Journal of Pediatric Nursing (2016) 31, e313–e322

A Meta-Analysis of the Efficacy and Safety of

Using Oil Massage to Promote Infant Growth
Xiwen Li RN, BSN, Qingling Zhong RN, MD ⁎, Longhua Tang RN, BSN
School of Nursing, Nanchang University, Nanchang, China

Received 9 December 2015; revised 12 April 2016; accepted 12 April 2016

Key words:
Problem The synthesizing evidence on the effectiveness of using oil massage to promote the growth of
Infant;
infants is still lacking. This paper aims to determine whether oil massage can promote the physical and
Oil;
neurobehavioral growth of infants according to variables and to evaluate whether oil massage is safe for
Massage therapy;
infant skin.
Growth and development;
Eligibility Criteria: The randomized controlled trials, clinical controlled trials and quasi-experimentally
Meta-analysis
designed trials published prior to or in 2014 were searched according to predetermined inclusion criteria
and exclusion criteria in Medline, PubMed, Ovid, the Cochran Library, and Chinese databases,
including the China National Knowledge Infrastructure, Wan Fang database and VIP journal integration
platform. Besides, the grey lectures were searched as well through Open Grey, GrayLIT Network and
Clinical Trials.gov.
Sample: Eight studies out of 625 retrieved articles were eligible for inclusion.
Results: Oil massage increased the infant weights, lengths and head circumferences. However, it did not
promote a significant advantage in neurobehavioral scores or cause a significant risk of adverse skin
reactions.
Implications: The core mechanisms and standard procedures of oil massage as well as the preferred oil
type should be the focus of future nursing practice and research.
Conclusions: Oil massage may effectively improve the physical growth of infants, and it presents a
limited risk of adverse skin reactions. However, the relationship between neurodevelopment and oil
massage requires further study.
© 2016 Elsevier Inc. All rights reserved.

OIL MASSAGE IS a traditional practice in many
countries, especially on the African and Asian continents,
Indian subcontinent and Mediterranean region, which have
used oil massage as part of newborn care for hundreds of
years. The practice of oil massage has also gained favor in
the neonatal intensive care units of developed countries
(Ahmed et al., 2007; Darmstadt & Saha, 2002).
In the western world, however, parents and nurses are
only taught massage to promote the development of low-risk
babies who do not have a low birth weight (Underdown,
Barlow, Chung, & Stewart-Brown, 2006), which may be
caused by a lack of exact information on the underlying
mechanisms of an effective infant massage. In addition, there
were no fixed guidelines describing the exact methodology
of infant massage. The practice of infant massage varies
across the world, and western cultures have adapted certain
traditional practices from eastern cultures. For example,
although the International Association of Infant Massage
teaches the use of nurturing touch and respectful communi-
cation in its training, other methods of training may
emphasize yoga-based movements and flexibility (Abdallah,
Badr, & Hawwari, 2013).

Background
⁎ Corresponding author: Qingling Zhong, RN, MD. Over the past decade, a number of researchers have
E-mail address: qingling5218@163.com. explored the effects of oil and massage on infant growth or

