Neonatal respiratory distress is a life-threatening lung disorder, so it is important to examine the effect of different intervention and care methods on respiratory distress in premature infants. The aim of this study was to determine the effect of foot reflex massage on the reduction of respiratory distress in premature infants in the intensive care unit.

 

In this study, in 2019, 100 premature infants were randomly assigned to two intervention and control groups by clinical trial method.
The study population consisted of prematurely neonatal infants admitted to the neonatal intensive care unit of Hamadan Fatemieh Hospital affiliated to Hamadan University of Medical Sciences. To determine the required sample size, the first type statistical error was considered 10% and the test power 80%. According to the study of Ajoodanian et al. (2013), the mean size (standard deviation) of the number of breaths in the intervention and control groups were 50.41 (11.58) and 56.71 (12.99), respectively (28).
Therefore, based on the following relationship, the sample size in each group was estimated 46.9:

 After obtaining permission from the Vice Chancellor for Research and the Research Ethics Committee of Tehran Islamic Azad University of Medical Sciences with the number IR.IAU.TMU.REC.1398.005 and registering the study in the Iranian Clinical Trials Center with the number 39980, the researchers referred to the Fatemieh Hospital Educational and Medical Center. The consent of the hospital director and the parents of the infants were taken to examine the samples. The sampling method was that the ward nurse was asked to drop the number of NCPAP neonatal records in the ward into two envelopes (a) and (b) each morning, without knowing which group each envelope belonged to. The researchers divided them into two groups: reflective foot massage and control group.
In the intervention group, reflexive foot massage was performed for three days and the control group received normal care. In both groups, a personal profile questionnaire and a respiratory distress index were completed before and after the intervention.
To analyze the data, the data were entered into SPSS version 16 (SPSS Inc., Chicago, IL., USA) and analyzed in two descriptive and analytical sections. Descriptive analysis for quantitative variables was performed using mean and standard deviation of the studied variables and rank and class data using absolute and relative frequencies. The studied variables, namely the percentage of oxygen saturation (Spo2) and the number of breaths and respiratory distress, had a normal distribution based on the Kolmogorov-Smirnov test; therefore, parametric tests were used for statistical analysis. In the analytical analysis, the considered outcomes were evaluated among the groups. It is worth mentioning that an independent t-test was used to compare the changes in saturated oxygen percentage and the number of breaths and respiratory distress between groups.

 

Results

Discussion

According to the results of the study, the reflexology method was effective on the physiological responses of infants and thus reducing respiratory distress in preterm infants. Comparing the two groups of reflective foot massage and control, on the first day of the intervention, the difference between oxygen saturation percentage and the number of breaths and respiratory distress between both intervention and control groups was significant and these differences increased on the third day after the intervention. Also, comparing the total changes in oxygen saturation percentage and number of breaths and respiratory distress in the two intervention sessions showed significant changes in oxygen saturation percentage and number of breaths and respiratory distress between the intervention and control groups.   
Samadi et al. (2014) studied the effect of foot reflexive massage on the physiological parameters of preterm infants in the neonatal intensive care unit of Ardabil Hospital. The results of their study showed that there was a statistically significant difference between the mean changes in the number of breaths before and after massage in the intervention group. Also, there was a significant difference between the mean changes in temperature before and after the intervention. In infants, when they were massaged, their pulse rate decreased and their oxygen levels increased, indicating that the massage was soothing for the infants (26).
The findings of the present study were consistent with the results of a study by Basiri-Moghadam et al. (2006) on twenty healthy premature infants admitted to the NICU in Mashhad (32) in terms of increasing the percentage of oxygen saturation; but in terms of changes in respiration rate, it did not fit. They reported that the massage technique affected the physiological responses of preterm infants and there was a significant difference between the intervention and control groups.
In this regard, Ajoodanian et al. (2013) conducted a study in the city of Tabriz (28) which was consistent with the present study in terms of reducing the number of breaths. They showed that the mean number of respiration and blood pressure and temperature of neonates in the whole three days in the group of massage with sunflower oil and massage with coconut oil and the control group at the end of three days were significantly different.
Also, Ramezani et al. (2017) in a study examined the effect of massage on 45 premature infants (34 to 28 weeks) with respiratory distress syndrome in the neonatal intensive care unit of Afzalipour Hospital in Kerman. The findings of this study showed that the percentage of oxygen saturation before and after massage was not significantly different; but the number of breaths decreased after the massage. The results of this study were consistent with the present study in terms of reducing the number of breaths; it must be pointed out that in the study of Ramezani et al. (2017) infants were massaged, but in the present study, reflective massage was used (27).
Studies in other countries have also yielded results that were comparable to the results of this study. In a study in the United States of Harrison et al. (2000) on 84 preterm infants aged six to nine days using a gentle touch of GHT ten minutes a day and three times a day for ten days, there was a statistically significant difference before and after the intervention. The study did not show the average number of breaths; but the amount of motor activity in infants was less (33).
Lee from South Korea (2005) showed that interventional massage on premature infants can significantly increase oxygen saturation after ten days. The results of Lee's study were consistent with the results of the present study and after the intervention, the number of breaths changed significantly. However, in Lee's study, the duration of the intervention was longer until the desired result was achieved, and from the ninth day of the intervention, the respiration rate of the infants receiving the intervention was significantly reduced (35).
Not to mention Epstein (2005) and Modrcin-Talbott (1997 ‌) provided evidence based on the reduction of oxygen saturation and consequent respiratory distress during treatment due to some stressful events in premature infants (36, 37). Therefore, during the treatment period, especially when massaging children, their vital signs should be constantly monitored.

 

Conclusion

Reflective foot massage is effective on physiological responses and reducing respiratory distress in premature infants. It seems that this easy, cheap and efficient intervention program can be considered in the executive instructions of health care and nurses' intervention and its education to mothers can be included in the country's educational programs.

 

Acknowledgments

Researchers consider it necessary to appreciate the sincere cooperation of the management and professors and nursing staff of Fatemieh Hospital, as well as all parents who allowed their infants to participate in this study. It is worth mentioning that this study was conducted after receiving the code of ethics with the number IR.IAU.TMU.REC.1398.005 from the National Committee of Ethics in Biomedical Research and the code IRCT (39980).

 

Conflicts of Interest

The authors declared no connflict of interest.