Literature Review Graduate 2,364 words

Massage Therapy for Feeding Intolerance in Preterm Infants

~12 min read 6 sections Health · Intervention

Abstract

This integrative literature review examines whether massage therapy can reduce feeding intolerance in infants born before 37 weeks gestation. Grounded in Roy's Adaptation Model and guided by the IOWA Model of Evidence-Based Practice, the review critically appraises four peer-reviewed studies investigating abdominal massage, enteral feeding improvement massage (EFIM), and general massage therapy. Evidence from randomized controlled trials and quasi-experimental designs suggests that massage reduces gastric residual volumes, abdominal distension, and vomiting frequency while supporting physical growth and gastrointestinal function. The review concludes that massage therapy holds promise as a safe, cost-effective nursing intervention in the NICU, though larger, more rigorous trials are needed to establish definitive clinical guidelines.

Key Takeaways

Introduction: Preterm birth burden and feeding intolerance problem
Background and Conceptual Definition of Feeding Intolerance: GI immaturity, FI pathophysiology, and clinical definitions
Significance for Nursing and Purpose of Review: Nursing relevance and review objectives
Theoretical Framework and Search Methodology: Roy's Adaptation Model and IOWA Model search strategy
Literature Review: Four studies on massage and feeding tolerance outcomes
Conclusion: Massage benefits confirmed; future research needed

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What makes this paper effective

The paper clearly defines its PICO question and consistently applies it throughout the review, giving the argument a focused clinical purpose.
It grounds the review in a named nursing theory (Roy's Adaptation Model) and an evidence-based practice framework (the IOWA Model), demonstrating familiarity with graduate-level nursing research methodology.
Each study in the literature review is summarized with attention to design, sample, intervention, and outcome, allowing meaningful cross-study comparison.

Key academic technique demonstrated

The paper exemplifies integrative literature review methodology: the author synthesizes findings across four primary studies rather than simply summarizing them in sequence, drawing conclusions about convergent outcomes (reduced abdominal circumference, lower gastric residual volumes) and noting where further research is needed. Explicitly operationalizing the outcome variables at the outset strengthens the review's internal consistency.

Structure breakdown

The paper follows a standard nursing research review format: Introduction (scope and burden of the problem) → Background (pathophysiology and conceptual definitions) → Significance and Purpose → Theoretical and Methodological Framework → Literature Review (four studies) → Conclusion with recommendations for future research. This logical progression moves from problem identification through evidence synthesis to practice implications.

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Essay 2,364 words

Introduction

Despite major medical advancements over several decades, nearly 10 percent of births in the United States continue to occur prematurely each year (Martin, Hamilton, Osterman, Driscoll, & Matthews, 2017). Creating a significant socioeconomic burden, preterm birth is one of the leading causes of infant morbidity and mortality in the United States, resulting in approximately $16.9 billion in medical care costs annually (Institute of Medicine [IOM], 2007). After days, weeks, or even months of intensive care, weight gain becomes a major criterion for hospital discharge. Feeding intolerance (FI) is a common complication among preterm infants that disrupts enteral feeding, resulting in feeding advancement delays, prolonging adequate weight gain and growth, and increasing hospital stays (Carter, 2012). Additionally, FI is associated with necrotizing enterocolitis (NEC), a gastrointestinal emergency and a leading cause of morbidity and mortality in this patient population (Moore & Wilson, 2011). The underlying cause of these problems is associated with the infant's immature gastrointestinal tract. Thus, optimizing enteral nutrition to support normal growth and development without increasing the risks of NEC becomes a challenging task for nurses and neonatologists.

Background and Conceptual Definition of Feeding Intolerance

Several strategies are used to improve feeding intolerance, including the use of standardized feeding protocols, early trophic feedings, human milk feedings, continuous or slow gavage feedings, infant body placement post-feeding, thickening of feeds, and the use of medications and pre- or probiotics (Dutta et al., 2015; Fanaro, 2013). Despite these interventions, an adequate solution to the problem remains unclear. Part of the difficulty may stem from a poor understanding and inconsistent definition of feeding intolerance.

