug Delivery Systems

Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis (Mtb), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the "End-TB" initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018-2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb, it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.

The Effectiveness of Baby Massage in Stunting Prevention: Study Based on Body Length Gain in Infants aged 0–3 Months

Baby massage is a gentle massage for infants aged 0-3 months that is believed to improve the baby's body length. The purpose of this study was to determine the impact of baby massage on the increase in body length and weight of infants aged 0-3 months. This type of research was quasi-experimental. The samples were mothers and infants 0-3 months, divided into the treatment and control groups. The number of samples for each group was 35 respondents. Baby massage was carried out by the mother twice a day, in the morning and evening after bathing, for one month. The enumerators collected data on length and weight before and after 1 month in both groups and statistically tested by unpaired t-test. The reduction in stunting prevalence in the treatment group was 22.8%, while the control group was 8.6%. The prevalence of underweight in the treatment group did not significantly change (2.9%), while the control group experienced an increase of 11.7%. The increase in body length of the treatment group was 4.49 cm, and the control group was 3.23 cm; the baby massage significantly affected body length for infants 0-3 months (ρ=0.000). The average weight gain of infants in the treatment group was 825.7 g, and the control group was 702.9 g; the baby massage was not significantly affected the body weight (ρ=0.224). Thus, the baby massage can be an alternative in boosting the length and weight of babies aged 0-3 months

Effect of Massage Therapy for the Treatment of Neonatal Jaundice: A Systematic Review and Dose-Response Meta-analysis

Background

The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review.

Methods

Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI).

Results

Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: <50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06; I² = 66%), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13; I² = 84%), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78; I² = 83%). The heterogeneity across studies was mild to moderate.

Conclusions

The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice.

Effects of hydrotherapy and tactile-kinesthetic stimulation on weight gain of preterm infants admitted in the Neonatal Intensive Care Unit

OBJECTIVE

The present study aimed to evaluate the effects of hydrotherapy and tactile-kinesthetic stimulation on the birth weight of preterm infants admitted in the Neonatal Intensive Care Unit.

METHOD

It was a randomized controlled trial, without blinding, in which 44 preterm infants of both sexes with gestational age between 32 and 34 weeks were included into two groups: hydrotherapy group (n = = 22) and tactile-kinesthetic stimulation group (n = 22). Weight gain was the parameter assessed daily.

RESULTS

In the tactile-kinesthetic stimulation group there was a variation in weight gain, but without significant difference (p = 0,43). However, in the hydrotherapy group, it was observed that increased weight gain started from the 2nd day (p < 0,001).

CONCLUSIONS

Hydrotherapy group presented significantly increased weight after the interventions, indicating that this technique can interfere with weight gain in preterm infants.

The effect of sensory stimulation on apnea of prematurity

Objectives

The study aims to assess the effect of sensory stimulation on apnoea among premature newborns.

Methods

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.

Results

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).

Conclusion

Sensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.

Effect of tactile-kinesthetic stimulation on growth, neurobehavior and development among preterm neonates

BACKGROUND

Preterm neonates are at risk of delayed growth and development. Hence, early tactile-kinesthetic stimulation (TKS) is required to improve their growth and development.

OBJECTIVE

To evaluate the effect of TKS on growth, neurobehavior and development among preterm neonates.

METHOD

An interventional study was conducted from August 2015 to July 2017 in the neonatal unit of Dr. Cipto Mangunkusumo Hospital. Preterm neonates were recruited via random sampling and divided into two groups (the intervention group and control group). TKS was performed for 15 min, three times a day, for 10 days. The anthropometric measurements, neurobehavior (Dubowitz score) and development (Capute Scale score) of neonates in both groups were assessed.

RESULTS

There were 126 preterm neonates (n = 63 in each group). During the 10-day TKS period, the intervention group had a significant increment in weight and length compared to the control group (p < 0.05) at 11-14 days, at term and 3 months. Moreover, increased tone, reflexes, and improvement in behavior based on the Dubowitz score were observed during monitoring. However, the result did not differ significantly (p > 0.05). There was no significant difference in terms of cognitive and language development in both groups (Developmental Quotient of Clinical Linguistic Adaptive Milestone Scale, Developmental Quotient of Clinical Adaptive Test and Full Scale Developmental Quotient scores, p > 0.05).

