Development of an Evidence-Based Guideline for Preterm Infant Massage by Parents

Approximately 20.6 million preterm infants with LBW (less than 2,500 g) are born every year worldwide [1]. Preterm infant birth accounted for 7.6% of the total number of births in Hong Kong in 2004 [2]. The survival rate of preterm infants with LBW has been increasing since the 1980s because of the advancement in high-technology neonatal care [3]. Studies have reported that preterm infants are at high risk of suffering from various kinds of developmental impairment [3,4]. Among these impairments, gastrointestinal dysmotility, a condition that commonly affects preterm infants, is particularly significant [5]. Underdeveloped gastrointestinal function and immature peristaltic activity result in poor weight gain and prolonged parenteral nutrition requirement [5]. Literature has suggested that infant massage can promote weight gain, increase gastric motility and vagal activity in preterm infants [6]. Vagal activity refers to the activity of the vagus nerve. Increases in vagal activity and gastric motility are significantly related to weight gain as observed in infants who receive infant massages [6]. According to Field et al.,[7] increased vagal activity may promote growth and development in infants. Vagal stimulation in preterm infants through a moderatepressure massage may enhance gastric motility and increase the release of food absorption hormones, which contribute to weight gain. In addition, infant massage performed by parents is safe and feasible; it is also reported to provide parents an increased level of satisfaction [8]. However, clinical protocols on infant massage in Neonatal Intensive Care Units (NICUs) are limited.