The Effect of Massage on Bilirubin Level in Infants
Condition: Massage; Neonatal Jaundice
MeSH terms: Jaundice, Neonatal; Jaundice
Study type: Interventional

Summary: 
      Jaundice (hyperbilirubinemia) which is one of the common causes of repeated hospitalizations
      in the neonatal period, is a physiological condition seen in 60% of term babies and 80% of
      premature babies in the first week of life . Premature babies are more susceptible
      tobilirubin neurotoxicity. Death and severe sequelae due to hyperbilirubinemia can be
      prevented by early diagnosis and treatment. Massage is one of the applications that can be
      used to reduce bilirubin levels in newborn infants. Baby massage facilitates bowel movements
      and bilirubin excretion by reducing enterohepatic circulation. This study was designed as a
      randomized controlled trial to investigate the effect of massage on bilirubin levels in
      premature infants.
    

Detailed description: 
      Neonatal jaundice is a physiological condition seen in 60% of infants and 80% of preterm
      infants in the first week of life. There is no clear data on the frequency of jaundice in
      newborns in our country. Jaundice is one of the common causes of 75% of hospitalizations in
      the first week after birth and the recurrence of hospitalizations in the neonatal period.
      Neonatal jaundice is a non-hazardous and transient condition that can usually resolve
      spontaneously without treatment. Although it is a transient condition, high bilirubin levels
      can cause kernicterus which causes severe neurological damage if not diagnosed and treated
      early .

      The severity and complications of hyperbilirubinemia in premature infants are different from
      term infants. Premature infants are more susceptible to damage caused by serum bilirubin,
      even at low levels of brain cells. Hyperbilirubinemia in preterm infants is more prevalent,
      severe, and protracted than that in term infants because of the immaturity of their red blood
      cells, livers, and gastrointestinal tracts. There also is often a delay in enteral feeds,
      which may limit intestinal flow and bacterial colonization, resulting in further enhancement
      of the enterohepatic circulation of bilirubin. Preterm neonates are more susceptible to
      bilirubin neurotoxicity. Almost all preterm infants less than 35 weeks gestational age have
      elevated total serum/plasma bilirubin levels, which results in neonatal jaundice, the
      yellowish discoloration of the skin and conjunctiva caused by bilirubin deposition. The major
      complication of an elevated total serum (hyperbilirubinemia) is bilirubin-induced neurologic
      dysfunction (BIND), which occurs when circulating bilirubin crosses the blood-brain barrier
      and binds to brain tissue . Jaundice is an important problem in newborn infants and death and
      severe sequelae due to hyperbilirubinemia can be prevented by early diagnosis and treatment.
      Various treatment methods have been developed to reduce bilirubin levels. The most commonly
      used methods are; blood exchange, phototherapy and pharmacological agents. Therapeutic
      interventions prevent BIND and thus kernicterus by lowering the level of bilirubin in the
      blood. Phototherapy is a common treatment for both treatment and prevention of increased
      bilirubin levels. Phototherapy has been widely used in the treatment of hyperbilirubinemia of
      the newborn for more than fifty years. Phototherapy has various side effects, such as damage
      to the retina and genitalia, loss of body water, skin rashes, watery stools and Bronze Baby
      Syndrome.

      Nowadays, studies on new treatment methods and different applications are being made which
      support the treatment of jaundice and shorten the length of hospital stay. Kangaroo care
      reduces the exposure of newborns to phototherapy, swimming, wiping and bathtub bathing have
      been reported to reduce bilirubin levels. Baby massage is one of the alternative and
      complementary therapies that can be used to reduce bilirubin levels.

      While there are many studies investigating the effect of infant massage on bilirubin levels
      in term neonates with healthy and hyperbilirubinemia, a limited number of studies
      investigating the effect of massage on bilirubin levels in premature infants were found.

      It is suggested that baby massage can be performed by trained nurses and mothers trained by
      nurses. Infant massage stimulates defecation by increasing bowel movements, thus decreasing
      enterohepatic circulation and increasing bilirubin excretion. Bilirubin excretion decreases
      the speed and severity of hyperbilirubinemia. In some studies investigating the effect of
      massage on bilirubin levels, transcutaneous bilirubin (TcB) levels or TSB levels were found
      to be significantly lower, also no significant difference was found in some studies.

      In our country, the studies on the benefits of baby massage for infants are quite new. There
      are two studies investigating the effect of massage on bilirubin levels in newborn infants.
      However, in one of these studies, the effect of infant massage on bilirubin levels in
      newborns who received phototherapy was investigated, while the effect of abdominal massage on
      TcB bilirubin levels in newborns was investigated in the other study. TSB levels are the gold
      standard in the evaluation of bilirubin levels in newborn infants. However, the blood needs
      to be taken from the baby, and taking blood is a painful procedure, and it may not always
      possible to get enough blood. Measurement of bilirubin level from the skin surface is both
      noninvasive, painless and simple. In this study, the effect of infant massage on bilirubin
      level in premature infants not receiving phototherapy was evaluated by transcutaneous
      bilirubin measurement method. This study was designed as a randomized controlled trial to
      investigate the effect of massage on bilirubin levels in premature infants.
    

Intervention name(s): Baby Massage
Intervention type(s): Other
Intervention description(s): Received baby massage and bilirubin levels were measured twice daily by the transcutaneous bilirubin meter for 5 days
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: In the study, the investigators were decided that at least 30 premature infants were included in each group considering that losses might occur during data collection. Block randomization method was used to control the selection bias that might arise during the determination of the study groups. In this method, the number and probability of groups are equal in each block. Infants in both groups were randomized to block stratified by sex and gestational week. In the block randomization, blocks are selected randomly and this process is continued until all the subjects to be included in the study are assigned to the groups and the number of subjects in the groups is equalized at the end of this procedure
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: neonatal jaundice; baby massage; transcutaneous bilirubin level; premature infant