|Year : 2016 | Volume
| Issue : 2 | Page : 96-99
The effect of massage on weight gain in very low birth weight neonates
Zahra Akbarian Rad1, Mohsen Haghshenas1, Yahya Javadian1, Mahmoud Hajiahmadi1, Fahimeh Kazemian2
1 Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
2 Department of Physiotherapy, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
|Date of Web Publication||8-Apr-2016|
Non-Communicable Pediatric Diseases Research Center, No 19, Amirkola Children's Hospital, Amirkola, Babol, Mazandaran Province, 47317-41151
Source of Support: None, Conflict of Interest: None
Background: Achieving optimal weight is one of the factors that takes into consideration in the discharge of preterm infants from the hospital. The aim of this study was to assess the effect of massage therapy on weight gain in very low birth weight neonates. Methods: This study is a nonrandomized blocking clinical trial in Neonatal Intensive Care Unit. Forty neonates who had inclusion criteria, were divided into two groups of case (n = 20) and control (n = 20). Both groups received standard care of preterm neonates. Additionally, case group received the massage therapy 3 times daily for 15 min for each time at 7 days. During the study, the weight of neonates was measured every day at 12 a.m. Results: Average weight of neonates between two groups had no statistically significant difference until 4 th day of study. However, this difference became significant after 4 th day became more and most significant (P = 0.04, 0.02, 0.01 respectively). The mean duration of hospital stay in the massage group (34/1 days ± 7/5) was less than the control group (41/7 days ± 9/1) significantly (P = 0.007). Conclusion: The massage therapy can promote weight gain in very low birth weight neonates and also leads to earlier discharge.
Keywords: Massage, neonate, preterm, very low birth weight
|How to cite this article:|
Rad ZA, Haghshenas M, Javadian Y, Hajiahmadi M, Kazemian F. The effect of massage on weight gain in very low birth weight neonates. J Clin Neonatol 2016;5:96-9
|How to cite this URL:|
Rad ZA, Haghshenas M, Javadian Y, Hajiahmadi M, Kazemian F. The effect of massage on weight gain in very low birth weight neonates. J Clin Neonatol [serial online] 2016 [cited 2021 Apr 12];5:96-9. Available from: https://www.jcnonweb.com/text.asp?2016/5/2/96/179900
| Introduction|| |
Preterm birth rate has increased over the past 20 years.  Today, there has been a considerable decline in neonatal mortality due to advances in antenatal, obstetric, and neonatal care.  More attention has been devoted to optimize the growth and development of premature infants.  The infant explores most of its world in the early months by touching.  The touch in neonates can be active or passive that passive touch can be delivered as a care touch (feeding, changing diapers, handling, holding, kangaroo mother care (KMC), and examination of newborn) and massage.  Massage has been described as "a mechanical manipulation of body tissues with rhythmical pressure and stroking for the purpose of promoting health and well-being."  There is generally a notion that massage improves circulation and sooth the peripheral and central nervous system.  Infants who received massage also showed less clinical signs of stress and lower level of plasma cortisol concentration than controls.  Massage of neonate can be performed with a lubricant to reduce the friction between the surface.  Trials on the effect of massage on growth in premature infants have used either massage alone as a form of tactile stimulation or massage with some type of vegetable oil.  It is not clear yet whether oil has any profit on the growth of preterm infants.  The present study was designed to test the effect of massage therapy on weight gain in very low birth weight neonates during 7 days of massage compared to standard care of very low birth weight neonates without massage.
| Methods|| |
This study is a nonrandomized blocking clinical trial in the Neonatal Intensive Care Unit (NICU) of the level III hospital from October 2012 to November 2014. Inclusion criteria were birth weight between 1000 and 1500 g, gestational age between 28 and 32 weeks, birth weight appropriate for their gestational age, gavage feeding, age between 10 and 20 days, medical stabilization, and receive KMC. Calories intake and time or duration of KMC in two groups were equal. Infants with congenital anomalies, central nervous system dysfunction, or medical conditions related to immaturity (such as respiratory distress syndrome, apnea, and hyperbilirubinemia), infant surgery, maternal history of alcohol or illicit drug exposure, and syphilis or hepatitis B were excluded. Prior to recruitment, informed consent was obtained from parents of eligible infants and attending physician. Forty neonates, who were selected for this study, were divided into two groups (20 massages and 20 controls). Infants were alternatively assigned in 10 blocks of four cases of control and massage. First neonate with the inclusion criteria was randomly assigned to the control block. The study on any case started when intravenous therapy was discontinued and neonate had a condition of medical stabilization.
