Comparison of the Effectiveness of Bath and Massage in Bilirubin Levels in Neonates

Document Type : Original Article


1 School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background: Jaundice is one of the most common health problems among neonates, involving almost 60% of full-term newborns, therefore requiring consequent phototherapy. Since phototherapy has several complications, considering alternative treatments has long been of pivotal importance. Therefore, the present study aimed at comparing the effectiveness of bath and massage in bilirubin levels in neonates.
Methods: This was a randomized clinical trial conducted on neonates who were born in Zeyaei Hospital in Ardakan, Iran, in 2018. A total of 90 neonates were selected using the convenience sampling method and then assigned into two intervention groups (i.e., bath group and massage group) and a control group through random allocation method. In the bath group, the neonates were bathed immediately after birth. In the massage group, the neonates received field massage twice a day each lasting 15 min for 5 consecutive days. The neonates belonging to the control group were served with routine care. The jaundice meter China 800 (jk) device was used to measure the skin bilirubin levels of the neonates in the three groups in a scheduled manner (i.e., days 1, 3, 5, and 7) at 9 a.m. The data were analyzed using the ANOVA, Chi-square test, Tukey's post hoc test, and repeated measures ANOVA in SPSS software (version 18).
Results: There was no significant difference between the mean bilirubin scores of the three groups over the first, third, and fifth days. A significant difference was found between the mean bilirubin scores of the bath and massage groups compared with that of the control group on the seventh day (P=0.001). Also, no significant difference was seen between the mean bilirubin levels of the bath and massage groups on the seventh day.
Conclusion: The findings revealed that there was no difference between the bath and massage techniques in reducing neonatal jaundice. Therefore, both techniques can be utilized in this regard.


1. Najib KS, Saki F, Hemmati F, Inaloo S. Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in the south of Iran (Fars Province). Iran Red Crescent Med J. 2013; 15(3):260-3. 2. Watchko JF. Identification of neonates at risk for hazardous hyperbilirubinemia: emerging clinical insights. Pediatr Clin North Am. 2009; 56(3):671-87.
3. Mirfazeli A, Najafi L, Noohi AH, Cheraghali R. Investigation of caused of severe indirect hyperbilirubinemia in Gorgan. J Gorgan Univ Med Sci. 2009; 11(4):82-6.
4. Geiger AM, Petitti DB, Yao JF. Rehospitalisation for neonatal jaundice: risk factors and outcomes. Paediatr Perinat Epidemiol. 2001; 15(4):352-8.
 5. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008; 358(9): 920-8.
 6. Basiri-Moghadam M, Basiri-Moghadam K, Kianmehr M, Jani S. 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.
 7. Seyyedrasooli A, Valizadeh L, Hosseini MB, Aagari Jafarabadi M, Mohammadzad M. Effect of vimala massage on physiological jaundice in infants: a randomized controlled trial. J Caring Sci. 2014; 3(3):165-73.
8. Kianmehr M, Moslem A, Moghadam KB, Naghavi M, Noghabi SP, Moghadam MB. The effect of massage on serum bilirubin levels in term neonates with hyperbilirubinemia undergoing phototherapy. Nautilus. 2014; 128:36-41.
9. Field T, Diego M, Hernandez-Reif M. Preterm infant massage therapy research: a review. Infant Behav Dev. 2010; 33(2):115-24.
10. 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.
11. Lin CH, Yang HC, Cheng CS, Yen CE. Effects of infant massage on jaundiced neonates undergoing phototherapy. Ital J Pediatr. 2015; 41(1):94.
12. Keshavarz M, Bolbol Haghighi N. Effects of kangaroo contact on some physiological parameters in term neonates and pain score in mothers with cesarean section. Koomesh. 2010; 11(2):91-8.
 13. Lei M, Liu T, Li Y, Liu Y, Meng L, Jin C. Effects of massage on newborn infants with jaundice: a metaanalysis. Int J Nurs Sci. 2018; 5(1):89-97.
14. Li Wang TS, Wang YY, Cao H. The effect of traditional Chinese medicine washing combined with massage for neonatal jaundice: a meta-analysis. TMR Integr Nurs. 2018; 1(2):36-44.
 15. Xiaohua Z, Huijuan C, Qundi L. Effect of hydrotherapy on neonates. Modern Clin Nurs. 2006; 4:16.
16. Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol. 2015; 33(3):271-80.
 17. Lund C. Bathing and beyond: current bathing controversies for newborn infants. Adv Neonatal Care. 2016; 16:S13-20.
 18. Brogan J, Rapkin G. Implementing evidence-based neonatal skin care with parent-performed, delayed immersion baths. Nurs Womens Health. 2017; 21(6):442-50
 19. Blume‚ÄźPeytavi U, Cork MJ, Faergemann J, Szczapa J, Vanaclocha F, Gelmetti C. Bathing and cleansing in newborns from day 1 to first year of life: recommendations from a European round table meeting. J Eur Acad Dermatol Venereol. 2009; 23(7):751-9.
20. Hong QG. Study on the effect of peripheral blood bilirubin of neonate by swimming. J Nurses Train. 2006; 1:3.