Comparison of Massage and Prone Position on Heart Rate and Blood Oxygen Saturation Level in Preterm Neonates Hospitalized in Neonatal Intensive Care Unit: A Randomized Controlled Trial

Azamolmolouk Elsagh, Razieh Lotfi, Siamak Amiri, Haleh Hatam Gooya


Background: These days, most of the admitted infants in neonatal intensive care units (NICU) are premature infants. Infant massage and prone position has been recommended for several decades to have a positive effect on preterm and low birth weight infants. The objective of this study was to determine the effects of neonatal massage with prone positioning in preterm infants on Heart Rate (HR), and Oxygen Saturation (O2Sa) status.

Materials and Methods: This is a controlled randomized three‑group clinical trial study conducted on hospitalized infants in selected hospitals of Alborz University of Medical Sciences in Karaj‑Iran. There are about 75 preterm infants (33‑37 weeks) who met inclusion criteria were randomly assigned to groups of position, massage as intervention groups, and a control group. Intervention (prone position and massage) was administrated for five straight days. The repeated measure ANOVA test was performed to evaluate and compare the effect of interventions. p value less than 0.05 was considered as statistical significance.

Results: The Repeated Measure two‑way Analysis of Variance (RM‑ANOVA) result showed a significant difference in HR and SaO2 in different time points among control, position and massage groups with RM‑ANOVA (F 10,360 = 10.376, p < 0.001). HR values was reduced and SaO 2 values was increased in intervention groups with RM‑ANOVA (F5,360 = 2.323, p < 0.001).

Conclusions: Results showed that massage and prone position equally led to the reduction of HR and increase of SaO 2, compared to control group.



Heart rate, intensive care units, massage, neonatal, oxygen, preterm infants, prone position

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Rangey PS, Sheth M. Comparative effect of massage therapy versus kangaroo mother care on body weight and length of hospital stay in low birth weight preterm infants. Int J Pediatr 2014;2014:434060. doi: 10.1155/2014/434060.

Yousefi J, Mirzade M, Tavasoli Askari N. To study the prevalence of LBW and to determine the ratio preterm to IUGR during one year in 22 Bahman Hospital in Mashhad. J Med Sci 2015:5:1‑6.

Pourashoori Z, Mirnia K, Ghorbani F, Safaiyan A, Nematzadeh MA, Arshadi Bostanabad M. Effect of blood sampling site on the changes in the physiological indices of preterm infants: A crossover clinical trial. Iran J Neonatol 2018;9:42‑8.

Madlinger‑Lewis L, Reynolds L, Zarem C, Crapnell T, Inder T, Pineda R. The effects of alternative positioning on preterm infants in the neonatal intensive care unit: A randomized clinical trial. Res Dev Disabil 2014;35:490‑7.

Aarnoudse‑Moens CS, Weisglas‑Kuperus N, van Goudoever JB, Oosterlaan J. Meta‑analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009;124:717‑28.

Juntaruksa P. Effects of individualized environmental modification program on neurobehavioral organizations of the very low birth weight infants (Doctoral dissertation, Chulalongkorn University); 2009.

Ma M, Noori S, Maarek JM, Holschneider DP, Rubinstein EH, Seri I. Prone positioning decreases cardiac output and increases systemic vascular resistance in neonates. J Perinatol 2015;35:424.

Sarkhy A, Thomson M. Feeding changes and positioning therapy for infants. In Esophageal and Gastric Disorders in Infancy and Childhood. Berlin, Heidelberg: Springer; 2017. p. 957‑61.

Rajaram R, Vizhi DM, Kumar VPRS. Effects of early neonatalmassage with therapeutic positioning in preterm and low birth weight babies on neurobehavioral and neurodevelopmental status. Int J Pharm Bio Sei 2017;8:440‑6.

Cândia MF, Osaku EF, Leite MA, Toccolini B, Costa NL, Teixeira SN, et al. Influence of prone positioning on premature newborn infant stress assessed by means of salivary cortisol measurement: Pilot study. Rev Bras Ter Intensiva 2014;26:169‑75.