The Field's protocol for massage was used  but in our study, whereas the lymph flow in the body is from distal to proximal,  the direction of massage only was done from distal to proximal. In massage group, the intervention was done 3 times/day for 15 min for each time during 7 consecutive days.  The interval of any session of massage therapy was at least 4 h and it was done 1 h after feeding. During the study, massage of all cases in the intervention group was done by one special nurse who was trained by the licensed physiotherapist.
Each session of massage consisted of 5 min of tactile stimulation in a prone position, followed by 5 min of kinesthetic stimulation in the supine position, and another 5 min period of tactile stimulation again. The nurse warmed and lubricated (with 1 cc olive oil) her hands before starting of massage and remained silent during intervention. During tactile stimulation, the infant was placed under warmer set that regulated with infant body temperature in a prone position and was given moderate pressure stroking with the flats of the fingers of both hands. Five 1-min intervals, consisting of 12 5-s periods of stroking, were applied to the following body regions: (a) From the top of the infant's head, down the back of the head to the neck, (b) from the back of the neck across the shoulders, (c) from the buttocks to the upper back, (d) simultaneously on both legs from the feet to the hips, and (e) both arms from the wrist to the shoulders synchronously.
For the kinesthetic phase, each of the five 1-min segments consisted of six passive flexions and extension movements lasting approximately 10 s. These "bicycling-like" movements of the limbs occurred in the following sequence: (a) Right arm, (b) left arm, (c) right leg, (d) left leg, and (e) both legs synchronously. Infant was monitored continuously for heart rate, respiratory rate, and percutaneous oxygen saturation during massage by monitoring set (S1800-made in England). None of the neonates showed an adverse effect due to massage during the study.
The weight of neonate was measured every day (at 12 a.m.) by digital balance (Seca 334-made in Germany) with a standard deviation of ±5 g. Head circumference and length of neonates was measured at before and after of study. Measuring and recording the data was carried out by one nurse who was not aware of the purpose of our study. The homogeneity of the massage and control groups was tested with independent t-test and Chi-square test, and comparison of the weight gain between the two groups was done using the repeated measurement test with SPSS version 21. Number of hospitalization days in NICU for all cases was calculated after discharging.
| Results|| |
None of the 40 neonates who were enrolled in the study were excluded during the study. Demographic data of two groups are showed in [Table 1]. Two groups were matched in terms of confounding variables such as birth weight, weight at enrollment, gestational age, age at enrollment, sex and Apgar score at 5 min of birth.
Results of our study demonstrated that average weight of neonates between massage group and control group had no statistically significant difference until 4 th day of study (P > 0/05). However, this difference became significant from 5 th day of the study and the following days became more and more significant [Table 2]. Infants in the massage group compared to baseline had 11/3% overweight but this range in the control group was 7/7% that this difference between two group was significant too (P = 0.000). The difference of head circumference and length between two groups was not statistically significant at the beginning and end of study (P > 0.05). The mean duration of hospital stay in the massage group (34/1 days ± 7/5) was shorter than the control group (41/7 days ± 9/1) for 7 days (P = 0.007). The prevalence of retinopathy of prematurity requiring surgery at 1-month-old in the control group was more than massage group (45% vs. 20%) but this difference was not statistically significant (P = 0.18).