http://dx.doi.org/10.1016/j.pedn.2016.04.003
0882-5963/© 2016 Elsevier Inc. All rights reserved.
e314
development during postnatal period. Investigations into the
effects of infant massage have mainly been conducted on
preterm infants and have focused on the infants' physical growth
and neurodevelopment, activity and motility levels, hospital stay
length and sleep behavior, among other outcomes. Massage has
been recommended as an intervention for promoting the growth
and development of preterm and low birth weight infants in
these studies (Abdallah et al., 2013; Diego, Field, &
Hernandez-Reif, 2005; Ho, Lee, Chow, & Pang, 2010;
Kelmanson & Adulas, 2006; Procianoy, Mendes, & Silveira,
2010; Vickers, Ohlsson, Lacy, & Horsley, 2004). Other
investigations into the effects of oil massage have suggested
that all types of oil act as a source of warmth and nutrition when
applied to infant skin, and they have the potential to prevent
infection and body temperature loss by improving the skin
barrier function and reducing the incidence of late hypothermia.
As a result, oil appears to offer a number of potential benefits for
neonatal growth (Darmstadt et al., 2002; Darmstadt et al., 2004;
Darmstadt et al., 2005; Lee, Gibson, & Simmer, 1993; Soriano,
Martinez, & Jorge, 2000). In addition, an early survey suggested
that massage could reduce infant hospital stays and hospital
costs (Field, Hernandez-Reif, & Freedman, 2004).
However, a few studies have explored the effects of
combining oil with massage for infants, and the attitude
towards oil massage has not been consistent. There is still a
paucity of integrated evidence on the efficacy and safety of
oil massage for infants. Therefore, we performed a
meta-analysis to assess the influence of oil massage on
infant to provide integrated evidence for neonatal nursing.
The Review
Aims
To determine whether oil massage can promote the physical
and neurobehavioral growth of infants according to variables
such as weight, length, head circumference and neurobehav-
ioral scores and to evaluate whether oil massage is safe for
infant skin based on the incidence of adverse skin reactions.
Search Method
Relevant studies were identified by searching the
following electronic databases for articles published up to
December 2014, the last search was performed on 31
December 2014: Medline (1950–2014), Pubmed (1865–
2014), Ovid (1993–2014), the Cochran Library (1990–
2014) and Chinese common databases, including the China
National Knowledge Infrastructure (CNKI) (1979–2014),
WanFang database (1990–2014) and VIP journal integration
platform (1989–2014). In addition, grey literatures were
searched as far as possible through Open Grey, GrayLIT
Network and Clinical Trials.gov. The search words con-
tained the various combinations of MeSH (Medical Subject
Headings) and free words as follows: 'infant' (MeSH),
'newborn,' 'neonate,' 'baby,' 'massage' (MeSH) and 'oils'
(MeSH). The studies were not screened based on language.
All of the citations were imported to the Note Express
X. Li et al.
management software (Beijing Aegean Technologies Co.
Ltd. Beijing, China) to remove duplicates and screen the
literature according to the title and abstract. We then
accessed the full text of relevant studies to confirm the
details. Two reviewers independently performed this pro-
cess, and disagreements were resolved by consensus with a
third reviewer.
The inclusion criteria were formulated according to the
PICOS model: (a) participants: infants from birth to
23 months of age; (b) intervention: massage combined
with all types of oils (with massage referring to the manual
application of moderate stress on some part of the body with
a regular technique that is different from general touching of
babies); (c) control: blank or massage-only (massage without
oil or massage with placebo); (d) outcomes: weight, body
length, head circumference, neurobehavioral scale score or
adverse skin reaction; (e) study type: randomized controlled
trial (RCT), clinical controlled trial (CCT) or quasi-exper-
imentally designed trial.
The exclusion criteria of article: (a) participants: adults or
animals; (b) intervention: only included oil or massage or
general touch rather than massage or there were comprehen-
sive interventions that included oil massage; (c) study type:
not RCT, CCT and quasi-experimentally designed trials; (d)
other: duplicate publication, and full texts were not available
through various methods.
Search Outcome
A total of 625 articles were retrieved, including 296
studies in English and 329 studies in Chinese. First, all of the
retrieved articles were imported to the Note Express
management software to identify and remove duplicates.
Second, 550 references were screened to remove clearly
inappropriate articles according to the title and abstract.
Then, the full texts of 14 articles were accessed to acquire
additional details. The reference lists of relevant studies were
screened using the snowball method and the grey literature
was also searched. However, available studies or data were
not found. Ultimately, eight studies that were published in
peer-reviewed journals met the inclusion criteria of this
meta-analysis (Figure 1).
Quality Appraisal
Two authors independently performed a quality assess-
