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Objective: To study the effect of maternal massage therapy on hospital stay in very-low-birth-weight infants who were already submitted to skin-toskin care.Study Design: A randomized study was performed including infants of birth weight X750 and p1500 g and gestational age p32 weeks. The exclusion criteria were as follows: death before completing 48 h and presence of major malformations. Neonates were divided into intervention group (IG) (standard care plus maternal massage) and control group (CG). Anthropometric data were always verified by a person blind to the group to which the newborn belonged. Maternal massage was performed four times a day on the face and limbs. Passive exercises of upper and lower limbs were also done by the mothers.Result: A total of 104 newborns were included, 52 in each group. Both groups were similar in gestational age (IG: 29.7 ± 1.6; CG: 29.4 ± 1.6 weeks), birth weight (IG: 1186±194; CG: 1156±198 g), gender, number of small-for-gestational-age infants, SNAPPE-II, deaths, gains in weight, length and head circumference. Incidence of late-onset sepsis was significantly lower in the intervention group (IG: 10.8%, n ¼ 5; CG: 38.3%, n ¼ 18; P ¼ 0.005). IG was discharged from the hospital 7 days before CG (IG: 42, confidence interval (CI) 95%: 38 to 46; CG: 49, CI 95%: 42 to 56), and presented 1.85 hazard ratio (CI 95%: 1.09 to 3.13; P ¼ 0.023) for early discharge. Keywords: massage therapy; tactile stimulation; kinesthetic stimulation; very-low-birth-weight infants; neonatal sepsis Introduction Early interruption of gestation brings consequences that still cannot be fully avoided even in neonatal units with the most modern technological resources and best survival rates. There is a high probability of preterm infants going beyond the neonatal period before reaching a growth 1 and development 2 pattern similar to that of term newborns. In addition, the need for a long hospital stay period makes the presence of parents essential for assistance, once the parents' competence to understand and provide the premature infant's needs is consolidated as one of the main medical criteria for hospital discharge. 3 Studies involving the hospital stay period of preterm infants showed that relatively simple measures improve their prognoses, such as skin-to-skin contact reduces the painful sensation of term neonates 4 and promotes the development and parental relation of preterm infants; 5 the creation of a sleep-provoking environment increases the growth rate of very-low-birth-weight (VLBW) infants; 6 the application of tactile-kinesthetic stimulation contributes to both growth and development of preterm infants between 1000 and 2000 g, without adverse effects on physiological parameters; 7 instructions to first-child parents on how to bathe and massage favors parent-infant bonding; 8 and the participation of mothers through massage with moderate pressure improves growth and development rates of term infants. 9 Despite these evidences, in two systematic revisions, one regarding the tactile-kinesthetic s...

BackgroundPreterm infants are high risk for delayed neurodevelopment. The main goal is to develop a program of early intervention for very preterm infants that allows families to apply it continuously at home, and quantify the results of early parental stimulation on improvement of cognition and motor skills.MethodsRandomized clinical Trial including inborn preterm infants with gestational age less than 32 weeks or birth weight less than 1500 g at 48 h after birth. Eligible for begin the intervention up to 7 days after birth. Study Protocol approved by the Brazilian national Committee of ethics in Research and by the institutional ethics committee.Intervention group (IG): skin-to skin care by mother (kangaroo care) plus tactile-kinesthetic stimulation by mothers from randomization until hospital discharge when they receive a program of early intervention with 10 parents’ orientation and a total of 10 home visits independently of the standard evaluation and care that will be performed. Systematic early intervention program will be according to developmental milestones, anticipating in a month evolutionary step acquisition of motor and / or cognitive expected for corrected age. Active comparator with a Conventional Group (CG): standard care according to the routine care of the NICU and their needs in the follow up program. Neurodevelopment outcome with blinded evaluations in both groups between 12 and 18 months by Bayley Scales of Infant and Toddler Development third edition and Alberta Motor Infant scale will be performed. All evaluations will be conducted in the presence of parents or caregivers in a safe room for the child move around during the evaluation.DiscussionIf we can show that a continuous and global early intervention at home performed by low income families is better than the standard care for very preterm infants, this kind of program may be applied elsewhere in the world. We received grants by Bill and Melinda Gates Foundation, DECIT, Cnpq and Health Ministry. Grand Challenges Brazil: All Children Thriving.Trial registrationThe study was restrospectively registered in ClinicalTrials.gov. in July 15 2016 (NCT02835612).