Effect of Massage Therapy on Transcutaneous Bilirubin Level in Healthy Term Neonates: Randomized Controlled Clinical Trial

Document Type : Original Article


1 Department of Neonatology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Department of Neonatology, Dr. Kermanshahi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran


Background: Neonatal jaundice is a common condition in approximately 60% of term newborns during the first week after birth. Therefore, it is necessary to detect methods for the prevention of this problem.This study was conducted to evaluate the impact of massage therapy on transcutaneous bilirubin level in healthy term newborns.
Methods: The present study was conducted on102 healthy term newborns. The newborns were randomly assigned to massage group and control group. The massage group received daily massage for five days from the first postnatal day while the control group received only routine neonatal care (without massage). In both groups, transcutaneous bilirubin level and frequency of defecation were the main studied variables.
Results: The frequency of defecation in the massage group increased from 1.08 on the first day to 4.08 on the fifth day, whereas it increased from 0.865 on the first day to 2.731 on the fifth day in the control group, indicating a significant difference between the two groups (P<0.005). Moreover, transcutaneous bilirubin levels on the first and second days were not significantly different in both groups, while it was significantly lower during the third to fifth days in the massage group compared to that in the control group (P<0.005).
Conclusion: The results of this study revealed that massage therapy could reduce transcutaneous bilirubin level and increase the frequency of defecation in healthy term neonates. 


1. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008; 358(9):920-8. 2. Martin RJ, Fanaroff AA, Walsh MC. Neonatal jaundice and liver disease. Fanaroff and martin's neonatalperinatal medicine: diseases of the fetus and infant. 10th ed. Philadelphia: Mosby Elsevier; 2015.
3. Kaplan M, Bromiker R, Hammerman C. Severe neonatal hyperbilirubinemia and kernicterus: are these still problems in the third millennium? Neonatology. 2011; 100(4):354-62.
 4. Chen J, Sadakata M, Ishida M, Sekizuka N, Sayama M. Baby massage ameliorates neonatal jaundice in fullterm newborn infants. Tohoku J Exp Med. 2011; 223(2):97-102.
5. Dennery PA, Lorch S. Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development. Pediatrics. 2007; 120(1):247-8.
6. Newman TB, Maisels MJ. Evidence Insufficient to recommend melanoma surveillance following phototherapy for jaundice. Arch Dermatol. 2007; 143(9):1216-7.
7. Smith SL, Lux R, Haley S, Slater H, Beachy J, MoyerMileur LJ. The effect of massage on heart rate variability in preterm infants. J Perinatol. 2013; 33(1):59-64.
 8. Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Massage and touch therapy in neonates: the current evidence. Indian Pediatr. 2010; 47(9):771-6.
9. Field T. Massage therapy. Med Clin North Am. 2002; 86(1):163-71.
10. Moyer-Mileur LJ, Haley S, Slater H, Beachy J, Smith SL. Massage improves growth quality by decreasing body fat deposition in male preterm infants. J Pediatr. 2013; 162(3):490-5.
 11. Zhao H, Guan L, Shi G. The effects of infant touch on neonatal jaundice. Chin J Nurs. 2003; 10:772-3.
12. Guiping L. The influence of defecation and icterous of newborn children on touching. Heilongjiang Nurs J. 2002; 8(3):472-34.
13. Meng Z, Hua C, Chongyu Y. Observation of the effect of caress on defecation and jaundice of newborn. J Qilu Nurs. 2006; 12(6):449-514.
14. Semmekrot BA, Gerrits GP. Optimal breastfeeding to prevent hyperbilirubinaemia in healthy, term newborns. Ned Tijdschr Geneeskd. 2004; 148(41): 2016-9.
15. Volosovets ОP, Мarkevich VЕ, Tarasova ІV, Loboda АМ. Introduction to neonatology. 2nd ed. Tokyo: Medical Academy of Classical Learning; 1994. P. 639.
16. Dalili H, Sheikhi S, Shariat M, Haghnazarian E. Effects of baby massage on neonatal jaundice in healthy Iranian infants: a pilot study. Infant Behav Dev. 2016; 42:22-6.
 17. Seyyedrasooli A, Valizadeh L, Hosseini MB, Asgari Jafarabadi M, Mohammadzad M. Effect of vamila massage on physiological jaundice in infants: a randomized controlled trial. J Caring Sci. 2014; 3(3):165-73.
18. Field T, Diego M, Hernandez-Reif M. Moderate pressure is essential for massage therapy effects. Int J Neurosc. 2010; 120(5):381-5.
19. Basiri-Moghadam M, Basiri-Moghadam K, Kianmehr M, JaniS. The effect of massage on neonatal jaundice in stable preterm newborn infants: a randomized controlled trial. J Pak Med Assoc. 2015; 65(6):602-6.
 20. Lin CH, Yang HC, Cheng CS, Yen CE. Effects of infant massage on jaundiced neonates undergoing phototherapy. Ital J Pediatr. 2015; 41:94.