Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: a review of clinical trials

The Effect of Abdominal Massage on Bilirubin Levels in Term Infants Receiving Phototherapy: A Randomized Controlled Trial

BACKGROUND

The incidence of neonatal hyperbilirubinemia in Europe and the United States is estimated to be 3.2 and 4.4 per 10,000 live births, respectively. Abdominal massage for hyperbilirubinemia is considered a safe complementary treatment for infants that may increase number of defecations and decrease bilirubin levels.

PURPOSE

This study was designed as a randomized controlled trial to determine the effect of abdominal massage on bilirubin levels in term infants receiving phototherapy.

METHODS

The sample consisted of 43 term newborns (intervention group: 23; control group: 20) who received phototherapy in a university hospital between June 2019 and February 2021. Information and observation forms were used for data collection. The intervention group received 6 abdominal massages over 2 days, performed 3 times a day, 6 hours apart, and lasting 5 minutes each.

RESULTS

Transcutaneous bilirubin levels and heart rate were significantly lower in the intervention group than in the control group at 48 hours (P = .015 and P = .033, respectively). Number of defecations was higher in the intervention group at 24 hours (P = .007) but there was no significant difference at 48 hours. The decrease in serum bilirubin between 24 and 48 hours was significantly greater in the intervention group (P = .005).

IMPLICATION FOR PRACTICE AND RESEARCH

Abdominal massage was effective in reducing bilirubin levels and may increase the number of defecations. Providing massage training to the parents of infants who are discharged early could be a protective approach to prevent the rise in bilirubin levels.

Evidence-Based Consensus Recommendations for Skin Care in Healthy, Full-Term Neonates in India

Purpose

Neonatal skin care practices guided by personal experience and preferences might be substantially different across different hospital settings. The aim of this consensus recommendation is to provide clinical practice guidance to healthcare practitioners on evidence-based neonatal skin care practices from delivery-to-discharge, in hospital settings.

Patients and Methods

A Scientific Advisory Board meeting on "Evidence-based Neonatal Skin Care Practices and Protocols" was held in December 2020 with an expert panel comprising neonatologists, pediatricians, obstetricians and gynecologists and pediatric dermatologist. Comprehensive literature search was performed up to 23 March 2021 using PubMed and Google Scholar to retrieve relevant evidence.

Results

Recommendations were developed on critical aspects of skin care in healthy full-term neonates including cleansing at birth, skin-to-skin care, cord care, diaper area care, initial and routine bathing, cleansers and emollients use, and criteria to choose appropriate skin care products. Recommendations include inclusion of skin assessment in routine neonatal care, first bath timing after cardio-respiratory and thermal stabilization, 6-24 hours after birth; bathing with water alone or adding a mild liquid cleanser could be considered appropriate as it does not impact the developing skin barrier; use of emollients is recommended for neonates with higher risk of development of eczema to maintain and enhance skin barrier function and integrity; and inclusion of skin care advice in neonatal discharge checklist. Importance of rigorous quality control, high-quality clinical trials for assessment of baby products, usage of products that are formulated appropriately for newborns, and full label transparency for baby products were highlighted. The panel identified gaps in literature and discussed the scope for future research.

Conclusion

These recommendations may help to standardize evidence-based skin care for healthy full-term neonates in Indian hospital settings to improve the quality of care that neonates receive in hospital and facilitate improvement in overall neonatal health outcomes.

The effect of massage on the bilirubin level in term infants receiving phototherapy

BACKGROUND

Massage has positive physiological effects on infants. Infant massage increases the excretion of waste products such as bilirubin from the body by accelerating the flow of the blood, lymph, and tissue fluids.

PURPOSE

The aim of the study is to investigate the effect of infant massage on hyperbilirubinemia in newborns receiving phototherapy.