ment, and disagreements were resolved through consulta-
tions with a third reviewer. Random sequence generation,
allocation concealment, blinded participants and personnel,
blinded outcome assessments, incomplete outcome data,
selective reporting and other biases were used to appraise the
original studies using the Cochrane collaboration tool for
assessing the risk of bias.
Data Abstraction
For data extraction, two authors independently applied a
checklist that was adapted from chapter 7.3 of the Cochrane
Oil Massage to Promote Infant Growth
Figure 1 Flowchart of the screening process.
Handbook (Higgins & Green, 2011). All disagreements were
resolved by consensus with a third reviewer. The extracted
data included the following: authors, publication year and
country, participants, study design, intervention, control,
outcomes, inclusion and exclusion criteria, setting, and
follow-up data.
Synthesis
Review Manager 5.3 was used to perform the meta-ana-
lysis, and the weighted mean differences (WMD) and 95%
confidence intervals (CIs) of continuous outcomes were
estimated. However, when the continuous outcome was
expressed in different units, the standardized mean difference
(SMD) between groups was estimated. The risk ratio (RR)
and 95% CIs of the dichotomous outcomes were also
calculated. A p-value of b 0.05 was considered statistically
significant, and the heterogeneity among the studies was
considered significant at a Cochran's Q statistic of p b 0.0
and I2 metric of N 50%, which was divided into low
heterogeneity (I 2 ≤ 25%), moderate heterogeneity
(25% b I2 ≤ 50%), high heterogeneity (50% b I2 b 75%),
and extreme heterogeneity (I2 ≥ 75%). If heterogeneity was
observed between studies (I2 N 50%), then random-effect
models and sensitivity analyses were adopted; otherwise,
fixed effect models were used (Higgins & Thompson, 2002;
Higgins, Thompson, Deeks, & Altman, 2003).
For studies with several intervention groups, we com-
bined the intervention groups to create a single pair-wise
comparison to which the results of this study were
incorporated. When studies had more than one control
group, preference was given to untreated control groups. If
the study included a mixture of two forms of an outcome,
e315
such as change-from-baseline data and final value scores, we
were advised to analyze them separately to avoid confusion
according to chapter 7.7 of the Cochrane Handbook (Higgins
& Green, 2011).
Results
Description of Included Studies
The eight articles included seven RCTs (Agarwal
et al., 2000; Arora, Kumar, & Ramji, 2005; Fallah,
Akhavan, Golestan, & Fromandi, 2013; Kumar et al.,
2013; Sankaranarayanan et al., 2005; Solanki et al., 2005;
Zhao, Pi, & Chen, 2014) and one quasi-experimentally
designed trial (Jansi, 2008), and they were all published
between 2000 and 2014. Among these, seven were written in
English and one was written in Chinese. The sample size
ranged from 48 to 125 participants, and the pooled sampled
size was 677. The length of the intervention varied from 5 to
31 days. Four studies used sunflower oil massage in the
intervention group (Arora et al., 2005; Fallah et al., 2013;
Kumar et al., 2013; Zhao et al., 2014) and one study used
coconut oil massage in the intervention group (Jansi, 2008).
Because the remaining studies had more than one interven-
tion group, we combined the intervention groups to create
a single pair-wise comparison (Agarwal et al., 2000;
Sankaranarayanan et al., 2005; Solanki et al., 2005). Three
articles had an untreated control group (Agarwal et al., 2000;
Jansi, 2008; Kumar et al., 2013), four articles had a
massage-only control group (Fallah et al., 2013;
Sankaranarayanan et al., 2005; Solanki et al., 2005; Zhao
et al., 2014); and one article had both untreated and
massage-only control groups, with preference given to the
untreated control group (Arora et al., 2005). A point worth
stressing is that one article analyzed the effects of oil
massage on full-term and preterm infants (Sankaranarayanan
et al., 2005); however, because this study had multiple
intervention groups, we extracted the data for full-term and
preterm infants as two independent research studies to avoid
a bias result from excessive combinations. Similarly, the
follow-up data at one and two months were treated as four
groups of independent data from two studies (Fallah et al.,
2013; Zhao et al., 2014). The characteristics of the included
studies are summarized in Table 1.
Most of the studies had a low risk of bias across the seven
domains. Six studies produced a random sequence using a
computer-generated random number list, and another two
studies did not report the method used (Jansi, 2008; Zhao
et al., 2014). Four studies conducted allocation concealment
(Arora et al., 2005; Fallah et al., 2013; Kumar et al., 2013;
Sankaranarayanan et al., 2005), although the remaining
studies did not report on this in detail. Only two studies
adopted the blinding method (Fallah et al., 2013; Solanki
et al., 2005). The study had selective reporting bias because
the authors did not report the reason for lost to follow-up
(Sankaranarayanan et al., 2005). None of studies presented
reporting bias, and one study presented bias from the study
e316 X. Li et al.