CONCLUSION

TKS was significantly effective in promoting growth, particularly weight and length, among preterm neonates. However, it did not significantly influence neurobehavior and development at 3 months of chronological age.

Pediatrics massage evidence map

BACKGROUND

This evidence map describes Pediatrics Massage intervention research reporting health outcomes. Massage is a complementary therapy and can be defined as any form of systematic tactile stimulation by human hands, the type of massage typically used in pediatrics care is a gentle, slow stroking of each part of the body in turn.

METHODS

The evidence map is based on the 3iE evidence gap map methodology. We searched four electronic databases from inception to November 2019 and included systematic reviews and non-systematic reviews. Systematic reviews were analyzed based on AMSTAR 2. We used tableau to graphically display confidence level, number of reviews, outcomes and a broad estimate of effectiveness.

RESULTS

The map is based on 38 reviews. Most of the reviews were published in the last ten years. The Pediatrics Massage was the most researched intervention. Massage was evaluated as an intervention in several health outcomes, resulting in the following confidence levels: 11 high, 13 moderate and 14 low. Every outcome effect was classified: 6 as no effect; 1 mixed and 28 as positive. The outcomes were divided into four major groups: physical and metabolic effects; vitality, well-being and quality of life, mental health; and management. High quality studies presented no effect and positive effects, highlighting outcomes related to neuro-motor development (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015), growth (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015) and stress disorders (Bennett et al., 2013; Vickers et al., 2015).

CONCLUSIONS

Pediatrics massage has been applied in different areas and these Evidence Gap Map provides an easy visualization of valuable information for patients, health practitioners and managers, in order to promote evidence-based complementary therapies.

Impact of emollient therapy for preterm infants in the neonatal period on child neurodevelopment in Bangladesh: an observational cohort study

BACKGROUND

Topical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants <33 weeks' gestational age in Bangladesh. We sought to determine whether the emollient treatments improved neurodevelopmental outcomes during early childhood.

METHODS

497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points.

RESULTS

123 children completed at least one follow-up visit. Lowess graphs suggest that lower proportions of children who received massage with either SSO or Aquaphor® had neurodevelopmental delays than control infants in a composite outcome of disabilities. In GEE analysis, infants receiving SSO showed a significant protective effect on the development of fine motor skills [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.86-0.98, p=0.006]. The Psychomotor Development Index (PDI) in the BSID II showed significantly lower disability rates in the Aquaphor group (23.6%) compared to the control (55.2%) (OR 0.21, 95% CI 0.06-0.72, p=0.004).

CONCLUSIONS

Emollient massage of very preterm, hospitalized newborn infants improved some child neurodevelopmental outcomes over the first 2 years of follow-up. Findings warrant further confirmatory research.

TRIAL REGISTRATION

ClinicalTrials.gov (98-04-21-03-2) under weblink https://clinicaltrials.gov/ct2/show/NCT00162747.

The effect of abdominal massage (I Love You method) on the gastric function of preterm infants hospitalized in the neonatal intensive care units: a randomized clinical trial

OBJECTIVES

Preterm infants often suffer from nutritional problems because of gastrointestinal problems. Massage could make the infants feel more peace and comfort, but limited studies have focused on the effects of massage on the gastric function. This study aimed to investigate the effects of abdominal massage on the gastric function of preterm infants.

METHODS

A randomized controlled trial compared gastric function of preterm infants with and without massage therapy. The preterm infants were randomly allocated to control and massage groups. The massage group received the abdominal massage before feeding, twice a day, for 15 min, over 5 days. Furthermore, the gastric function was compared between the control and experimental groups. The data were analyzed using SPSS software (Version 15.0).

RESULTS

The average weight in both groups had no significant (p>0.05) changes before and after the study, and both groups showed a negative trend in the weight gain. The abdominal circumference, the frequency of vomiting episodes, the residual volume, and defecation frequency were significantly (p<0.05) different between the two groups after the intervention.

CONCLUSIONS

The abdominal massage could be an effective nonmedicinal method to reduce the gastrointestinal problems in the preterm infants. The abdominal massage could be offered to the preterm infants as an inexpensive, available, and feasible method to alleviate gastrointestinal problems as well as improve the gastric function.

Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review

INTRODUCTION

Neonates who undergo painful medical procedures should be given analgesics to reduce future adverse risks. The evidence for massage therapy (MT) as an analgesic method still varies, both in its terminology and implementation. Only a few studies on this topic have been conducted using a standardised trial approach. This review can thus become the basis for better future research.

OBJECTIVE

This review aims to identify literature on MT practices as a method to manage or control pain in neonates undergoing painful procedures.

METHODS

The methodology for this review followed the JBI scoping review methodology guidelines. Searches were performed in several databases: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier) and EMBASE. Data collected were then extracted by two independent reviewers, synthesised and presented in the form of tables and narratives.

RESULTS

Fifteen studies involving a total of 1,058 neonates in nine countries were identified in the search as meeting the criteria set for this review. One study was a comparative study, five were quasi-experiment studies and nine were randomised control trials (RCT).

CONCLUSION

The implementation of massage as a non-pharmacological analgesic method for neonates undergoing painful procedures varied among the reviewed studies. Differences were identified in terms of the body part massaged, the duration and intensity of the massage, the level of pressure and the combination of massage with other methods. All studies presented positive results for reducing pain intensity in neonates undergoing procedural pain. Therefore, it is crucial that the method used for giving massage should be practical, accurate and safe.

Prevalence and perceptions of infant massage in India: study from Maharashtra and Madhya Pradesh states

Background

Knowledge of the prevailing infant care practices and their effects is important to inform practice and public programs. Infant massage is a traditional practice in India but remains less studied. This study was conducted to study the prevalence and perceptions of infant massage practices in two states of India.

Methods

A total of 1497 caretakers of children under 18 months of age were interviewed in a cross-sectional study at immunisation units of medical schools in Maharashtra (MH) and Madhya Pradesh (MP) states and through home visits in villages in MH during March through August 2018.

Results

Infant massage was a prevalent practice (93.8% [95%CI: 92.4,94.9]) in both study states – 97.9%[95%CI:96.9,98.8] in MH and 85.3%[95%CI: 81.9,88.3] in MP – and the prevalence did not vary between male (94.5%) and female (93.5%) infants (p = 0.44). Massage was mostly initiated in the first week of life (82%); it is widely viewed as a traditional practice. It was common to massage the baby once daily (77%), before bathing (77%), and after feeding (57%). Massage was mostly conducted using oils (97%). In MH, preferred oils were a sesame oil-based proprietary traditional medicine oil (36%) and coconut oil (18%) while olive (29%) and mustard (20%) oils were most popular in MP. Commonly reported application techniques included gentle massage with minimal pressure, pressing (30%) and manually stretching certain joints (60%). Commonly reported perceived benefits of infant massage included increased bone strength, better sleep and growth, while no harm was perceived (95%).

Conclusion

Infant oil massage is a highly prevalent traditional practice in MH and MP. Clear guidance on the use of massage, choice of oil, and techniques for application is required to optimize benefits and minimize risks of this popular traditional practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-020-02416-y.

Effects of Massage on Postoperative Pain in Infants With Complex Congenital Heart Disease

BACKGROUND

Pain management is an essential component of care for pediatric patients following surgery. Massage reduces self-reported postoperative pain in adults with heart disease but has received little attention in postoperative pediatric patients with complex congenital heart disease (CCHD).

OBJECTIVES

The aim of the study was to evaluate the effectiveness of massage compared to a rest period on postoperative pain scores and physiological responses in infants with CCHD.

METHODS

We used a two-group randomized clinical trial design with a sample of 60 infants with CCHD between 1 day and 12 months of age following their first cardiothoracic surgery. Both groups received standard postoperative care. Group 1 received a daily 30-minute restriction of nonessential caregiving (quiet time), and Group 2 received a daily 30-minute massage. Interventions continued for seven consecutive days. Pain was measured six times daily using the Face, Legs, Activity, Cry, Consolability Pain Assessment Tool (FLACC). Average daily doses of analgesics were recorded. Heart rates (HRs), respiratory rates (RRs), and oxygen saturations (SpO2) were recorded continuously. Daily averages, pre- and postintervention FLACC scores, and physiological responses were analyzed using descriptive statistics, generalized linear mixed models repeated measures, latent growth models, and/or regression discontinuity analysis. Fentanyl-equivalent narcotic values were used as a time-varying covariate.

