Does massage help preterm infants?

I think the answer to the question posed in the title of the post is the usual answer: ‘it depends‘. In this case it depends on what you mean by massage, and what you mean by ‘help’. All massage is not the same, so exactly how it is done, how long for, and how frequently it is done, are bound to affect the results.

A systematic review published last year Wang, L., et al. (2013). “The Efficacy of Massage on Preterm Infants: A Meta-Analysis.” Am J Perinatol concluded that there seems to be an increase in weight gain in infants receiving regular massage, and some reduction in hospital stay (likely linked to the increased weight gain), but little evidence of other beneficial outcomes.

A new trial examined similar outcomes:  Abdallah B, Badr LK, Hawwari M. The efficacy of massage on short and long term outcomes in preterm infants. Infant Behavior and Development. 2013;36(4):662-9. that is; weight gain, hospital stay and development at 12 months corrected.

This study unfortunately used two sequential prospective cohorts rather than randomizing the infants, although the outcome assessments were said to be masked, I must say that is irrelevant. In fact, in general terms I would say that there really is no point trying to mask the intervention in a study design like this, you are just fooling yourself if you think it makes a difference. The Bayley scales of infant development were administered at 12 months of age, by one of the principal investigators, who must have known that this was a sequential group study, but is described as being blind to group assignment! The Bayley scores in the first group had a mean of 106, and in the second group were an amazing 120. Which is a spectacular result from 10 episodes of massage, each of which lasted 10 minutes.

On the other hand, we can maybe give the authors, in Beirut, a bit of slack (if I was a neonatologist in Beirut right now, I am not sure I would be trying to do clinical trials!). They listed 5 outcomes as important in the publication (and don’t choose a single primary outcome); including weight gain and developmental scores: they also examined pain scores after a heel-prick, which were lower in the massage group than the non-massage group.

Overall I think that the evidence that regular massage leads to increased weight gain is reasonably good, I presume that the mechanoreceptor stimulation probably leads to an increase in bone formation by a mechanism similar to the improved bone-mineralisation that occurs with weight bearing exercise, at least that is my guess.

Any effect on other outcomes remains unproven, despite this new, potentially biased study.

I also think it is a good way to get parents involved in the care of their infants, doing something which is pleasant for the parents and for their babies, which is harmless and may well have benefits.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research. Bookmark the permalink.

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