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  • Original Article
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The effect of massage on heart rate variability in preterm infants

A Corrigendum to this article was published on 27 February 2013

Abstract

Objective:

To test the hypothesis that massage would improve autonomic nervous system (ANS) function as measured by heart rate variability (HRV) in preterm infants.

Study Design:

Medically stable, 29- to 32-week preterm infants (17 massage, 20 control) were enrolled in a masked, randomized longitudinal study. Licensed massage therapists provided the massage or control condition twice a day for 4 weeks. Weekly HRV, a measure of ANS development and function, was analyzed using SPSS generalized estimating equations.

Results:

Infant characteristics were similar between groups. HRV improved in massaged infants but not in the control infants (P<0.05). Massaged males had a greater improvement in HRV than females (P<0.05). HRV in massaged infants was on a trajectory comparable to term-born infants by study completion.

Conclusion:

Massage-improved HRV in a homogeneous sample of hospitalized, medically stable, preterm male infants and may improve infant response to exogenous stressors. We speculate that massage improves ANS function in these infants.

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References

  1. Cohen G, Vella S, Jeffery H, Lagercrantz H, Katz-Salamon M . Cardiovascular stress hyperreactivity in babies of smokers and in babies born preterm. Circulation 2008; 118 (18): 1848–1853.

    Article  PubMed  Google Scholar 

  2. Longin E, Gerstner T, Schaible T, Lenz T, Konig S . Maturation of the autonomic nervous system: differences in heart rate variability in premature vs term infants. J Perinat Med 2006; 34 (4): 303–308.

    Article  PubMed  Google Scholar 

  3. Patural H, Pichot V, Jaziri F, Teyssier G, Gaspoz JM, Roche F et al. Autonomic cardiac control of very preterm newborns: a prolonged dysfunction. Early Hum Dev 2008; 84 (10): 681–687.

    Article  PubMed  Google Scholar 

  4. Cohen G, Lagercrantz H, Katz-Salamon M . Abnormal circulatory stress responses of preterm graduates. Pediatr Res 2007; 61 (3): 329–334.

    Article  PubMed  Google Scholar 

  5. Diego MA, Field T, Hernandez-Reif M . Vagal activity, gastric motility, and weight gain in massaged preterm neonates. J Pediatr 2005; 147 (1): 50–55.

    Article  PubMed  Google Scholar 

  6. Lee HK . The effect of infant massage on weight gain, physiological and behavioral responses in premature infants. Taehan Kanho Hakhoe Chi 2005; 35 (8): 1451–1460.

    PubMed  Google Scholar 

  7. Mathai S, Fernandez A, Mondkar J, Kanbur W . Effects of tactile-kinesthetic stimulation in preterms: a controlled trial. Indian Pediatr 2001; 38 (10): 1091–1098.

    CAS  PubMed  Google Scholar 

  8. White-Traut RC, Nelson MN, Silvestri JM, Patel MK, Kilgallon D . Patterns of physiologic and behavioral response of intermediate care preterm infants to intervention. Pediatr Nurs 1993; 19 (6): 625–629.

    CAS  PubMed  Google Scholar 

  9. Kim MS, Cho KS, Woo H, Kim JH . Effects of hand massage on anxiety in cataract surgery using local anesthesia. J Cataract Refract Surg 2001; 27 (6): 884–890.

    Article  CAS  PubMed  Google Scholar 

  10. Moyer-Mileur L, Luetkemeier M, Boomer L, Chan GM . Effect of physical activity on bone mineralization in premature infants. J Pediatr 1995; 127 (4): 620–625.

    Article  CAS  PubMed  Google Scholar 

  11. Ng PC, Lam CW, Lee CH, Ma KC, Fok TF, Chan IH et al. Reference ranges and factors affecting the human corticotropin-releasing hormone test in preterm, very low birth weight infants. J Clin Endocrinol Metab 2002; 87 (10): 4621–4628.

    Article  CAS  PubMed  Google Scholar 

  12. Ellis KJ, Yao M, Shypailo RJ, Urlando A, Wong WW, Heird WC . Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model. Am J Clin Nutr 2007; 85 (1): 90–95.

    Article  CAS  PubMed  Google Scholar 

  13. Matthews SG . Antenatal glucocorticoids and programming of the developing CNS. Pediatr Res 2000; 47 (3): 291–300.

    Article  CAS  PubMed  Google Scholar 

  14. Dent GW, Smith MA, Levine S . The ontogeny of the neuroendocrine response to endotoxin. Brain Res Dev Brain Res 1999; 117 (1): 21–29.

    Article  CAS  PubMed  Google Scholar 

  15. Chatow U, Davidson S, Reichman BL, Akselrod S . Development and maturation of the autonomic nervous system in premature and full-term infants using spectral analysis of heart rate fluctuations. Pediatr Res 1995; 37 (3): 294–302.

    Article  CAS  PubMed  Google Scholar 

  16. DiPietro JA, Costigan KA, Pressman EK, Doussard-Roosevelt JA . Antenatal origins of individual differences in heart rate. Dev Psychobiol 2000; 37 (4): 221–228.

