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Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial
Hany Aly1, Mohamed F Moustafa, Sahar M Hassanein
1Neonatology Department, The George Washington University Hospital & Children's National Medical Center, Washington, DC 20037, USA.
Insights
Massage and physical activity in preterm infants improved bone formation, indicated by increased serum PICP levels. However, this intervention did not significantly alter bone resorption markers (urinary Pyd).
Area of Science:
- Neonatal Medicine
- Pediatric Bone Metabolism
- Developmental Pediatrics
Background:
- Osteopenia of prematurity contributes to significant morbidity in preterm infants.
- Previous studies suggest positive outcomes with massage and physical activity for premature infants.
- The specific impact of these interventions on bone formation and resorption in preterm infants remains unclear.
Purpose of the Study:
- To investigate if combined massage and physical activity stimulate bone formation in premature infants.
- To determine if these interventions can reduce bone resorption in preterm infants.
- To test the hypothesis that a combined protocol enhances bone metabolism.
Main Methods:
- A prospective, double-blinded, randomized trial involving 30 preterm infants (28-35 weeks gestation).
- Infants were assigned to a control group or an intervention group receiving daily massage and physical activity.
- Serum type I collagen C-terminal propeptide (PICP) and urinary pyridinoline crosslinks (Pyd) were measured to assess bone formation and resorption, respectively.
Main Results:
- The intervention group showed a significant increase in serum PICP over time, indicating enhanced bone formation.
- While urinary Pyd also increased in the intervention group, it did not differ significantly between groups, suggesting no change in bone resorption.
- Control group infants exhibited decreased PICP and increased Pyd, signifying reduced bone formation and increased resorption.
Conclusions:
- A combined massage and physical activity protocol effectively improves bone formation in preterm infants.
- This intervention did not significantly impact bone resorption markers.
- The observed increase in Pyd in both groups may reflect ongoing bone resorption and calcium mobilization in preterm infants.
Background:
Osteopenia of prematurity is a known source for morbidity in preterm infants. Premature infants have shown favorable outcomes in response to massage and physical activity. Whether such intervention can stimulate bone formation or decrease bone resorption is yet to be determined.
Objective:
To test the hypothesis that massage combined with physical activity can stimulate bone formation and ameliorate bone resorption in premature infants.
Design/Methods:
A prospective double-blinded randomized trial was conducted at the Neonatal Intensive Care Unit of Ain Shams University in Cairo, Egypt. Thirty preterm infants (28 to 35 weeks' gestation) were randomly assigned to either control group (Group I, n=15) or intervention group (Group II, n=15). Infants in the intervention group received a daily protocol of combined massage and physical activity. Serum type I collagen C-terminal propeptide (PICP) and urinary pyridinoline crosslinks of collagen (Pyd) were used as indices for bone formation and resorption, respectively. PICP and Pyd were measured at enrollment and at discharge for all subjects. t-Test, ANOVA and linear regression analysis were used for statistical analyses.
Results:
There was no difference between groups I and II in gestational age (32.1+/-1.8 vs 31.5+/-1.4 weeks) or birth weight (1.429+/-0.148 vs 1.467+/-0.132 g). In the control group, serum PICP decreased over time from 82.3+/-8.5 to 68.78+/-14.6 (p<0.01), while urinary Pyd increased from 447.7+/-282.8 to 744.9+/-373.6 (p<0.01) indicating decreased bone formation and increased bone resorption, respectively. In the intervention group, serum PICP increased over time from 62.5+/-13.8 to 73.84+/-12.9 (p<0.01). Urinary Pyd also increased over time from 445.7+/-266.5 to 716.8+/-301.8 (p<0.01). In a linear regression model including gestational age and intervention, serum PICP increased significantly in the intervention group (regression coefficient 18.8+/-4.6, p=0.0001) while urinary Pyd did not differ between groups (regression coefficient=5.6+/-114.3, p=0.961).
Conclusions:
A combined massage and physical activity protocol improved bone formation (PICP) but did not affect bone resorption (Pyd). Pyd increased over time in both groups, possibly due to continuous bone resorption and Ca mobilization.