RESULTS

Adjusted pain scores were lower for the massage group on all days except Day 7. Overall, there were no group effects on level of pain or differential rate of change in pain. However, the massage group had lower daily pain scores with small to medium effect size differences, largest at Days 4, 5, and 6, and lower average daily HR and RR. There was little difference between groups in SpO2. Infants demonstrated immediate effects of massage, with HR and RR decreasing and oxygen saturations increasing.

DISCUSSION

This study provides beginning evidence that postoperative massage may reduce pain and improve physiological parameters in infants with congenital heart disease. This nonpharmacological adjunct to pain management may provide a particular benefit for this population by reducing demand on the cardiorespiratory system.

Adverse events associated with paediatric massage therapy: a systematic review

INTRODUCTION

Massage therapy (MT) is frequently used in children. No study has systematically assessed its safety in children and adolescents. We systematically review adverse events (AEs) associated with paediatric MT.

METHODS

We searched seven electronic databases from inception to December 2018. We included studies if they (1) were primary studies published in a peer-reviewed journal, (2) involved children aged 0-18 years and (3) a type of MT was used for any indication. No restriction was applied to language, year of publication and study design. AEs were classified based on their severity and association to the intervention.

RESULTS

Literature searches identified 12 286 citations, of which 938 citations were retrieved for full-text evaluation and 60 studies were included. In the included studies, 31 (51.6%) did not report any information on AEs, 13 (21.6%) reported that no AE occurred and 16 studies (26.6%) reported at least one AE after MT. There were 20 mild events (grade 1) that resolved with minimal intervention, 26 moderate events (grades 2-3) that required medical intervention, and 18 cases of severe AEs (grades 4-5) that resulted in hospital admission or prolongation of hospital stay; of these, 17 AEs were volvulus in premature infants, four of which were ultimately fatal events.

CONCLUSION

We identified a range of AEs associated with MT use, from mild to severe. Unfortunately, the majority of included studies did not report if an AE occurred or not, leading to publication bias. This review reports an association between abdominal massage with volvulus without malrotation in preterm infants; it is still to be defined if this is casual or not, but our findings warrant caution in the use of abdominal massage in preterm infants.

Culturally Based Practice in Neonatal Procedural Pain Management: A Mini Review

Cultural factors have gradually become important considerations in health services, including in pain management for adult and pediatric patients. However, research on culturally based pain management in neonates remains limited. This mini review aims to provide an overview of procedural pain management in neonates based on cultural approaches from various countries. The review found that there are several analyses of pain management procedures for neonates developed from cultural practices, namely, acupuncture, foot massage and reflexology, Yakson touch therapy, and aromatherapy. The acupuncture method (invasive and non-invasive) is more widely studied using randomized controlled trials (RCTs) than the other methods because the techniques applied can be standardized and measured. There are indications of the positive impact of all the methods examined in this review, but the results of studies have not been consistent because of the diversity of outcome measurement methods used and because of the difficulty of creating standardized procedures to measure pain management methods that are based on cultural practices.

Benefits of Infant Massage for Infants and Parents in the NICU

Infant massage is an ancient therapeutic technique used around the world. For infants who experience painful procedures, are exposed to the stressful NICU environment, and are separated from their parents, infant massage has been promoted as a method to reduce stress and promote bonding. In this article, we review the current literature on infant massage in the NICU. There is evidence that infant massage has beneficial effects on preterm infants in the NICU, including shorter length of stay; reduced pain; and improved weight gain, feeding tolerance, and neurodevelopment. Parents who performed massage with their infants in the NICU reported experiencing less stress, anxiety, and depression. Neonatal nurses can obtain education and certification in infant massage and can teach parents infant massage techniques, thereby promoting the health and well-being of parent-infant dyads.

Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science

Natural plant oils are commonly used as topical therapy worldwide. They are usually easily accessible and are relatively inexpensive options for skin care. Many natural oils possess specific compounds with antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties, making them attractive alternative and complementary treatments for xerotic and inflammatory dermatoses associated with skin-barrier disruption. Unique characteristics of various oils are important when considering their use for topical skin care. Differing ratios of essential fatty acids are major determinants of the barrier repair benefits of natural oils. Oils with a higher linoleic acid to oleic acid ratio have better barrier repair potential, whereas oils with higher amounts of irritating oleic acid may be detrimental to skin-barrier function. Various extraction methods for oils exist, including cold pressing to make unrefined oils, heat and chemical distillation to make essential oils, and the addition of various chemicals to simulate a specific scent to make fragranced oils. The method of oil processing and refinement is an important component of selecting oil for skin care, and cold pressing is the preferred method of oil extraction as the heat- and chemical-free process preserves beneficial lipids and limits irritating byproducts. This review summarizes evidence on utility of natural plant-based oils in dermatology, particularly in repairing the natural skin-barrier function, with the focus on natural oils, including Olea europaea (olive oil), Helianthus annus (sunflower seed oil), Cocos nucifera (coconut oil), Simmondsia chinesis (jojoba oil), Avena sativa (oat oil), and Argania spinosa (argan oil).

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

OBJECTIVE

The 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.

METHODS

Forty-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.

RESULTS

During 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.

CONCLUSION

Our 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.

Survey of complementary and alternative medicine in pediatric inpatient settings

OBJECTIVES

While use of complementary and alternative medicine (CAM) is common in children, we know little about its use for hospitalized children. This survey measured the rate of CAM use, specific modalities used, and policies related to CAM use for hospitalized children.

DESIGN

Anonymous survey of hospitals in the Pediatric Research in Inpatient Settings (PRĪS) network SETTING: Hospitals in the PRĪS network.

MAIN OUTCOME MEASURES

Rate of overall and specific CAM modality use, including whether these modalities are provided, permitted, or prohibited, and presence of a written policy on CAM use.

RESULTS

Of 99 sites queried, 22 responded. Of these, 82% of sites reported some CAM presence, and 63% reported official provision of CAM therapies. Freestanding children's hospitals provided more modalities than other types of hospitals. There was no difference in number of modalities by geographic location. The most commonly provided CAM modalities were massage and biofield therapies. The most commonly prohibited modalities were inpatient placebos outside of research settings, medical marijuana, and inpatient homeopathic preparations. Only one site reported having a written policy on CAM use.

CONCLUSIONS

Among responding institutions, the most reported some CAM presence with a wide variety of CAM modalities provided and permitted. Written institutional policies on CAM were rare.

The effect of tactile-kinesthetic stimulation on growth indices of healthy neonates

Therapeutic touch is emphasized by healthcare professionals for improvement of neonates' growth and development. However, inconsistencies exist regarding effects and methods of massage in neonates. The purpose of this clinical trial is to assess and comprise intervention and control groups regarding the effects of tactile-kinesthetic stimulation (TKS) by mothers on growth indices of healthy term neonates. Sixty healthy term neonates were randomly assigned into intervention and control groups. Mothers of neonates in the experimental group were trained to perform TKS for their newborns at home before feeding for at least 28 consecutive days, two times a day, and 15 min each time. Neonates in the control group were not required to receive this intervention. The neonates' growth indices were measured within 24 h after birth, and then at days 14 and 28. During the study and the three consecutive measurements, no significant difference was found between the mean weights, heights, and head circumferences of the neonates in the two groups (p > 0.05).

Drug-Induced Hyperglycaemia and Diabetes

Drug-induced hyperglycaemia and diabetes is a global issue. It may be a serious problem, as it increases the risk of microvascular and macrovascular complications, infections, metabolic coma and even death. Drugs may induce hyperglycaemia through a variety of mechanisms, including alterations in insulin secretion and sensitivity, direct cytotoxic effects on pancreatic cells and increases in glucose production. Antihypertensive drugs are not equally implicated in increasing serum glucose levels. Glycaemic adverse events occur more frequently with thiazide diuretics and with certain beta-blocking agents than with calcium-channel blockers and inhibitors of the renin-angiotensin system. Lipid-modifying agents may also induce hyperglycaemia, and the diabetogenic effect seems to differ between the different types and daily doses of statins. Nicotinic acid may also alter glycaemic control. Among the anti-infectives, severe life-threatening events have been reported with fluoroquinolones, especially when high doses are used. Protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors have been reported to induce alterations in glucose metabolism. Pentamidine-induced hyperglycaemia seems to be related to direct dysfunction in pancreatic cells. Phenytoin and valproic acid may also induce hyperglycaemia. The mechanisms of second-generation antipsychotic-associated hyperglycaemia, diabetes mellitus and ketoacidosis are complex and are mainly due to insulin resistance. Antidepressant agents with high daily doses seem to be more frequently associated with an increased risk of diabetes. Ketoacidosis may occur in patients receiving beta-adrenergic stimulants, and theophylline may also induce hyperglycaemia. Steroid diabetes is more frequently associated with high doses of glucocorticoids. Some chemotherapeutic agents carry a higher risk of hyperglycaemia, and calcineurin inhibitor-induced hyperglycaemia is mainly due to a decrease in insulin secretion. Hyperglycaemia has been associated with oral contraceptives containing high doses of oestrogen. Growth hormone therapy and somatostatin analogues may also induce hyperglycaemia. Clinicians should be aware of medications that may alter glycaemia. Efforts should be made to identify and closely monitor patients receiving drugs that are known to induce hyperglycaemia.

