Premature births continue to challenge the medical community – both clinicians and researchers. The majority of preterm deliveries are spontaneous, with or without premature rupture of fetal membranes.
Premature births are more common among Blacks, the poor, the unmarried, cigarette smokers, underweight women, women with multiple gestations, women with uterine abnormalities, women with a history of preterm delivery and women without prenatal care. But the majority of women identified as having an increased risk of delivering a premature baby do not deliver prematurely. Efforts to provide these high-risk women with early care or enhanced prenatal services have generally failed to improve prenatal outcomes, according to an editorial in a recent New England Journal of Medicine (June 12, 2003.)
In the editorial, Dr. Michael F. Greene states, "It has become almost a platitude to lament the complexity and intractability of the problem of preterm delivery, the poor predictive value of screening tests for its occurrence, its resistance to attempted interventions and its increasing rate."
The percent of preterm births rose to 11.8% over the past decade. With no end in sight and with solutions as elusive as a slippery eel, there is renewed interest in helping premature babies grow better once they are out of the womb and – perhaps the most important issue – helping them develop more optimal behavioural and motor responses.
Can we claim that massage therapy of premature babies makes a difference – any useful, lasting difference in outcome?
Massage therapy of newborns may be controversial to some orthodox clinicians. In fact, when one uses a search engine with the search words ‘infant massage,’ as I did recently in doing research for my seminar on this topic, one can be either impressed or disappointed by the wide range in reliability of available sites. Some sites are peer-reviewed while others are not (by now readers of this monthly column will know that to me and most of my colleagues, only peer-reviewed data matters.)
In Miami at the Touch Research Institutes, affiliated with the University of Miami School of Medicine, Drs. Maria Hernandez-Reif and Tiffany Field, together with their enthusiastic associates, have looked critically at the outcomes of massage therapy for premature babies.
The protocol of most studies called for 30 to 45 minutes of daily stroking and flexion and extension of extremities to medically stable infants. The massage therapy is provided in 10- to 15-minute sessions, 3 times a day, for 2 to 4 weeks.
The outcome is potentially amazing. Three studies showed a 21% to 47% greater weight gain for massage therapy versus the standard care; a greater degree of bone mineralisation; earlier hospital discharge; and more optimal behavioural and motor responses were all noted in the group of babies who received massage therapy.
A meta-analysis (a method which looks at a number of studies regarding the overall outcome) revealed that 72% of infants receiving massage therapy did better than controls. According to the Miami doctors, massage therapy improves the clinical and developmental course of preterm infants.
The timing of the massage therapy, however, was critically important. The best outcomes occurred when it was started early and in the 900 to 1500 gram weight range.
The underlying mechanism of how massage therapy works requires further study. The current focus is on hormones and chemicals, such as IGF-1 and oxytocin, together with the effects of massage on gastric motility.
Claudie Gordon-Pomares, a respected psychologist who spends her time between Canada and France – in fact she lives close to Calgary – has traveled far and wide and over the past 20 years has collected more than 17,000 observations. She is particularly interested in multisensory stimulation for babies. The thinking is that early stimulation of the senses (smell, taste, sight, hearing and touch) lead to better development of the baby's later personality.
Her methods are easy to implement in nurseries, day care centres and at home. Her work may be approached with a healthy degree of scepticism by some clinicians, but at the Center for Disease Control in Atlanta, a relatively new term has emerged: nutrigenomics. The theory is that our genetic signature may be responsible for what we like to eat and taste. Nutritional genomics and massage therapy may have something in common – what we want to feel and what we want to eat may all depend on our DNA profile.
For further resources on this potentially fascinating topic – one with little financial cost, few side-effects and the potential ability to get premature babies to grow better and develop optimally – see the web site of the International Association of Infant Massage at www.iaim-us.com. For more information on multisensory stimulation for babies, access Nestle Nutrition's web site at www.nestle.ca.
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