title: The effects of massage therapy in hospitalized preterm neonates: A systematic review.
abstract: OBJECTIVE
  The aim of this study was to perform a systematic review to identify, evaluate and summarise studies on the administration of therapeutic massage to preterm neonates during their stay in the NICU, and to assess their methodological quality.
  
  
  METHODS
  systematic review following PRISMA statements guidelines.
  
  
  METHODS
  A comprehensive search was performed including relevant articles between January 2004 and December 2013, using the following electronic databases: Medline, PEDro, Web of Science and Scopus.
  
  
  METHODS
  Two reviewers conducted a review of the selected articles: one evaluated the methodological quality of the studies and performed data extraction and the other performed a cross-check. Divergences of opinion were resolved by discussion with a third reviewer. The studies reviewed implemented a wide variety of interventions and evaluation methods, and therefore it was not possible to perform a meta-analysis. The following data were extracted from each article: year of publication, study design, participants and main measurements of outcomes obtained through the intervention. A non-quantitative synthesis of the extracted data was performed. Level of evidence was graded using the Jadad Scale.
  
  
  RESULTS
  A total of 23 articles met the inclusion criteria and were thus included in the review; these presented a methodological quality ranging from 1 to 5 points (with a mean of 3 points). Most studies reported that the administration of various forms of therapeutic massage exerted a beneficial effect on factors related to the growth of preterm infants. The causes indicated by the researchers for these anthropometric benefits included increased vagal activity, increased gastric activity and increased serum insulin levels. Other demonstrated benefits of massage therapy when administered to hospitalised preterm infants included better neurodevelopment, a positive effect on brain development, a reduced risk of neonatal sepsis, a reduction in length of hospital stay and reduced neonatal stress.
  
  
  CONCLUSIONS
  Although based on a qualitative analysis of heterogeneous data, the present review suggests that a clear benefit is obtained from the administration of massage therapy in hospitalised preterm infants, a finding which should encourage the more generalised use of massotherapy in NICU clinical practice.
authors.affiliation: Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Leon, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Álvarez
authors.affiliation: Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Leon, Spain. Electronic address: dferg@unileon.es.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernández
authors.affiliation: University of Huelva, Spain; Universidade Atlântica de Lisboa, Portugal.
authors.forename: Juan
authors.initials: J
authors.lastname: Gómez-Salgado
authors.affiliation: University Hospital of Leon, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Rodríguez-González
authors.affiliation: University Hospital of Leon, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rosón
authors.affiliation: University Hospital of Leon, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Lapeña
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008405:Massage
keywords: Massage; Massage therapy; Premature birth; Premature infant; Preterm birth; Preterm infant; Tactile stimulation; Tactile-kinesthesic stimulation; Therapeutic touch