METHODS

The study population consisted of infants admitted to the neonatal intensive care unit of a public hospital in Istanbul between October 2021 and January 2022 with a need for phototherapy. Sixty-one newborns who met the study criteria were randomized and divided into two as the experimental (n=30) and control (n=31) groups. All infants were followed up for 3 days, and phototherapy was applied twice a day. In addition to phototherapy, infant massage was applied to the experimental group for 10 min just before the phototherapy. The bilirubin level was measured 2 h after the end of phototherapy for both groups. Moreover, diapers were changed 8 times a day, every 3 h, in both groups.

RESULTS

The groups were homogeneous in terms of descriptive data, and no significant difference was observed between the groups (p>0.05). When bilirubin levels were compared, there was a significant decrease in bilirubin levels in the experimental group starting from the third day (p =.000). The frequency of defecation on the second and third days increased significantly in the experimental group (p =.000).

CONCLUSION

Infant massage can increase the frequency of defecation and help decrease bilirubin levels in newborns diagnosed with hyperbilirubinemia.

STandards for Reporting Interventions in Clinical Trials Of Tuina/Massage (STRICTOTM): Extending the CONSORT statement

OBJECTIVES

Massage is a common therapy of nonpharmacological treatments, particularly in Tuina (Chinese massage) as its most common style, detailed guidance in reporting the intervention is warranted for its evaluation and replication. Based on the CONSORT (Consolidated Standards of Reporting Trials), we aimed to develop an Extension for Tuina/Massage, namely "The STandards for Reporting Interventions in Clinical Trials Of Tuina/Massage (STRICTOTM)."

METHODS

A group of professional clinicians, trialists, methodologists, developers of reporting guidelines, epidemiologists, statisticians, and editors has developed this STRICTOTM checklist through a standard methodology process recommended by the EQUATOR (Enhancing the QUAlity and Transparency of Health Research) Network, including prospective registration, literature review, draft of the initial items, three rounds of the Delphi survey, consensus meeting, pilot test, and finalization of the guideline.

RESULTS

A checklist of seven items (namely Tuina/Massage rationale, details of Tuina/Massage, intervention regimen, other components of the intervention, Tuina/Massage provider background, control or comparator interventions, and precaution measures), and 16 subitems were developed. Explanations and examples (E&E) for each item are also provided.

CONCLUSIONS

The working group hopes that the STRICTOTM, in conjunction with both the CONSORT statement and extension for nonpharmacologic treatment, can improve the reporting quality and transparency of Tuina/Massage clinical research.

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.

Mathematical model for treatment of neonatal hyperbilirubinemia

Based on the mechanism of neonatal hyperbilirubinemia treatment methods (light, exchange blood and drugs), three types of neonatal hyperbilirubinemia treatment mathematical models are established, and the expressions of the model solutions are given in this paper. By applying clinical test data and numerical approximation algorithm, the relevant parameters in the model can be estimated. According to the standards of "Expert Consensus", two treatment plans are designed, which are 1) the combined transfusion and phototherapy treatment plan and 2) the combined treatment plan of drugs, transfusion and phototherapy. The results of the program operation are numerically simulated and compared with the treatment data of clinical cases. It is found that the coincidence effect is important, which verified the rationality of the model. The model results can track and predict the changes of bilirubin levels in real-time, which provides a theoretical basis for the clinical design of treatment plans.

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.

Role of Kangaroo Mother Care in the Management of Neonatal Hyperbilirubinemia in Both Term and Preterm Neonates: A Systematic Review

BACKGROUND

Neonatal hyperbilirubinemia (NNH) is the most common clinical sign seen in neonatal practice. Kangaroo mother care (KMC), a new strategy has been tried for the management of hyperbilirubinemia.

AIMS

To evaluate the role of KMC for reduction of bilirubin and duration of phototherapy in term and preterm neonates.

METHOD

The literature search was done for various randomized control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, ongoing clinical trials and abstracts of conferences.

RESULTS

This review included five RCTs that fulfilled inclusion criteria. Out of five trials, two trials reported a significant reduction in bilirubin and three trials reported a significant reduction in duration of phototherapy.

CONCLUSION

KMC may be a novel strategy in the management of NNH. However, due to small sample size and heterogeneity between the trials, the current evidence is not sufficient. Hence, large trials with adequate sample sizes are needed.