Various factors are thought to contribute to the pathophysiology of FI. Biochemical and functional maturation of the gastrointestinal system normally occurs gradually over the last trimester of pregnancy; however, in the preterm infant, mechanical function, enzymatic digestion, hormonal responses, bacterial colonization, and local immunity are impaired (Fanaro, 2013). Delayed gastric emptying and reduced motility resulting in abnormal sphincter tone are attributed to the immaturity of duodenal motor function and the absence of coordination between the antrum and duodenum (So, Ng, & Fok, 2003). As a physiologic consequence, infants born prematurely present with many of the symptoms associated with FI, including gastric residuals, abdominal distension, delayed meconium passage, and emesis (Fanaro, 2013).

Moore and Wilson (2011) conceptually define feeding intolerance in the preterm infant as the inability to digest enteral feeding, presented as gastric residual volumes (GRV) of more than 50%, abdominal distention or emesis or both, and disruption of the patient's feeding plan. Carter (2014) further develops the concept of FI to include apnea, bradycardia, and temperature instability as additional symptoms of FI for nursing assessment in her guidelines of care. Fanaro (2013) agrees with the above definition and further elaborates to include delayed meconium passage as a contributing factor, concluding that the interpretation of these clinical symptoms is difficult when accounting for multiple confounding variables such as the safety of nutritional supply and various prenatal, perinatal, and postnatal environments of the preterm infant. For the purposes of this review, the conceptual definition of feeding intolerance described by Moore and Wilson (2011) will be used, and outcome variables are operationally defined to include a reduction in GRV, reduced abdominal distention measured by abdominal circumferences, reduced daily emesis, and increased frequency of stools.

Significance for Nursing and Purpose of Review

The information provided in this review can assist nurses in deciding whether massage therapy can be used as a nursing intervention to increase infant adaptation and improve gastrointestinal function. The overall benefit of the intervention would be improved weight gain leading to reduced hospital stays.

The purpose of this review is to identify, critically appraise, and present new research investigating the use of massage therapy as an intervention for reducing feeding intolerance in infants born before 37 weeks gestation.

2 Sections Hidden · 810 words

Theoretical Framework and Search Methodology330 words

Roy's Adaptation Model, which emphasizes patient adaptation to the environment, is an ideal conceptual framework to address the PICO question: Does providing massage, as compared to standard care only, to infants born less than 37 weeks gestation, improve feeding intolerance? Essentially, the Roy Adaptation Model (RAM) emphasizes positive, constant interaction and…

Literature Review480 words

The neonatal timespan is one of the most susceptible phases for the infant. In particular, there continues to be a high death rate of…

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Conclusion

Despite significant technological developments over the past decade, approximately 10 percent of babies born annually in the United States are premature. One of the most pressing problems experienced by preterm infants is feeding intolerance, which encompasses impaired metabolic functions, inability to properly swallow, suck, and gag, fragile abdominal muscles, restricted nutrient storage, minimal stomach capacity, and diminished ability to digest and absorb nutrients. Research conducted by Shaeri et al. (2017), Tekgunduz et al. (2014), Kim and Bang (2017), and Choi et al. (2016) has shown positive results for providing massage to infants to improve feeding tolerance. Massage administered regularly to premature infants after feeding has been shown to increase mean abdominal circumference values, diminish the recurrence of vomiting incidents, and significantly reduce gastric residual volume. However, future research encompassing larger participant samples, greater numbers of massage sessions, and longer intervention periods is needed to establish robust clinical guidelines for this promising nursing intervention.

References

Carter, B. M. (2012, December 1). Feeding intolerance in preterm infants and standard of care guidelines for nursing assessments. Newborn and Infant Nursing Reviews, 12, 187–201. http://dx.doi.org/10.1053/j.nainr.2012.09.007

Choi, H., Kim, S. J., Oh, J., Lee, M. N., Kim, S., & Kang, K. A. (2016). The effects of massage therapy on physical growth and gastrointestinal function in premature infants: A pilot study. Journal of Child Health Care, 20(3), 394–404.