Table 1 Characteristics of the studies enrolled in this meta-analysis

First author and Study design Objects Number Intervention group Control group Duration of Measures
year of subjects intervention (day)
Agarwal 2000 RCT Full term 125 Herbal oil massage Blank 28 Weight gain (kg)
objects Sesame oil massage Length gain (cm)
Mustard oil massage Head circumference (cm)
mineral oil massage
Arora 2005 RCT Preterm 62 Sunflower oil Only massage 28 Weight gain (g)
objects massage Blank Weight gain velocity (g/kg/day)
Length (cm)
Head circumference (cm)
Neurobehavioral score
Fallah 2013 RCT Preterm 54 Sunflower oil Only massage 14 Weight (g)
objects massage Length (cm)
Head circumference (cm)
Adverse reaction
Jansi 2008 Quasi- objects 64 Coconut oil massage Blank 5 Weight (g)
experimental Neurobehavioral score
Kumar 2013 RCT Preterm 48 Sunflower oil Blank 28 Weight (g)
objects massage Weight gain (g)
Length (cm)
Head circumference (cm)
Sankaranarayanan RCT Full term 192 Coconut oil massage Only massage 31 Weight gain (g)
2005 objects Mineral oil massage Weight gain velocity (g/kg/day)
Preterm Length (cm)
objects Head circumference (cm)
Neurobehavioral score
Adverse reaction
Solanki 2005 RCT objects 118 Safflower oil massage Only massage 5 Adverse reaction
Coconut oil massage
Zhao 2014 RCT Preterm 78 Sunflower oil Only massage 21 Weight (g)
objects massage Length (cm)
Head circumference (cm)
Adverse reaction
Abbreviations: RCT, randomized controlled trials.

design (Jansi, 2008). The results of the quality assessment
are shown in Graph 1.
Effects of Oil Massage on Infant Physical
Parameters
Effects of Oil Massage on Infant Weight
In all of the included studies, three outcome types
reflected an increase in body weight (weight, weight gain
and weight gain velocity). 'Weight' is the final infant weight
after intervention. 'Weight gain' corresponds to the change-
from-baseline data, namely the difference value between the
final and baseline data. 'Weight gain velocity' is the growth
speed of the standardized weight. Because these three
outcomes cannot be combined and mutually transformed,
we analyzed them separately to avoid confusion as
advised by chapter 7.7 of the Cochrane Handbook (Higgins
& Green, 2011).
Weight. Five studies that included a total of 401
participants provided data for the infant weight analysis
immediately after the intervention (Arora et al., 2005; Fallah
et al., 2013; Jansi, 2008; Kumar et al., 2013;
Sankaranarayanan et al., 2005). The meta-analysis showed a
significant increase in weight for the oil massage intervention
[SMD = 0.23, 95% CI (0.03–0.44), p = 0.02]. The hetero-
geneity between studies was low (I2 = 22%). Two studies
that had a total of 264 participants provided follow-up data
for the weights at one and two months (Fallah et al., 2013;
Zhao et al., 2014). The results of the meta-analysis indicated
that infant massage significantly increased weight
[SMD = 1.19, 95% CI (0.93–1.46), p b 0.00001], and
heterogeneity was not observed (I2 = 0) (Figure 2).
Weight gain. Three studies that had a total of 216
participants provided data on the weight gain immediately
post-intervention (Agarwal et al., 2000; Arora et al., 2005;
Kumar et al., 2013). The oil massage intervention for infants
promoted weight gain of 138.18 g [95% CI (112.82–163.54,
p b 0.00001], and heterogeneity was not observed (I2 = 0).
(Figure 2).
Oil Massage to Promote Infant Growth e317

Figure 2 Forest plots of the association between oil massage and the increase in infant weight. The weight, the standardized mean
differences or the mean difference and the corresponding 95% CI of each study are indicated. Abbreviations: CI, confidence interval; IV,
inverse variance; and SD, standard deviation.

