Vickers A, Ohlsson A, Lacy J B, Horsley A
Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
Cochrane Database Syst Rev. 2000(2):CD000390. doi: 10.1002/14651858.CD000390.
It has been argued that infants in Neonatal Intensive Care Units are subject both to a highly stressful environment - continuous, high-intensity noise and bright light - and to a lack of the tactile stimulation that they would otherwise experience in the womb or in general mothering care. As massage seems to both decrease stress and provide tactile stimulation, it has been recommended as an intervention to promote growth and development of preterm and low-birth weight infants.
To determine whether preterm and / or low birth-weight infants exposed to massage experience improved weight gain and earlier discharge compared to infants receiving standard care; to determine whether massage has any other beneficial or harmful effects on this population.
Databases were searched using the term 'massage', 'touch' or 'tactile stimulation' with 'infant - newborn', 'infant - premature' and 'infant - low birth weight'. The main databases searched were those of the Cochrane Collaboration Field in Complementary Medicine and the Neonatal Collaborative Review Group.
Randomised trials in which infants with gestational age at birth < 37 weeks or weight at birth < 2500g received systematic tactile stimulation by human hands. At least one outcome assessing weight gain, length of stay, behaviour or development must be reported.
Data extracted from each trial were baseline characteristics of sample, weight gain, length of stay and behavioural and developmental outcomes. Physiological and biochemical outcomes were not recorded. Data were extracted by three reviewers independently. Statistical analysis was conducted using the standard Cochrane Collaboration methods.
Massage interventions improved daily weight gain by 5g (95% CI 3.5, 6.7g). There is no evidence that gentle, still touch is of benefit (increase in daily weight gain -0.2g; 95% CI -2.4, 1.9g). Massage interventions also appeared to reduce length of stay by 4.6 days (95% CI 2.6, 6.6) though there are methodological concerns about the blinding of this outcome. There was also some evidence that massage interventions have a slight, positive effect on postnatal complications and weight at 4 - 6 months. However, serious concerns about the methodological quality of the included studies, particularly with respect to selective reporting of outcomes, weaken credibility in these findings.
REVIEWER'S CONCLUSIONS: Evidence that massage for preterm infants is of benefit for developmental outcomes is weak and does not warrant wider use of preterm infant massage. Where massage is currently provided by nurses, consideration should be given as to whether this is a cost-effective use of time. Future research should assess the effects of massage interventions on clinical outcome measures, such as medical complications or length of stay, and on process-of-care outcomes, such as care-giver or parental satisfaction.
有人认为，新生儿重症监护病房的婴儿既面临高度紧张的环境——持续的高强度噪音和强光，又缺乏在子宫内或一般母婴护理中原本会体验到的触觉刺激。由于按摩似乎既能减轻压力又能提供触觉刺激，因此被推荐作为促进早产和低体重婴儿生长发育的一种干预措施。
确定与接受标准护理的婴儿相比，接受按摩的早产和/或低体重婴儿体重增加是否改善以及出院是否更早；确定按摩对这一群体是否有其他有益或有害影响。
使用“按摩”“触摸”或“触觉刺激”与“婴儿 - 新生儿”“婴儿 - 早产”和“婴儿 - 低体重”等术语检索数据库。主要检索的数据库是补充医学领域的Cochrane协作网数据库和新生儿协作审查组数据库。
出生孕周<37周或出生体重<2500g的婴儿接受人工系统触觉刺激的随机试验。必须报告至少一项评估体重增加、住院时间、行为或发育的结果。
从每项试验中提取的数据为样本的基线特征、体重增加、住院时间以及行为和发育结果。未记录生理和生化结果。由三位评审员独立提取数据。使用Cochrane协作网的标准方法进行统计分析。
按摩干预使每日体重增加5克（95%可信区间3.5，6.7克）。没有证据表明轻柔、静止的触摸有益（每日体重增加-0.2克；95%可信区间-2.4，1.9克）。按摩干预似乎还使住院时间缩短了4.6天（95%可信区间2.6，6.6），不过对这一结果的盲法存在方法学上的担忧。也有一些证据表明按摩干预对产后并发症和4至6个月时的体重有轻微的积极影响。然而，对纳入研究的方法学质量，尤其是对结果的选择性报告的严重担忧，削弱了这些发现的可信度。
早产婴儿按摩对发育结果有益的证据薄弱，不支持更广泛地使用早产婴儿按摩。如果目前由护士提供按摩，应考虑这是否是一种具有成本效益的时间利用方式。未来的研究应评估按摩干预对临床结果指标（如医疗并发症或住院时间）以及护理过程结果（如护理人员或家长满意度）的影响。