| Discussion|| |
The present study demonstrates significantly more weight gain in the massage group compared to the control group over 4 days of massage. In this study, massage therapy causes more weight gain in very low birth weight neonates after 5 days. Duration of each massage session was 15 min for 3 times/day until 7 days and the distance between each massage had at least 4 h in our study. In Massaro et al., Kumar et al., Alizadeh et al. and Field' studies that had results similar to our study about effect of massage on weight in preterm neonates, the direction of massage was from proximal to distal, ,,, but in this study, the direction of massage was from distal to proximal. In our study, the massage began on an average of 15 days after birth. Additionally, all infants massage performed by one specific nurse. Neonates of the intervention group were discharged from hospital earlier than the control group for 7 days on average. Kumar et al.  found that massage therapy of premature infant increases the weight gain after 28 days of massage. In their study, intervention group received the massage from the 1 st day of birth until 28 days by mothers in hospital or after discharging at home. Alizadeh et al. studied 44 infants with birth weight of 1000 to 2500 g for 5 days and their study showed massage resulted in a significant difference in weight gain between intervention and control groups (P = 0.001). Number of daily massage in this study was similar to our study (3 times for 15 min at each time) except that the distance between each massage time was 2 h. In this study, infants who received massage were discharged earlier from the hospital on an average 12 days. Another study by Badiee et al.  used the massage (5 min 3 times a day for 5 days), similar to our study, resulted in increasing the rate of weight gain in preterm infants. Their study included three groups of massage by mother, massage by nurses, and without massage (control) that showed massage by mother or nurses increased weight in preterm infant with gestational age between 28 and 34 weeks without reference to birth weight when compared to control group. Unlike our study, the massage was performed by several nurses in the second group and each massage session was only 5 min in the intervention groups. A study in Iran by Hosseinzadeh et al.  presented that massage increases the rate of weight gain in infants but infants who were enrolled had weight of 2000 to 2500 g whereas our inclusion criteria were weight of 1000 to 1499 g. In another study in America by Massaro et al.  on infants <33 weeks and birth weight <1500 g, weight gain was significantly higher than the control group infants who were 1000 and 1499 g (P < 0.05). In their study, massage had no effect on weight gain in infants <1000 g. Infants who received massage, duration of hospital stay did not show significant differences from the control group in its study. The result of another study in Iran to determine the effect of therapeutic touch on weight premature infants was conducted by Keshavarz et al.  showed a moderate pressure massage for 5 days (3 times a day for 20 min) due to significant difference on weight gain in preterm infants with birth weight of more than 1500 g between the intervention and control groups (P = 0.01). The massage was done in right and left lateral positions in this study but we massaged the infants in supine and prone positions. Golchin et al.  studied the effects of massage on weight gain in infants with birth weights <2500 g and the results showed that massage increases the speed of their weight; the average birth weight of the massaged infants was 1709 g whereas in our study, it was 1275 g. Field et al.  in a study of 5-day (15 min 3 times a day) demonstrated that the massage increased the rate of weight gain in preterm infants was similar to the results obtained in the present study. As regards, the mean birth weight and weight gain entry to the study were 1789 and 1292 g, respectively, whereas in our study those were 1275 and 1238 g, respectively.
Amini et al.  examined 10-day massage effect on weight gain in preterm infants and the results showed that weight gain was not significantly different between the two groups at the end of the study, while like our study, intervention group was massaged commonly by a trained massage therapist. Age of enrollment in their study was 2 to 7 days after birth. Mendes and Procianoy conducted a study in Brazil,  contrary to the results of this study showed that massage therapy by mothers had no significant effect on the increase in weight gain in infants <1500 g but the hospital stay in the intervention group was 7 days less than the control group (P = 0.007). Because of their result did not show a significant effect of massage on weight gain, perhaps the mothers cannot use moderate pressure during massage therapy because of their intense emotions about their small baby. However, based on our idea the massage can be more effective if it was done by nurses or other trained ones. We propose to study the effect of massage by trained fathers on weight gain in preterm infants for future studies.
| Conclusion|| |
This study showed that the massage or deep tactile stimulation can promote weight gain in hospitalized, very low birth weight infants in the NICU. Infant massage that has also led to earlier discharge and reduced hospital costs will follow. As one of the measures of the quality of nursing care in the NICU is neonatal weight gain, we suggested that the massage can be used as an effective method in conjunction with other treatments.
We are grateful to the Clinical Research Development Committee of Amirkola Children's Hospital, NICU personal of Ayatollah Rouhani Hospital and Mrs. Fatemeh Rahmaanpour for their contribution to this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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