Weight gain velocity. Two studies evaluated the impact of
infant oil massage on the weight gain velocity following the
intervention (Arora et al., 2005; Sankaranarayanan et al.,
2005). The meta-analysis revealed a statistically significant
increase that favored oil massage [WMD = 1.07, 95% CI
(0.47–1.67), p b 0.0005], and the heterogeneity was low
(I2 =21%). (Figure 2).
Effects of Oil Massage on Infant Body Length
Four studies evaluated the effectiveness of using oil
massage for infant height (Arora et al., 2005; Fallah et al.,
2013; Kumar et al., 2013; Sankaranarayanan et al., 2005).
The meta-analysis consisted of 337 participants and did not
reveal significant increases in the body length
[WMD = 0.02, 95% CI (− 0.40 to 0.44), p = 0.93], and the
heterogeneity was moderate (I2 = 36%). However, two
studies reported follow-up data for infant height at one
and two months (Fallah et al., 2013; Zhao et al., 2014),
and the meta-analysis showed that oil massage improved
the infant height by 0.41 cm [95% CI (0.08–0.74),
p = 0.02]; in addition, heterogeneity was not observed
(I2 = 0) (Figure 3).
e318 X. Li et al.

Figure 3 Forest plots of the association between oil massage and infant length. The weight, mean difference and the corresponding 95% CI
of each study are indicated. Abbreviations: CI, confidence interval; IV, inverse variance; and SD, standard deviation.

Effects of Oil Massage on the Infant Head Circumference
Four studies evaluated the effectiveness of oil massage on
infant head circumference (Arora et al., 2005; Fallah et al.,
2013; Kumar et al., 2013; Sankaranarayanan et al., 2005). A
meta-analysis that consisted of a total of 337 participants at
post-intervention did not observe significant increases in the
intervention group [WMD = 0.20, 95% CI (− 0.06 to 0.47),
p = 0.13], and the heterogeneity was moderate (I2 = 48%).
However, two studies reported head circumference data after
1–2 months and showed that oil massage improved the
infants' head circumference by 0.32 cm [95% CI (0.24–
0.40), p b 0.00001]; in addition, the heterogeneity was low
(I2 = 6%). (Figure 4).
Effects of Oil Massage on Neurobehavioral Development
Two studies measured the neurobehavioral scale score.
However, these two studies only included two same items:
habituation and state regulation (Arora et al., 2005; Jansi,
2008). Therefore, we only analyzed habituation and state
regulation in this meta-analysis, which did not reveal a
benefit of oil massage for these measures [SMD = 0.22, 95%
CI (− 0.16 to 0.60), p = 0.26; SMD = 0.23, 95% CI (− 0.15

Figure 4 Forest plots of the association between oil massage and infant head circumference. The weight and mean difference and the
corresponding 95% CI of each study are indicated. Abbreviations: CI, confidence interval; IV, inverse variance; and SD, standard deviation.
Oil Massage to Promote Infant Growth e319

Figure 5 Forest plots of the association between oil massage and the neurobehavioral scale score. The weight, the standardized mean
differences and its corresponding 95% CI of each study are indicated. Abbreviations: CI, confidence interval; IV, inverse variance; M-H,
Mantel–Haenszel; and SD, standard deviation.