A Meta-Analysis of the Efficacy and Safety of Using Oil Massage to Promote Infant Growth

The synthesizing evidence on the effectiveness of using oil massage to promote the growth of infants is still lacking. This paper aims to determine whether oil massage can promote the physical and neurobehavioral growth of infants according to variables and to evaluate whether oil massage is safe for infant skin.

ELIGIBILITY CRITERIA

The randomized controlled trials, clinical controlled trials and quasi-experimentally designed trials published prior to or in 2014 were searched according to predetermined inclusion criteria and exclusion criteria in Medline, PubMed, Ovid, the Cochran Library, and Chinese databases, including the China National Knowledge Infrastructure, Wan Fang database and VIP journal integration platform. Besides, the grey lectures were searched as well through Open Grey, GrayLIT Network and Clinical Trials.gov.

SAMPLE

Eight studies out of 625 retrieved articles were eligible for inclusion.

RESULTS

Oil massage increased the infant weights, lengths and head circumferences. However, it did not promote a significant advantage in neurobehavioral scores or cause a significant risk of adverse skin reactions.

IMPLICATIONS

The core mechanisms and standard procedures of oil massage as well as the preferred oil type should be the focus of future nursing practice and research.

CONCLUSIONS

Oil massage may effectively improve the physical growth of infants, and it presents a limited risk of adverse skin reactions. However, the relationship between neurodevelopment and oil massage requires further study.

A Meta-Analysis of Preterm Infant Massage: An Ancient Practice With Contemporary Applications

OBJECTIVE

To evaluate the efficacy of massage on the short- and long-term outcomes of preterm infants.

METHODS

A search was conducted using the PRISMA framework. Validity of included studies was assessed using criteria defined by the Cochrane Collaboration that was carried out independently by two reviewers with a third reviewer to resolve differences.

RESULTS

Thirty-four studies met the inclusion criteria, 3 were quasi-experimental, 1 was a pilot study, and the remaining 30 were randomized controlled trials (RCTs). The outcomes that could be used in the meta-analysis and found in more than three studies noted that massage improved daily weight gain by 0.53 g (95% CI = 0.28-0.78), p < 0.0001, and resulted in a significant improvement in mental scores by 7.89 points (95% CI = 0.96-14.82), p < 0.03. There were no significant effects on length of hospital stay, caloric intake, or weight at discharge. Other outcomes were not analyzed either because the units of measurement varied or because means and standard deviations were not provided by the authors. These included vagal activity and heart rate variability (5 studies), neurobehavioral states (7 studies), pain responses (2 studies), maternal outcomes (2 studies), breastfeeding (2 studies), and physiologic parameters: bone formation (2 studies), immunologic markers (1 study), brain maturity (1 study), and temperature (1 study). The quality of the studies was variable with methods of randomization and blinding of assessment unclear in 18 of the 34 studies.

CONCLUSIONS

Massage therapy could be a comforting measure for infants in the NICU to improve weight gain and enhance mental development. However, the high heterogeneity, the weak quality in some studies, and the lack of a scientific association between massage and developmental outcomes preclude making definite recommendations and highlight the need for further RCTs to contribute to the existing body of knowledge.

Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

BACKGROUND

European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care.

METHODS

The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients.

RESULTS

Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided.

