24. Jain S, Kumar P, McMillan DD. Prior leg massage decreases pain responses to heel stick in preterm babies. J Paediatr Child Health. 2006;42(9):505-508. 25. Bellieni CV, Cordelli DM, Marchi S, et al. Sensorial saturation for neonatal analgesia. Clin J Pain. 2007;23(3):219-221.
26. Brummelte S, Grunau RE, Chau V, et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71(3):385396. 27. Grunau RE. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006;11:268-275.
CLINICAL BOTTOM LINE Commentary on “The Effects of Massage Therapy to Induce Sleep in Infants Born Preterm”
“How could I apply this information?” Infants in this study demonstrated fewer sleep behaviors immediately after massage compared with sleep behaviors with no massage. As clinicians in the neonatal intensive care unit (NICU), we try to protect and promote infants’ sleep, essential for optimal brain growth and development. Although previous research suggests that massage seems to be a beneficial intervention for improving self-regulation in infants born preterm, its effects on state regulation remain unclear. Infants maintained physiologic stability (ie, heart rate and oxygen saturation) during the 30 minutes postmassage, and the authors concluded that massage can be safely applied to infants born preterm. Thus, massage therapy seems to be a safe intervention for infants near term who are clinically stable and likely promotes improved self-regulation, but may not improve overall sleep patterns. “What should I be mindful about when applying this information?” The small sample of infants who were clinically stable, 34 weeks’ mean gestational age at birth, and 38 weeks’ postconceptual age at the time of the study support the applicability of study results to a subset of the NICU population. Infants were randomized into 2 different massage protocols, and a nonmassage group. The massage techniques were adapted from a previously published protocol and are described adequately to be reproduced. A particular consideration for clinicians in the NICU is the relatively short dosage (once for 10 minutes). A clinician investigating the use of massage in the NICU must apply these results with caution for the population born preterm. Further research is needed to determine the influence on state regulation—both sleep and awake/alert states—of massage over a longer timeframe, or the cumulative effects of massage. Lastly, clinicians in the NICU should be mindful that (1) the massage protocol was implemented by experienced physical therapists with pediatric board certification working in the NICU, and (2) the assessment of sleep was based on the objective measure of actigraphy, and clinical judgment (most commonly used in the NICU) seems to differ. This suggests the need for research to investigate the clinical meaningfulness of different approaches to measuring sleep patterns.
Cheryl Moody, PT, PCS Children’s Hospital Colorado Aurora, Colorado Beth M. McManus, PT, MPH, ScD, PCS University of Colorado Aurora, Colorado The authors declare no conflicts of interest. DOI: 10.1097/PEP.0000000000000083
410
Yates et al
Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
26. Brummelte S, Grunau RE, Chau V, et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71(3):385396. 27. Grunau RE. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006;11:268-275.
CLINICAL BOTTOM LINE Commentary on “The Effects of Massage Therapy to Induce Sleep in Infants Born Preterm”
“How could I apply this information?” Infants in this study demonstrated fewer sleep behaviors immediately after massage compared with sleep behaviors with no massage. As clinicians in the neonatal intensive care unit (NICU), we try to protect and promote infants’ sleep, essential for optimal brain growth and development. Although previous research suggests that massage seems to be a beneficial intervention for improving self-regulation in infants born preterm, its effects on state regulation remain unclear. Infants maintained physiologic stability (ie, heart rate and oxygen saturation) during the 30 minutes postmassage, and the authors concluded that massage can be safely applied to infants born preterm. Thus, massage therapy seems to be a safe intervention for infants near term who are clinically stable and likely promotes improved self-regulation, but may not improve overall sleep patterns. “What should I be mindful about when applying this information?” The small sample of infants who were clinically stable, 34 weeks’ mean gestational age at birth, and 38 weeks’ postconceptual age at the time of the study support the applicability of study results to a subset of the NICU population. Infants were randomized into 2 different massage protocols, and a nonmassage group. The massage techniques were adapted from a previously published protocol and are described adequately to be reproduced. A particular consideration for clinicians in the NICU is the relatively short dosage (once for 10 minutes). A clinician investigating the use of massage in the NICU must apply these results with caution for the population born preterm. Further research is needed to determine the influence on state regulation—both sleep and awake/alert states—of massage over a longer timeframe, or the cumulative effects of massage. Lastly, clinicians in the NICU should be mindful that (1) the massage protocol was implemented by experienced physical therapists with pediatric board certification working in the NICU, and (2) the assessment of sleep was based on the objective measure of actigraphy, and clinical judgment (most commonly used in the NICU) seems to differ. This suggests the need for research to investigate the clinical meaningfulness of different approaches to measuring sleep patterns.
Cheryl Moody, PT, PCS Children’s Hospital Colorado Aurora, Colorado Beth M. McManus, PT, MPH, ScD, PCS University of Colorado Aurora, Colorado The authors declare no conflicts of interest. DOI: 10.1097/PEP.0000000000000083
410
Yates et al
Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