to 0.61), p = 0.24], and the heterogeneity was high (I2 = 62%;
I 2 = 63%). Because sensitivity analyses could not be
performed, a random-effects model was adopted. (Figure 5).
Effects of Oil Massage on the Rate of Adverse Skin
Reactions
Four studies that consisted of 442 participants measured the
rate of adverse skin reactions after oil massage, which was not
observed to increase the incidence of adverse skin reactions
[RR = 0.69, 95% CI (0.13–3.51), p = 0.65], and the hetero-
geneity was high (I2 = 77%); thus, a random-effects model
was adopted. The meta-analysis of this outcome was
strongly influenced by one study that had inconsistent
results. By removing the Chinese study (Zhao et al., 2014)
from the sensitivity analysis, the results were the same,
although the 95% CI was widened [95% CI (0.49–3.97),
p = 0.53] and the heterogeneity was reduced (I2 = 0%).
(Figure 6).
Discussion
The results of this meta-analysis suggest that oil massage
is effective in promoting increases of infant body weight.
The follow-up data showed that oil massage also promoted
increases of the body length and head circumference. In the
analysis of body length, there was moderate heterogeneity
(I2 = 36), which may have been caused by the different

Figure 6 Forest plots of the association between oil massage and the occurrence of adverse skin reactions. The weight, the risk ratio and its
corresponding 95% CI are indicated. Abbreviations: CI, confidence interval; IV, inverse variance; M-H, Mantel–Haenszel; and SD, standard
deviation.
e320
Graph 1 Quality assessment results of included studies.
practices of oil massage among the studies, including
different massage regions, oil types, frequencies, durations,
dosages, etc. (Bennett, Underdown, & Barlow, 2013).
According to an early survey, although massage was
associated with weight gain, only 38.6% of the NICUs at
90 U.S. hospitals offered infant massage or instructed parents
in infant massage, which may be caused by a lack of
information on the underlying mechanisms of massage
(Field, Diego, & Hernandez-Reif, 2010). Other investiga-
tions pointed out that the potential mechanisms of massage
might include increased vagal activity, gastric activity, IGF-1
and insulin (Cao et al., 2000; Diego, Field, & Hernandez-
Reif, 2014; Field, Diego, & Hernandez-Reif, 2011).
However, the combination of those mechanisms does not
X. Li et al.
explain all of the variance in weight gain, and limited
evidence indicates that massage combined with oils is
superior to massage alone, highlighting the need for
additional mechanism studies.
The results of the meta-analysis indicated that head
circumference was not significantly different between the oil
massage and control groups subsequent to the intervention,
although this result may have been caused by the short
intervention length and delayed effects. The moderate
heterogeneity (I 2 = 48%) might be explained by the
differences rate of normal cranial growth, different massaged
regions, different massage frequencies and durations in the
different studies.
With respect to the neurobehavioral score, we only
analyzed two available items, habituation and state regula-
tion. Although high heterogeneity was observed (I2 = 62%
and I2 = 63%), insufficient data were available to allow for
sensitivity and subgroup analyses. For consistency with
available reviews, two studies were included in the analysis
using a random-effects model. The oil massages were not
observed to impact the infant neurobehavioral score, which
might have been caused by the short intervention length and
delayed effects. A previous study suggested that the
neurodevelopmental effects cannot be observed over short
time periods, and neurodevelopment will improve if this
interaction continues after discharge (Procianoy et al., 2010).
This effect might be associated with neuromotor stimulation
provoked through the activation of the superior colliculus
(Vaivre-Douret et al., 2009). In addition, because the number
of studies on neurobehavioral outcomes was small and
underpowered, these conclusions are weak and require
confirmation with further study.
With respect to adverse skin reactions after intervention,
significant evidence was not observed that oil massage
increases the risk of skin side effects. The heterogeneity was
high (I2 = 65%), which was largely because of the impact of
one study (Zhao et al., 2014) because the remaining two
studies did not show evidence of effectiveness. In these two
studies, the number of adverse skin reactions in the oil
massage group was larger than that in the control group;
however, these adverse reactions were mild and did not
require discontinuation, and they disappeared within 1–2
days (Sankaranarayanan et al., 2005; Solanki et al., 2005).
In the past decade, it has been widely acknowledged that
the application of oil on skin could be used in clinical
