Weight Gain in Preterm Infants following Parent-Administered Vimala Massage: A Randomized Controlled Trial

ABSTRACT

Massage has been proposed as a way of facilitating development and growth of newborns through its effects on increasing blood flow, heart rate, digestion, and immunity. Massage might increase basal metabolism and nutrient absorption through endocrine effects such as increase in insulin and adrenaline and decrease in cortisol. Preliminary studies have suggested significant impact on weight gain with shortening of in-hospital stays of up to 6 days. We compared weight gain among preterm infants receiving Vimala massage plus usual care versus usual care alone. A randomized controlled trial was conducted. Sixty clinically stable preterm newborns with a corrected gestational age of 30 to 35 weeks receiving enteral nutrition in the hospital nursery were included. Half of them were assigned at random to receive Vimala massage twice daily for 10 days plus usual nursery care; the others received usual nursery care. Weight, head circumference, caloric intake, and nutritional method were recorded daily. Group characteristics were compared with analysis of variance, t test, and χ² test as appropriate. There were no differences between groups in gender, gestational age, initial weight, head circumference, and caloric intake and type of nutrition at baseline. Infants receiving massage had a larger weight gain versus the control group since the third day (188.2 ± 41.20 g/kg versus 146.7 ± 56.43 g/kg, p < 0.001). Hospital stay was shorter in infants receiving massage and usual nursery care (15.63 ± 5.41 days versus 19.33 ± 7.92 days, p = 0.03). The addition of parent-administered Vimala massage to usual nursery care resulted in increased weight gain and shorter hospital stay among clinically stable preterm newborns.

KEYWORDS

Preterm - weight gain - Vimala massage

REFERENCES

• 1 Hack M, Horbar J D, Mallory M H, Tyson J E, Wright E, Wright L. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network.  Pediatrics. 1991;  87 587-597
• 2 Escobar G J, Littenberg B, Petitti D B. Outcome among surviving very low birthweight infants a metaanalysis.  Arch Dis Child. 1991;  66 204-211
• 3 Field T. Preterm infant massage therapy studies: an American approach.  Semin Neonatol. 2002;  7 487-494
• 4 Vickers A, Ohlsson A, Lacy J B, Horsley A. Massage for promoting growth and development of preterm and/or low birth-weight infants.  Cochrane Database Syst Rev. 2004;  (2) CD000390
• 5 Field T M, Schanberg S M, Scafidi F, Bauer C R et al.. Tactile/kinesthesic stimulation effects on preterm neonates.  Pediatrics. 1986;  77 654-658
• 6 Scafidi F, Field T, Schanberg S, Bauer C, Vega-Lahr N et al.. Effects of tactile/kinaesthetic stimulation on the clinical course and sleep/wake behavior of preterm neonates.  Infant Behav Develop. 1986;  9 91-105
• 7 Dieter J N, Field T, Hernández-Reif M, Emory E K, Redzepi M. Stable preterm infants gain more weight and sleep less after five days of massage therapy.  J Pediatr Psychol. 2003;  28 403-411
• 8 Diego M A, Field T, Hernandez-Rief M. Vagal activity, gastric motility, and weight gain in massaged preterm neonates.  J Pediatr. 2005;  147 50-55
• 9 Field T M. Stimulation of preterm infants.  Pediatr Rev. 2003;  24 4-11
• 10 Scafidi F A, Field T, Schanberg S M. Factors that predict which preterm infants benefit most from massage therapy.  J Dev Behav Pediatr. 1993;  14 176-180
• 11 Jain S, Kumar P, McMillan D D. Prior leg massage decreases pain responses to heel stick in preterm babies.  J Paediatr Child Health. 2006;  42 505-508
• 12 Acolet D, Modi N, Giannakoulopoulos X, Bond C, Weg W, Clow A et al.. Changes in plasma cortisol and cathecholamine concentrations in response to massage in preterm infants.  Arch Dis Child. 1993;  68(1 Spec No) 29-31
• 13 Kuhn C M, Schandberg S M, Field T et al.. Tactile-kinesthetic stimulation effects on sympathetic and adrenocortical function in preterm infants.  J Pediatr. 1991;  119 434-440
• 14 Field T, Sacafidi F, Schanberg S. Massage of preterm newborns to improve growth and development.  Pediatr Nurs. 1987;  13 385-387
• 15 Moyer-Mileur L, Luetkemeier M, Boomer L, Chan G M. Effect of physical activity on bone mineralization in premature infants.  J Pediatr. 1995;  127 620-625
• 16 Morrow C J, Field T M, Scafidi F A et al.. Transcutaneous oxygen tension in preterm neonates during neonatal behavioral assessments and heelsticks.  J Dev Behav Pediatr. 1990;  11 312-316
• 17 McClure V. Infant Massage: A Handbook for Loving Parents. 3rd ed. New York; Bantam Books 2002: 69-128
• 18 Field T, Hernandez-Reif M, Diego M, Feijo L, Vera Y, Gil K. Massage therapy by parents improves early growth and development.  Infant Behav Dev. 2008;  31 149-152
• 19 Field T. Massage therapy facilitates weight gain in preterm infants.  Curr Dir Psychol Sci. 2001;  10 51-54
• 20 Hernandez-Reif M, Diego M, Field T. Preterm infants show reduced stress behaviours and activity after 5 days of massage therapy.  Infant Behav Dev. 2007;  30 557-561
• 21 Field T, Diego M A, Hernandez-Reif M, Deeds O, Figuereido B. Moderate versus light pressure massage therapy leads to greater weight gain in preterm.  Infant Behav Dev. 2006;  29 574-578
• 22 Lahat S, Mimouni F B, Ashbel G, Dollberg S. Energy expenditure in growing preterm infants receiving massage therapy.  J Am Coll Nutr. 2007;  26 356-359
• 23 Goldstein F S, Kuint J, Weller A, Feldman R, Dollberg S et al.. Massage therapy by mothers and trained professionals enhances weight gain in preterm infants.  Early Hum Dev. 2002;  67 37-45

APPENDIX

Instructions Provided to Parents to Administer Vimala Massage to Their Newborns

Apply moderate pressure.

Face: Gently massage upper lids with your thumbs outward, from the nose to the cheeks; slide your thumbs from the upper lip to the cheeks, then under the ears with index and middle finger from ears the chin.

Arms and hands: Gently massage the armpit with circular movements; slide your hands from the shoulder to the wrists; use twisting movements in opposite direction, gently turning each finger for a circular massage on the dorsum of the hands.

Wrist: Slide your hands from the wrist up to the shoulder with revolving movements in arms and forearms.

Chest: Slide both hands starting from the midline to the sides, from the sides to midline, then from midline to the right shoulder and back to the midline, then from midline to left shoulder and back to the midline. Extend both arms and cross them over the chest.

Abdomen: Slide hand down the abdomen, alternating left and right; slide hands together from right to left over the abdomen. Slide your hands downward on the left side, upward on the right side of the abdomen, then over the belly and bottom and coming down on the left side (inverted U). Slide fingertips of both hands over the abdomen, from right to left.

Legs and feet: Slide your hands from the thigh to the ankle, with twisting movements in opposite directions over thigh, leg, and foot; turn each toe; dorsal flexion of the sole and dorsum of the foot; circular movements in ankles; slide hands from ankle to thigh with ascending movements.

Finally, turn the child facedown. Slide both hands from the back of the neck to the hips from top to bottom, alternating. Slide your hands from side to side in opposite directions; with the index and middle finger draw circles from top to bottom following the spine. Slide your fingertips from the head to the hips, top to bottom as if you were combing the back.

To end the massage, thank the child and say good-bye.