Early intervention centred on infant massage in preterm infants: effects on brain development

Preterm birth can be associated with long-term neurodevelopmental abnormalities, including motor delay, reduced cognitive performance and behavioural problems. This is at least partly explained by the detrimental effects of a highly stressful environment and the lack of tactile stimulation normally experienced in the womb. We have recently shown that an early intervention in preterm newborns based on infant massage accelerates brain development, resulting in a pattern more similar to that observed in term-born infants. This might suggest that massage therapy favours a process of brain maturation more similar to that observed in full-term infants, possibly through an attenuation of the differences between the extrauterine and the intrauterine environment. In our previous studies, massage was delivered by a physiotherapist in the NICU, and no measures of brain structure were obtained with advanced imaging techniques. In the present project we propose several innovations that will clarify some of the remaining controversies on the effect of infant massage on neurodevelopment. In particular, the mothers will directly provide the massage as part of the intervention program, likely enhancing the effectiveness of the intervention. Also, the short term effects of infant massage on brain structure and function will be explored with advanced neuroimaging techniques, which will provide new insights into the neurobiological correlates of massage. We recruited 20 singleton preterm infants (gestational age 28-30 weeks) born at the Royal Brisbane and Women’s Hospital or the S. Chiara Hospital, Pisa, Italy (with parental informed consent), and we will randomly allocate them to one of two groups (intervention group or control group). Following a short training period, mothers of the intervention group were asked to perform three massage sessions per day, starting from day 14 and lasting at least until term equivalent age. Infants of the control group underwent routine care and there will be no specific interventions. The effects of massage were measured at short term (term age) using advanced neuroimaging and EEG techniques that allowed us to explore several aspects of brain microstructure and function. Short-term effects on mother’s mood and anxiety and on mother-infant bonding were also explored by means of structured scales and questionnaires. Long-term (24 months) outcome measures assessed child development, parent child interaction and parental psychological, social and emotional problems. Our results on the effects of the intervention on mother’s mental health and mother-infant relationship are promising, demonstrating the potential role of infant massage in decreasing indexes of maternal depression, anxiety and stress while enhancing maternal responsiveness and self-efficacy as well as maternal representations of attachment. We have also shown how new neuroimaging and high-density EEG techniques are sensitive to the functional and structural modifications associated to early intervention and can be used to validate their effects . The assessment of structural and functional connectivity can be effectively investigated in newborn infants with no need for sedation and no other risks. It is of great interest that objective measures of brain connectivity appear to reflect the maturation of functional processes of the preterm brain. The group differences we found between massaged and controls, albeit very preliminary and not yet supported by reliable statistics, are promising and seem to go towards the demonstration of measureable effects of early intervention upon brain maturation.