nursing. The cutaneous application of oil has been
thoroughly studied, and the benefits mainly include the
following: (a) enhancing the skin barrier function, reducing
infections and saving the lives of newborns (Darmstadt
et al., 2004; Darmstadt et al., 2005); (b) promoting
somatic growth because the fatty acids in the oil provide
nutrition supplementation (Fernandez, Krishnamoorthy,
Patil, Mondkar, & Swar, 2005; Soriano et al., 2000); and
(c) reducing transepidermal water loss, which leads to
improved thermoregulation with a reduced incidence of
hypothermia (Darmstadt et al., 2005; Kulkarni, Kaushik,
Oil Massage to Promote Infant Growth
Gupta, Sharma, & Agrawal, 2010). In this meta-analysis, oil
massage was not observed to have a significant adverse
effect on infant skin. As a result, oil massage could be
considered as a safe method for infant care; however, this
finding does not preclude the potential for an adverse
reaction absolutely. The choice of oil type should be noted
for infant care applications. For example, an early study
suggested that mustard oil might have toxic effects on the
epidermal barrier (Darmstadt & Saha, 2002).
This meta-analysis had certain limitations. First, the
number of available studies was small, which may influence
the reliability of the results. Second, certain studies included
unclear information on the allocation concealment and the
blinding method. Finally, although the parents were trained
and measures were taken to ensure that participants used the
standard oil massage process, certain factors were difficult to
control, which may account for the variability.
Implication
Although this meta-analysis suggests that oil massage is
safe and effective for improving infant physical growth,
nursing staff should use discretion according to the infant's
physical state when determining whether to conduct oil
massage. Providers would better exercise special cautions
when performing massages on preterm infants with a
vulnerable physical condition.
According to current research, coconut oil, sunflower oil and
sesame oil are reliable and efficient (Agarwal et al., 2000;
Darmstadt & Saha, 2002; Sankaranarayanan et al., 2005), which
regarded as a recommended oil type that could be applied to
clinical practice, while the other harmless and diverse oil types
are still waiting for to be explored and identified. Moreover, the
unclear influence of oil massage on neurobehavioral develop-
ment of newborn needs to be further evaluated by using a
uniform neurobehavioral score scale, such as the NICU
Network Neurobehavioral Scale (NNNS) that is a comprehen-
sive standardized assessment designed to measure processes of
biobehavioral organization in neonates offering 13 neurobe-
havioral domains including: habituation, attention, handling,
quality of movement, regulation, nonoptimal reflexes, asym-
metrical reflexes, stress/abstinence, arousal, hypertonicity,
hypotonicity, excitability, and lethargy (Coleman et al., 2013).
Presently, clinical guidelines are lacking pertaining to
standard massage methods, thus health care practitioners
should reach an agreement on detailed massage techniques in
the future including operational skills, duration of interven-
tion as well as body regions and corresponding sequences,
thereby enabling parents to continuously perform effective
massage after discharge. The neural actions and hormone
levels of infant would be a cue for further research to
investigate the core and potential mechanism of oil massage,
which could depend on animal models at early stage, because
some studies based on animal experiments claim that the
mechanism is possibly related to increased vagus nerve
activity and hormonal releasing such as insulin (Uvnas-
Moberg, 1996, 1997).
e321
In a word, oil massage is worth being applied to neonatal
nursing practice to promote the physical growth of infants,
but the effect to improve the neurodevelopment requires to
be further confirmed using uniform neurobehavioral score
scale. Nursing staff should explore more reliable oil and
gradually reach an agreement on the standard method of
oil-based massage in the future clinical practice.
Conclusions
Based on this meta-analysis, oil massage was found to
improve the physical growth of infants and presented limited
risks of adverse skin reactions. However, the relationship
between neurobehavioral development and oil massage
remains elusive. Further research could focus on the core
mechanisms by which oil massage promotes the physical
growth of infants and additional uniformity could be
achieved in the types of massages performed by parents
after hospital discharge. With respect to the study design,
future studies are encouraged to have a large sample size and
follow a high-quality randomized controlled design with
allocation concealment and blinding.
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