Application of Massage for the Management of Neonatal Hyperbilirubinemia: Systematic Review and Network Meta-Analysis

Background: Neonatal jaundice is a common health problem which is expected to be seen in 60–80 % of healthy newborns, with 10% occurrence of hyperbilirubinemia in neonates during first week of life. Massage therapy has been practiced for centuries to gain health benefits in infants. We aimed to evaluate effectiveness of various types of infant massage in reduction of neonatal jaundice and the need for phototherapy.

Methods: we conducted electronic search in nine databases, with inclusion of RCTs that investigated newborn babies receiving massage therapy with documented bilirubin before and after the treatment.

Results:

• Bilirubin level

1. For neonates requiring phototherapy (PT), in the 3^rd and 4^th days of life massage and phototherapy (MP) appears to be more effective in reducing bilirubin level than P alone. However, this effect becomes non-significant in the 14^th day of life. In contrast, MEP significantly reduces SB level at the age of 14 days.
2. For neonates who didn’t require PT, the best statistically significant reduction was observed with the acupressure massage between the 3^rd and 7^th days of life. In the 14^th day of life, massage combined with bathing appears to be the most effective arm.

• Duration of phototherapy, there was a significant reduction in the massage, enema and phototherapy group when compared to MP and phototherapy alone (P) groups.
• Increasing stool frequency and the decreasing the time needed till meconium turns yellow: evidence suggests that massage 1-2 times/day is the most effective arm.
• Body weight, MB appears to have a positive and a statistically significant effect on weight gain.

Conclusion: Massage therapy could be an effective adjuvant to PT in order to reduce the PT duration. However, it did not reduce the requirement for PT.