Effect of tactile kinesthetic stimulation on preterm infants’ weight and length of hospital stay in Khartoum, Sudan

Methods

This study is a quasi-experimental study. It was conducted during a 6 month period; between January and June 2013 in 4 hospitals in Khartoum, Sudan. Two hospitals were chosen for intervention (Omdurman Maternity Hospital [55 preterm infants], and Khartoum Teaching Hospital [25 preterm infants]), and the other 2 hospitals as controls (Alsaudi Maternity Hospital [55 preterm infants], and Gaafer Ibn-Auf Children Hospital [25 preterm infants]).

The 160 preterm infants were selected depending on the following criteria: birth weight of 1000-1200gm, gestational age of 30-37 weeks, breast milk being fed by tube, and age 4 days since birth. A number of 9 preterm infants were dropped due to attrition of their mothers from the study and only 151 preterm infants completed the study. Preterm infants were randomly assigned into 2 groups (case or control group) following informed consent from their mothers. The randomization of the 4 hospitals was made by using a simple random sampling (lottery method), the 2 hospitals (Omdurman Maternity Hospital and Khartoum Teaching Hospital) were assigned as the case group, and the other 2 hospitals (Alsaudi Maternity Hospital and Gaafer Ibn-Auf Children Hospital) were assigned as the control group. Preterm infants in the control group received routine care, while preterm infants in the case group received TKS in addition to routine care.

The mothers involved in this study undertook a 3 constitutive day training program. In day one, the researchers read and discussed the module in Arabic with the mothers, and they trained the mothers demonstrating on a doll. On day 2, the trained mothers applied their skills on their own preterm infants, and on day 3 they started the actual measurements of weight for 7 days. During the first 3 days of training, the mothers were closely observed by researchers to ensure accurate intervention.

Tactile kinesthetic stimulation was performed for 15 minutes, 3 sessions per day for 7 consecutive days. The procedure was started half an hour after feeding, physiological parameter was observed pre and post technique (temperature, pulse rate, respiratory rate, and oxygen saturation). The procedure of TKS follows Field’s protocol for medically stable preterm infants.8

They were massaged 3 times per day for 7 days. Fifteen minute stimulation sessions consisted of 3 standardized 5 minutes phase. The preterm infants were stroked during the first and third phase and their limbs were moved passively into flexion and extension during the middle 5 minutes phase. For the stroking phases with moderate pressure the preterm infant was placed in a prone position. The trained mother provided the stroking, placing her warm fingers on the preterm infant body. The stroking occurred for 5, one-minute periods (12 strokes at approximately 5 seconds per stroking motion) over each region as the following sequence: From the top of the head to the neck and back again, from the neck, across the shoulders and back again, from the upper back to the waist and back again, from the hip to the feet and back to the hip on both legs, and from the shoulder to the hand and back to the shoulder on both arms. Then the preterm infant was placed in supine position for the subsequent flexion/extension of limbs phase, 5, one-minute segments of 6 passive flexion/extension (kinesthetic) movement (like bicycling) were provided, approximately 10 seconds for each arm, then each leg, and finally both legs. For the final phase, the preterm infant was returned to the prone position and given the stroking process again.

This study was approved by the Graduate College and Research Ethics Committee, University of Medical Sciences and Technology, Khartoum, Sudan, (IRB 00008867) and a consent form was completed by the mothers of the preterm infants. The data was analyzed using the Statistical Package for Social Sciences version 17 (SPSS Inc., Chicago, IL, USA). The chi-square test was used to analyze the differences in mothers and preterm infant’s characteristics. The independent “t” test was used to analyze the difference in preterm infant’s weight and hospital stays, between case and control groups, and a paired sample t-test was used to determine the differences before and after intervention. All values were tabulated as averages (mean) with standard deviation (SD). P-values less than 0.05 were considered significant.