Dutta, S., Singh, B., Chessell, L., Wilson, J., Janes, M., McDonald, K., … Fusch, C. (2015). Guidelines for feeding very low birth weight infants. Nutrients, 7, 423–442. http://dx.doi.org/10.3390/nu7010423

Fanaro, S. (2013, August 17). Feeding intolerance in the preterm infant [Supplemental article]. Early Human Development, 89, S13–S20. http://dx.doi.org/10.1016/j.earlhumdev.2013.07.013

Field, T., Diego, M., & Hernandez-Reif, M. (2010). Preterm infant massage therapy research: A review. Infant Behavior and Development, 33(2), 115–124. http://dx.doi.org/10.1016/j.infbeh.2009.12.004

Field, T., Diego, M., & Hernandez-Reif, M. (2011, June). Potential underlying mechanisms for greater weight gain in massaged preterm infants. Infant Behavior and Development, 34, 383–389. http://dx.doi.org/10.1016/j.infbeh.2010.12.001

Institute of Medicine. (2007). Preterm birth: Causes, consequences, and prevention [PDF version]. http://dx.doi.org/10.17226/11622

Kim, H. (2017). The effects of Enteral Feeding Improvement Massage (EFIM) on premature infants: A randomized controlled trial. Journal of Clinical Nursing.

Martin, J. A., Hamilton, B. E., Osterman, M. J., Driscoll, A. K., & Matthews, T. J. (2017). Births: Final data for 2015 [National vital statistics reports, DHHS Publication No. 2017–1120]. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf

Modrcin-Talbott, M. A., Harrison, L. L., Groer, M. W., & Younger, M. S. (2003). The biobehavioral effects of gentle human touch on preterm infants. Nursing Science Quarterly, 16(1), 60–67. http://dx.doi.org/10.1177/0894318402239068

Moore, T. A., & Wilson, M. E. (2011). Feeding intolerance: A concept analysis. Advances in Neonatal Care, 11(3), 149–154. http://dx.doi.org/10.1097/ANC.0b013e31821ba28e

Nyqvist, K. H., & Karlsson, K. H. (1997, June). A philosophy of care for a neonatal intensive care unit: Operationalization of a nursing model. Scandinavian Journal of Caring Sciences, 11(2), 91–96. http://dx.doi.org/10.1111/j.1471-6712.1997.tb00438.x

Polit, D. F., & Beck, C. T. (2017). Theoretical frameworks. In Nursing research: Generating and assessing evidence for nursing practice (10th ed., pp. 117–136). Philadelphia, PA: Wolters Kluwer.

Roy, C. (2011, October 5). Research based on the Roy Adaptation Model: Last 25 years. Nursing Science Quarterly, 24, 312–320. http://dx.doi.org/10.1177/0894318411419218

Shaeri, M., Ghadami, A., Valiani, M., Armanian, A. M., & Amini Rarani, S. (2017). Effects of abdominal massage on feeding tolerance in preterm infants hospitalized in selected hospitals of Isfahan, Iran. International Journal of Pediatrics, 5(3), 4503–4510.

So, A. K., Ng, P. C., & Fok, T. G. (2003). Gastrointestinal dysmotility in preterm infants. Hong Kong Journal of Paediatrics, 8, 101–106. Retrieved from http://hkjpaed.org/details.asp?id=140&show=12345&artcount=F

Tekgündüz, K. Ş., Gürol, A., Apay, S. E., & Caner, İ. (2014). Effect of abdomen massage for prevention of feeding intolerance in preterm infants. Italian Journal of Pediatrics, 40(1), 89.

Key Concepts in This Paper

Feeding Intolerance Preterm Infant Abdominal Massage Gastric Residual Volume Roy's Adaptation Model NICU Nursing Enteral Feeding Necrotizing Enterocolitis IOWA Model GI Maturation