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Effect of Multimodal Interventions on Pain, Stress, and Neurodevelopmental Outcomes in Neonates With Malignant and
Sharath Hullumani1, Shrutika Sharad1, Aishik Ghosh1
1Faculty of Physiotherapy, Datta Meghe Institute of Higher Education and Research (DU), Sawangi Meghe, Wardha, Maharashtra, 442001, India, 91 9964066927.
Insights
This systematic review evaluates multimodal therapies for infants with tumors, aiming to reduce procedural stress and improve neurodevelopmental outcomes. Findings will guide clinical practice and future research for this vulnerable population.
Area of Science:
- Neonatal oncology
- Developmental pediatrics
- Integrative medicine
Background:
- Neonatal tumors often require invasive procedures, causing pain and stress during critical brain development.
- Procedural stress can negatively impact neurodevelopmental trajectories, affecting cognition and behavior.
- Multimodal interventions are being explored to complement standard care for pain and stress management.
Purpose of the Study:
- To systematically evaluate the effectiveness of multimodal therapies in reducing stress and suffering in neonates with tumors.
- To assess the impact of these interventions on neurodevelopmental outcomes in affected infants.
Main Methods:
- Systematic review adhering to PRISMA-P standards.
- Inclusion of studies on multimodal therapies (physiotherapy, massage, music therapy, kangaroo care, etc.) for neonates with benign or malignant tumors.
- Comprehensive literature search across major databases (PubMed, Embase, CINAHL, Cochrane, CancerLi) and inclusion of various study designs (RCTs, cohort, case-control).
Main Results:
- The review is ongoing, with anticipated completion between June 2025 and December 2027.
- Data synthesis and analysis will be performed by two independent, blinded reviewers.
- Quality of evidence will be assessed using the GRADE framework.
Conclusions:
- This review will provide evidence-based insights into multimodal interventions for neonates with tumors.
- Findings aim to inform clinical recommendations and guide the development of integrative strategies.
- The ultimate goal is to optimize neurodevelopmental outcomes in this vulnerable infant population.
Background:
Both benign and malignant tumors in neonates frequently necessitate invasive diagnostic and therapeutic procedures, exposing infants to significant pain and stress during critical periods of brain development. Procedural stress can disrupt the hypothalamic-pituitary-adrenal axis, affect synaptic pruning, and alter myelination, potentially leading to long-term cognitive and neurodevelopmental impairments. While standard medical care remains the cornerstone of management, there is growing interest in multimodal interventions-including integrative therapies, physiotherapy, and non-pharmacological approaches such as massage, music therapy, kangaroo care, and sensory stimulation-to mitigate discomfort and support neurodevelopmental outcomes.
Objective:
This study aimed to systematically evaluate how well multimodal therapies reduce stress and suffering while enhancing neurodevelopmental outcomes in infants with both benign and malignant tumors.
Methods:
The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) standards will be followed in the conduct of this systematic review. Studies that use multimodal therapies (eg, physiotherapy, massage, music therapy, kangaroo care, or other non-pharmacologic techniques) for newborns with proven malignant or benign tumors will be considered. A thorough literature search will be conducted using databases such as the PubMed, Embase, and CINAHL, Cochrane, and CancerLi. Cohort studies, case-control studies, quasi-experimental studies, and randomized controlled trials will all be considered. Measures of pain (such as validated neonatal pain scales), stress (such as cortisol levels and behavioral markers), and neurodevelopment (such as the Bayley Scales of Infant Development) will be the main objectives.
Results:
The anticipated timeline for completing this systematic review is June 2025 to December 2027. Two independent reviewers will conduct each stage of the review process in a blinded manner to minimize bias.
Conclusions:
This systematic review aims to provide evidence-based insights into the role of multimodal interventions in enhancing standard care for neonates undergoing tumor-related procedures. Conclusions regarding clinical impact will be conditional on the quality and consistency of the evidence, as assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). The findings are expected to guide future research, inform cautious clinical recommendations, and support the development of integrative strategies to optimize neurodevelopmental outcomes in this vulnerable population.
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