CONCLUSION

Health care professionals can use these recommendations as the basis of their advice to parents.

Effects of infant massage on jaundiced neonates undergoing phototherapy

BACKGROUND

Infant massage is a natural way for caregivers to improve health, sleep patterns, and reduce colic. We aimed to investigate the effects of infant massage on neonates with jaundice who are also receiving phototherapy.

METHODS

Full-term neonates with jaundice, admitted for phototherapy at a regional teaching hospital, were randomly allocated to either a control group or a massage group. The medical information for each neonate, including total feeding amount, body weight, defecation frequency, and bilirubin level, was collected and compared between two groups.

RESULTS

A total of 56 patients were enrolled in the study. This included 29 neonates in the control group and 27 in the experimental group. On the third day, the massage group showed significantly higher defecation frequency (p = 0.045) and significantly lower bilirubin levels (p = 0.03) compared with the control group. No significant differences related to feeding amount or body weight were observed between the two groups.

CONCLUSION

Infant massage could help to reduce bilirubin levels and increase defecation frequency in neonates receiving phototherapy for jaundice.

The Relationship between Gentle Tactile Stimulation on the Fetus and Its Temperament 3 Months after Birth

OBJECTIVE

The aim of this study was to evaluate the effect of gentle tactile stimulation on the fetus in its temperament 3 months after birth.

METHOD

A total of 302 mother-3-month-infant dyads enrolled the retrospective cohort study. 76 mothers had regular gentle tactile stimulation on the fetus in their pregnancy; 62 mothers had irregular tactile stimulation on the fetus, and the rest of 164 mothers who had no tactile stimulation served as nonexposure group. Temperament was assessed using the EITS (a nine-dimensional scale of temperament).

RESULTS

Significant difference in temperament type was found among infants in 3 groups at 3 months of age. In the regular practice group, the babies with easy type temperament accounted for 73.7%, which was higher than that in irregular practice group (53.2%, P = 0.012) and that in the control group (42.1%, P < 0.001). Compared to infants in no practice group, the infants who had received regular gentle tactile stimulation before birth were lower in negative mood (P = 0.047) while higher in adaptability (P < 0.001), approach (P = 0.001), and persistence (P = 0.001), respectively.

CONCLUSION

Regular gentle tactile stimulation on fetus may promote the formation of easy type infant temperament.

Newborn physiological immaturity: a concept analysis

Background:

Most standardized nursing care plans for healthy neonates include multiple nursing diagnoses to reflect nurses' judgments on the infant's status; however scientific literature concerning this issue is scarce. Newborn physiological immaturity is a concept in the ATIC terminology (architecture, terminology, interface, information, nursing [infermeria], and knowledge [coneixement]) to represent the natural status of vulnerability of the healthy neonate.

Purpose:

To identify the essential attributes of the concept and provide its conceptual and operational definition, using the Wilsonian approach.

Findings:

The concept under analysis embeds a natural cluster of vulnerabilities and environmental interactions that enhance the evolving maturation process.

Implications for Practice:

The use of this diagnosis may simplify the process of charting the nursing care plans and reduce time needed for documentation while maintaining the integrity of the information.

Implications for Research:

Consistent development and use of nursing concepts is essential for knowledge building. Studies on the actual use of nursing diagnoses are needed to inform decision making.

Learning and adherence to baby massage after two teaching strategies

PURPOSE

Little is known about learning/adherence after different baby massage teaching strategies. We compared the learning/adherence after two strategies.

DESIGN AND METHODS

Twenty mothers from the group manual-course (GMC) and 20 from the group manual-orientations (GMO) received a booklet. GMC participated in a course during the third trimester. GMO received verbal instructions during the postpartum hospital stay. Multiple-choice and practical tests assessed learning (GMC: performing strokes on a doll; GMO: on the baby). Adherence was measured 3 months after childbirth.

RESULTS

No differences were found between the groups in learning/adherence.

PRACTICE IMPLICATIONS

Both teaching strategies showed similar and positive results.

Sunflower oil versus no oil moderate pressure massage leads to greater increases in weight in preterm neonates who are low birth weight

BACKGROUND

Growth velocity is one of the most important problems in low birth weight (LBW) neonates.