Álvarez MJ, Fernández D, Gómez‑Salgado J, Rodríguez‑González D, Rosón M, Lapeña S. The effects of massage therapy in hospitalized preterm neonates: A systematic review. Int J Nurs Stud 2017;69:119‑36.

Hymel GM, Rich GJ. Health psychology as a context for massage therapy: A conceptual model with CAM as mediator. J Bodyw Mov Ther 2014;18:174‑82.

Gray L, Watt L, Blass EM. Skin‑to‑skin contact is analgesic in healthy newborns. Pediatrics 2000;105:e14.

Wolever RQ, Caldwell KL, McKernan LC, Hillinger MG. Integrative medicine strategies for changing health behaviors: Support for primary care. Primary Care 2017;44:229‑45.

Comerford KC, editor. Nursing 2015 Drug Handbook. Lippincott Willi & Wilkins; 2014.

Smith SL, Haley S, Slater H, Moyer‑Mileur LJ. Heart rate variability during caregiving and sleep after massage therapy in preterm infants. Early Hum Dev 2013;89:525‑9.

Eichenwald EC, Hansen AR, Martin CR, Stark AR, editors. Cloherty and Stark’s Manual of Neonatal Care. 8th ed. Philadelphia, PA: Wolters Kluwer; 2016. p. 630‑40.

Zargham‑Boroujeni A, Elsagh A, Mohammadizadeh M. The effects of massage and breastfeeding on response to venipuncture pain among hospitalized neonates. Iran J Nurs Midwifery Res 2017;22:308.

Oren‑Amit A, Berkovitch M, Bahat H, Goldman M, Kozer E, Ziv‑Baran T, et al. Complementary and alternative medicine among hospitalized pediatric patients. Complement Ther Med 2017;31:49‑52.

Field T. Preterm newborn pain research review. Infant Behav Dev 2017;49:141‑50.

Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Massage and touch therapy in neonates: The current evidence. Indpediatr 2010;47:771‑6.

Yates CC, Mitchell AJ, Booth MY, Williams DK, Lowe LM, Hall RW. The effects of massage therapy to induce sleep in infants born preterm. Pediatr Phys Ther 2014 winter; 26:405‑10.

Ghorbani F, Asadollahi M, Valizadeh S. Comparison the effect of sleep positioning on cardiorespiratory rate in noninvasive ventilated premature infants. Nurs Midwifery Stud 2013;2:182.24.

Ammari A, Schulze KF, Ohira‑Kist K, Kashyap S, Fifer WP, Myers MM, et al. Effects of body position on thermal, cardiorespiratory and metabolic activity in low birth weight infants. Early Hum Dev 2009;85:497‑501.

Desai SA, Nanavati RN, Jasani BB, Kabra N. Comparison of neonatal pain, agitation, and sedation scale with premature infant pain profile for the assessment of acute prolonged pain in neonates on assisted ventilation: A prospective observational study. Indian J Palliat Care 2017;23:287.

Bellieni CV, Buonocore G. Sensorial Saturation and the 3Ts rule. In: Neonatal Pain. Springer; 2017. p. 141‑6.

Chimello JT, Gaspardo CM, Cugler TS, Martinez FE, Linhares MB. Pain reactivity and recovery in preterm neonates: Latency, magnitude, and duration of behavioral responses. Early Hum Dev 2009;85:313‑8.

Gardner SL, Carter BS, Enzman‑Hines MI, Hernandez JA. Merenstein & Gardner's handbook of neonatal intensive care. 8th ed. United States: St. Louis, Missouri: Elsevier; 2015.

Yiallourou SR, Walker AM. Effects of sleeping position on development of infant cardiovascular control. Arch Dis Childhood 2008;93:868‑72.

Alinejad‑Naine M. Neonatal positioning during care in neonatal intensive care unit. Iran J Cardiovasc Nurs 2014;3:60‑5.31.

Oishi Y, Ohta H, Hirose T, Nakaya S, Tsuchiya K, Nakagawa M, et al. Combined effects of body position and sleep status on the cardiorespiratory stability of near‑term infants. Sci Rep 2018;8:8845.


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