This systematic review study examined randomized, controlled, clinical trials and quasi-experimental studies that evaluated the impact of massage therapy on preterm infants’ feeding intolerance. Given the crucial role of neonatal nutrition and its association with cardiovascular disease risk factors, bone problems and cognitive function in adulthood and the potential positive effect of massage on this variable, and also since some review studies have investigated the effect of massage therapy on a number of outcomes in preterm infants while no systematic review studies have yet examined the effect of this method on feeding intolerance in these infants, this review study was conducted to determine the effect of massage therapy on feeding intolerance in preterm infants. In addition, massage therapy has a role in stimulating the digestive system and the vagus nerve in preterm infants and may thereby affect the growth of these infants. Īccording to a meta-analysis conducted by Wang et al., massage therapy is a cost-effective intervention that improves weight gain and reduces hospitalization time in preterm infants. Feeding intolerance is one of the major causes of weight loss in preterm infants that increases the risk of infection and prolongs prenatal feeding. A high GRV increases the risk of gastrointestinal complications, such as necrotizing enterocolitis (NEC). The incomplete development of the gastrointestinal motility system in premature infants increases the gastric emptying time and decelerates bowel movements and eventually leads to symptoms such as constipation, abdominal distention and increased gastric residual volume (GRV). Feeding problems are one of the factors causing the prolonged hospitalization of premature infants in NICUs. Due to their prematurity, these infants lack a proper coordination between sucking, swallowing and breathing, and their risk of aspiration is therefore increased and they have to be fed by gavage. Many premature babies are transferred to NICUs after birth and are fed by tube (nasal or oral route). In recent years, significant improvements have been made in the care provided to these infants however, prematurity is still a major cause of infant morbidity and mortality in developing countries. Each year, one million out of the 15 million premature infants born die in the first year of life due to the complications of premature birth. Premature birth is one of the most important direct causes of neonatal mortality, and the second leading cause of child mortality after pneumonia. Given the limited number of reviewed studies, the small number of neonates examined, and the short intervention periods, it is recommended that clinical trial be conducted with accurate methodology, longer interventions and larger sample sizes to ensure the effect of massage on feeding intolerance in these infants. Massage therapy significantly reduces the gastric residual volume and vomiting in preterm infants. The mean abdominal circumference (MD = − 1.51 95% CI: − 4.86 to 1.84 P = 0.38) and mean gastric residual number (MD = − 0.05 95% CI: − 0.34 to 0.24 P = 0.74) were lower in the massage therapy group compared to the control group, although not in a statistically significant manner. According to the meta-analysis conducted on 128 preterm infants, the mean gastric residual volume (MD = − 2.11 95% CI: − 2.76 to − 1.45, P < 0.00001) and mean frequency of vomiting (MD = − 0.84 95% CI: − 1.37 to − 0.31 P = 0.002) were significantly lower in the massage therapy group compared to the control group. Of the 528 reviewed articles, eight were eligible for this study and finally six studies were included in the meta-analysis. GRADE approach was used to assess the quality of the evidence. The results of the meta-analysis were reported as mean difference, and the heterogeneity of the studies was evaluated using I 2. The risk of bias in the studies was assessed using the Cochrane guidelines. MethodsĪ search was carried out in English databases including Medline (via PubMed), Scopus, Cochrane Library, Google Scholar, Embase (via Ovid) and Persian databases including SID and Magiran for articles published until November 2019 with language restrictions (English or Persian) but no time restrictions. This systematic review investigates the effect of massage on feeding intolerance in preterm infants. Massage therapy is a cost-effective intervention that has a positive impact on the health of infants and their parents. Feeding intolerance in premature infants is one of the main causes of their long-term hospitalization in NICUs.
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