AIMS

The purpose of this study was to compare the effects of body massage with and without sunflower oil on the growth of LBW preterm neonates in Iran.

STUDY DESIGN

A single-blinded randomized clinical trial

SUBJECTS

This study examined neonates admitted to NICU with gestational age of 33-37 weeks and birth weight of 1500-1999 g, without birth asphyxia and medically stable

OUTCOME MEASURES

Neonates were randomly assigned to two groups to receive moderate pressure massage alone or the same massage with sunflower oil by their mothers, three times a day for 14 consecutive days. The primary variables were increases in mean of growth parameters (weight, height and head circumference) that were evaluated 14 days after intervention, at ages 1 and 2 months. Secondary variables were clinical side effects.

RESULTS

Fifty-four neonates including 25 girls and 29 boys with mean gestational age of 35.3 ± 1.26 weeks were evaluated. Means of gestational age, birth weight and length of NICU stay were not different in both groups. In the oil massage group, mean weight at ages 1 month (mean ± SD: 2339 ± 135 vs. 2201 ± 93 g, P = 0.04) and 2 months (mean ± SD: 3301 ± 237 vs. 3005 ± 305 g, P = 0.005) was significantly greater than that of the body massage group. No adverse events were seen in the two groups.

CONCLUSION

Sunflower oil massage might be used as an effective and safe intervention for weight gain in LBW preterm neonates.

Effect of olive and sunflower seed oil on the adult skin barrier: implications for neonatal skin care

Natural oils are advocated and used throughout the world as part of neonatal skin care, but there is an absence of evidence to support this practice. The goal of the current study was to ascertain the effect of olive oil and sunflower seed oil on the biophysical properties of the skin. Nineteen adult volunteers with and without a history of atopic dermatitis were recruited into two randomized forearm-controlled mechanistic studies. The first cohort applied six drops of olive oil to one forearm twice daily for 5 weeks. The second cohort applied six drops of olive oil to one forearm and six drops of sunflower seed oil to the other twice daily for 4 weeks. The effect of the treatments was evaluated by determining stratum corneum integrity and cohesion, intercorneocyte cohesion, moisturization, skin-surface pH, and erythema. Topical application of olive oil for 4 weeks caused a significant reduction in stratum corneum integrity and induced mild erythema in volunteers with and without a history of atopic dermatitis. Sunflower seed oil preserved stratum corneum integrity, did not cause erythema, and improved hydration in the same volunteers. In contrast to sunflower seed oil, topical treatment with olive oil significantly damages the skin barrier, and therefore has the potential to promote the development of, and exacerbate existing, atopic dermatitis. The use of olive oil for the treatment of dry skin and infant massage should therefore be discouraged. These findings challenge the unfounded belief that all natural oils are beneficial for the skin and highlight the need for further research.

The benefits of giving a massage on the mental state of massage therapists: a randomized, controlled trial

OBJECTIVES

The objective of this study was to determine whether giving a massage had an impact of the mental state of the massage therapist.

DESIGN

The design of this study was a randomized, controlled, blinded study with two parallel groups.

SETTINGS/LOCATION

This study was conducted at an accredited school of therapeutic massage in Dallas, Texas.

SUBJECTS

The study comprised healthy female and male final-term massage students between ages 18 and 65 years.

INTERVENTIONS

The participants were randomized into two groups: (1) the experimental group who gave a 1-hour Swedish massage to a massage client (Massage group), or (2) the control group who sat in a room doing normal, daily activities (Control group). Both these activities were a normal part of the daily routine for these massage students.

OUTCOME MEASURES

The primary outcomes were the change in the Depression Anxiety and Stress Scale (DASS) scores pre- and postparticipation.

RESULTS

Twenty-two (22) participants were randomized in this trial. The baseline characteristics were comparable between the two groups. A statistically significant advantage for the massage group was found relative to the control group in subjective anxiety (DASS Anxiety Subscale, p=0.014). There were no significant differences between the groups with regard to total DASS score (p=0.540), subjective depressive symptoms (DASS Depression Subscale, p=0.472) and subjective stress-related symptoms (DASS Stress Subscale, p=0.919). There were no adverse events reported by any participant.

CONCLUSIONS

This study shows that massage therapists themselves may benefit from giving a therapeutic massage by experiencing less subjective anxiety following the giving of a massage.