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Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants

European Journal of Pediatrics volume 180, pages 207–215 (2021)Cite this article

Abstract

Massage therapy (MT) improves growth parameters in preterm infants. The growth of lean mass rather than fat mass has been associated with better long-term outcomes. We aimed to study the effect of tactile/kinesthetic MT on growth and body composition parameters in preterm infants. Preterm (< 32 weeks gestation) infants were randomly assigned at corrected gestational age of 35 weeks to receive 3 consecutive, 15-min, sessions of MT over 5 days or routine care. Primary outcome was mean daily weight gain. Secondary outcomes included anthropometric measurements and body composition parameters assessed by dual X-ray absorptiometry (DXA) scan. Out of 218 infants screened, 86 were eligible and 60 infants (30 in each group) were recruited after parental consent. MT was associated with significant increase in daily weight gain [19.3 (10–34.3) versus 6.2 (2.5–18.4) g/day, p = 0.01] and growth velocity [12.5 (6–21) versus 3.6 (1.6–12.6) g/kg/d, p = 0.01] compared with routine care. Infants on MT showed significant increase in total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values compared with routine care group. In conclusions, MT improves growth quality as evident by increased total and regional lean masses, increased bone mineral density, and peripheral rather than central fat distribution.

What is known on this subject?
• Massage therapy (MT) for preterm infants leads to achievement of faster independent oral feeding, increased weight gain, less stress, less response to pain, less occurrence of sepsis, and shorter hospital stay.
• Growth of lean mass rather than fat mass has been associated with better long-term outcomes.
What this study adds?
• Tactile/kinesthetic massage therapy in preterm infant is associated with improved growth parameters and anthropometric measures.
• Tactile/kinesthetic massage therapy increased total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values.

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Fig. 1

Abbreviations

BMD:

bone mineral density

DXA:

dual-energy X-ray absorptiometry

IGF-1:

insulin-like growth factor 1

MT:

massage therapy

TBLH:

total body less head

References

  1. Abdallah B, Badr LK, Hawwari M (2013) The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev 36:662–669

    Article  Google Scholar 

  2. Acolet D, Modi N, Giannakoulopoulos X, Bond C, Weg W, Clow A, Glover V (1993) Changes in plasma cortisol and catecholamine concentrations in response to massage in preterm infants. Arch Dis Child 68:29–31

    CAS  Article  Google Scholar 

  3. Alvarez MJ, Fernandez D, Gomez-Salgado J, Rodriguez-Gonzalez D, Roson M, Lapena S (2017) The effects of massage therapy in hospitalized preterm neonates: a systematic review. Int J Nurs Stud 69:119–136

    Article  Google Scholar 

  4. Aly H, Moustafa MF, Hassanein SM, Massaro AN, Amer HA, Patel K (2004) Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial. J Perinatol 24:305–309

    Article  Google Scholar 

  5. Diego MA, Field T, Hernandez-Reif M (2005) Vagal activity, gastric motility, and weight gain in massaged preterm neonates. J Pediatr 147:50–55

    Article  Google Scholar 

  6. Diego MA, Field T, Hernandez-Reif M (2008) Temperature increases in preterm infants during massage therapy. Infant Behav Dev 31:149–152

    Article  Google Scholar 

  7. Diego MA, Field T, Hernandez-Reif M (2014) Preterm infant weight gain is increased by massage therapy and exercise via different underlying mechanisms. Early Hum Dev 90:137–140

    Article  Google Scholar 

  8. Dieter JN, Field T, Hernandez-Reif M, Emory EK, Redzepi M (2003) Stable preterm infants gain more weight and sleep less after five days of massage therapy. J Pediatr Psychol 28:403–411

    Article  Google Scholar 

  9. Field T, Diego M, Hernandez-Reif M (2011) Potential underlying mechanisms for greater weight gain in massaged preterm infants. Infant Behav Dev 34:383–389

    Article  Google Scholar 

  10. Field T, Diego M, Hernandez-Reif M, Dieter JN, Kumar AM, Schanberg S, Kuhn C (2008) Insulin and insulin-like growth factor-1 increased in preterm neonates following massage therapy. J Dev Behav Pediatr 29:463–466

    Article  Google Scholar 

  11. Field T, Diego MA, Hernandez-Reif M, Deeds O, Figuereido B (2006) Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behav Dev 29:574–578

    Article  Google Scholar 

  12. Field TM, Schanberg SM, Scafidi F, Bauer CR, Vega-Lahr N, Garcia R, Nystrom J, Kuhn CM (1986) Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics 77:654–658

    CAS  PubMed  Google Scholar 

  13. Gonzalez AP, Vasquez-Mendoza G, Garcia-Vela A, Guzman-Ramirez A, Salazar-Torres M, Romero-Gutierrez G (2009) Weight gain in preterm infants following parent-administered Vimala massage: a randomized controlled trial. Am J Perinatol 26:247–252

    Article  Google Scholar 

  14. Hernandez-Reif M, Diego M, Field T (2007) Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behav Dev 30:557–561

    Article  Google Scholar 

  15. Hofman PL, Regan F, Jackson WE, Jefferies C, Knight DB, Robinson EM, Cutfield WS (2004) Premature birth and later insulin resistance. N Engl J Med 351:2179–2186

    CAS  Article  Google Scholar 

  16. Lu LC, Lan SH, Hsieh YP, Lin LY, Chen JC, Lan SJ (2020) Massage therapy for weight gain in preterm neonates: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract 39:101168