    Article  CAS  PubMed  Google Scholar 

  17. Nakamura T, Horio H, Miyashita S, Chiba Y, Sato S . Identification of development and autonomic nerve activity from heart rate variability in preterm infants. Biosystems 2005; 79 (1–3): 117–124.

    Article  PubMed  Google Scholar 

  18. Kapoor A, Dunn E, Kostaki A, Andrews MH, Matthews SG . Fetal programming of hypothalamo-pituitary-adrenal function: prenatal stress and glucocorticoids. J Physiol 2006; 572 (Pt 1): 31–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Smith SL . Heart period variability of intubated very-low-birth-weight infants during incubator care and maternal holding. Am J Crit Care 2003; 12 (1): 54–64.

    PubMed  Google Scholar 

  20. Stevens J . Applied Multivarite Statistics for the Social Sciences. 3rd edn Lawrence Erlbaum Associates: Mahwah, NJ, 1996.

    Google Scholar 

  21. Moyer-Mileur LJ, Brunstetter V, McNaught TP, Gill G, Chan GM . Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants. Pediatrics 2000; 106 (5): 1088–1092.

    Article  CAS  PubMed  Google Scholar 

  22. Finlay DD, Nugent CD, Nelwan SP, Bond RR, Donnelly MP, Guldenring D . Effects of electrode placement errors in the EASI-derived 12-lead electrocardiogram. J Electrocardiol 2010; 43 (6): 606–611.

    Article  PubMed  Google Scholar 

  23. Neu M, Browne JV, Vojir C . The impact of two transfer techniques used during skin-to-skin care on the physiologic and behavioral responses of preterm infants. Nurs Res 2000; 49 (4): 215–223.

    Article  CAS  PubMed  Google Scholar 

  24. Goto K, Mirmiran M, Adams MM, Longford RV, Baldwin RB, Boeddiker MA et al. More awakenings and heart rate variability during supine sleep in preterm infants. Pediatrics 1999; 103 (3): 603–609.

    Article  CAS  PubMed  Google Scholar 

  25. Hunt CE . Ontogeny of autonomic regulation in late preterm infants born at 34–37 weeks postmenstrual age. Semin Perinatol 2006; 30 (2): 73–76.

    Article  PubMed  Google Scholar 

  26. Witcombe NB, Yiallourou SR, Sands SA, Walker AM, Horne RS . Preterm birth alters the maturation of baroreflex sensitivity in sleeping infants. Pediatrics 2012; 129 (1): e89–e96.

    Article  PubMed  Google Scholar 

  27. Toichi M, Sugiura T, Murai T, Sengoku A . A new method of assessing cardiac autonomic function and its comparison with spectral analysis and coefficient of variation of R-R interval. J Auton Nerv Syst 1997; 62 (1-2): 79–84.

    Article  CAS  PubMed  Google Scholar 

  28. Field T, Diego MA, Hernandez-Reif M, Deeds O, Figuereido B . Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behav Dev 2006; 29 (4): 574–578.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Elsmen E, Hansen Pupp I, Hellstrom-Westas L . Preterm male infants need more initial respiratory and circulatory support than female infants. Acta Paediatr 2004; 93 (4): 529–533.

    Article  CAS  PubMed  Google Scholar 

  30. Stark MJ, Clifton VL, Wright IM . Sex-specific differences in peripheral microvascular blood flow in preterm infants. Pediatr Res 2008; 63 (4): 415–419.

    Article  PubMed  Google Scholar 

  31. Stark MJ, Clifton VL, Wright IM . Microvascular flow, clinical illness severity and cardiovascular function in the preterm infant. Arch Dis Child Fetal Neonatal Ed 2008; 93 (4): F271–F274.

    Article  CAS  PubMed  Google Scholar 

  32. Charmandari E, Kino T, Souvatzoglou E, Chrousos GP . Pediatric stress: hormonal mediators and human development. Horm Res 2003; 59 (4): 161–179.

    CAS  PubMed  Google Scholar 

  33. De Rogalski-Landrot I, Roche F, Pichot V, Teyssier G, Gaspoz JM, Barthelemy JC et al. Autonomic nervous system activity in premature and full-term infants from theoretical term to 7 years. Auton Neurosci 2007; 136 (1-2): 105–109.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Julie Hatch, RN for her assistance in anthropometric data collection and Nancy Allen at the University of Utah Cardiovascular Research and Training Institute for her contributions to the heart rate variability analysis. We are sincerely grateful to the licensed massage therapists: Elizabeth Bingham, Andy Drake, Heidi Huish, Teri Josephson, Susie Kay, Shannon Northroup, Angela Rinehart, Change Vriens and Karen Salas Wheeler for their commitment and dedication in providing the intervention to the infants. This study was supported by grants from the National Institutes of Health (NCCAM R21 AT004185-01); University of Utah Interdisciplinary Research Committee, College of Nursing Research Committee, and Division of Neonatology Development Fund.

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Correspondence to S L Smith.

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Smith, S., Lux, R., Haley, S. et al. The effect of massage on heart rate variability in preterm infants. J Perinatol 33, 59–64 (2013). https://doi.org/10.1038/jp.2012.47

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