    Article  Google Scholar 

  17. Massaro AN, Hammad TA, Jazzo B, Aly H (2009) Massage with kinesthetic stimulation improves weight gain in preterm infants. J Perinatol 29:352–357

    CAS  Article  Google Scholar 

  18. Mendes EW, Procianoy RS (2008) Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates. J Perinatol 28:815–820

    CAS  Article  Google Scholar 

  19. Moyer-Mileur LJ (2007) Anthropometric and laboratory assessment of very low birth weight infants: the most helpful measurements and why. Semin Perinatol 31:96–103

    Article  Google Scholar 

  20. Moyer-Mileur LJ, Haley S, Slater H, Beachy J, Smith SL (2013) Massage improves growth quality by decreasing body fat deposition in male preterm infants. J Pediatr 162:490–495

    Article  Google Scholar 

  21. Panagiotopoulos C, Ronsley R, Kuzeljevic B, Davidson J (2012) Waist circumference is a sensitive screening tool for assessment of metabolic syndrome risk in children treated with second-generation antipsychotics. Can J Psychiatr 57:34–44

    Article  Google Scholar 

  22. Pieltain C, De Curtis M, Gerard P, Rigo J (2001) Weight gain composition in preterm infants with dual energy X-ray absorptiometry. Pediatr Res 49:120–124

    CAS  Article  Google Scholar 

  23. Quintal VS, Diniz EM, Caparbo Vde F, Pereira RM (2014) Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life. J Pediatr 90:556–562

    Article  Google Scholar 

  24. Ramel SE, Gray HL, Christiansen E, Boys C, Georgieff MK, Demerath EW (2016) Greater early gains in fat-free mass, but not fat mass, are associated with improved neurodevelopment at 1 year corrected age for prematurity in very low birth weight preterm infants. J Pediatr 173:108–115

    Article  Google Scholar 

  25. Scafidi FA, Field TM, Schanberg SM, Bauer CR, Tucci K, Roberts J, Morrow C, Kuhn CM (1990) Massage stimulates growth in preterm infants: a replication. Infant Behav Dev 13:167–188

    Article  Google Scholar 

  26. Simon L, Frondas-Chauty A, Senterre T, Flamant C, Darmaun D, Roze JC (2014) Determinants of body composition in preterm infants at the time of hospital discharge. Am J Clin Nutr 100:98–104

    CAS  Article  Google Scholar 

  27. Tekgunduz KS, Gurol A, Apay SE, Caner I (2014) Effect of abdomen massage for prevention of feeding intolerance in preterm infants. Ital J Pediatr 40:89

    Article  Google Scholar 

  28. Wang L, He JL, Zhang XH (2013) The efficacy of massage on preterm infants: a meta-analysis. Am J Perinatol 30:731–738

    Article  Google Scholar 

  29. Wheeden A, Scafidi FA, Field T, Ironson G, Valdeon C, Bandstra E (1993) Massage effects on cocaine-exposed preterm neonates. J Dev Behav Pediatr 14:318–322

    CAS  Article  Google Scholar 

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Acknowledgments

We would like to thank Miss Sakina Kamal for her effort in randomization and allocation of infants into study groups. We would like to thank the parents and families in the Neonatal Intensive Care Unit at Mansoura University Children’s Hospital.

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Affiliations

  1. Neonatal Intensive Care Unit, Mansoura University Children’s Hospital, Mansoura, Egypt

    Maha Abd Elmoneim, Heba Azmy Mohamed, Amal Awad, Nehad Nasef & Hesham Abdel-Hady

  2. Paediatric Endocrinology Unit, Mansoura University Children’s Hospital, Mansoura, Egypt

    Amany El-Hawary & Nanees Salem

  3. Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Rania El helaly

  4. Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Maha Abd Elmoneim, Amany El-Hawary, Nanees Salem, Nehad Nasef & Hesham Abdel-Hady

Authors
  1. Maha Abd Elmoneim
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  2. Heba Azmy Mohamed
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  3. Amal Awad
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  4. Amany El-Hawary
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  5. Nanees Salem
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  6. Rania El helaly
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  7. Nehad Nasef
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  8. Hesham Abdel-Hady
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Contributions

Hesham Abdel-Hady, Amany El-Hawary, Nehad Nasef, and Nanees Salem participated in formulating the hypothesis, design of the study, data collection, data interpretation, and writing of the manuscript. Nehad Nasef and Nanees Salem did statistical analysis and wrote the first draft of the manuscript. Maha Abd Elmoneim, Heba Azmy Mohamed, and Amal Awad participated in design of the study and data collection. Rania El helaly participated in the design of the study, laboratory analysis, data interpretation, and writing of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Nehad Nasef.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article has been approved by the Institutional Review Board (IRB), Mansoura Faculty of Medicine, Mansoura, Egypt.

Informed consent

Informed consent was obtained from all individual participants included in the study. A written informed consent was taken from the parents of the infant to publish the included photos in Supplement 1.

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Elmoneim, M.A., Mohamed, H.A., Awad, A. et al. Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants. Eur J Pediatr 180, 207–215 (2021). https://doi.org/10.1007/s00431-020-03738-w

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  • DOI: https://doi.org/10.1007/s00431-020-03738-w

Keywords

  • Preterm infant
  • Massage therapy
  • Growth
  • DXA scan