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The Somatic Connection  |   January 2016
As the Twig Is Bent, so Grows the Tree—Part 6: In a Multicenter Study, OMTh Shortens Length of Stay in the Neonatal Intensive Care Unit
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   January 2016
As the Twig Is Bent, so Grows the Tree—Part 6: In a Multicenter Study, OMTh Shortens Length of Stay in the Neonatal Intensive Care Unit
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 60-61. doi:10.7556/jaoa.2016.014
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 60-61. doi:10.7556/jaoa.2016.014
Web of Science® Times Cited: 15
Three reviews in this edition of “The Somatic Connection” (see items titled “As the Twig is Bent, so Grows the Tree”) describe the notable progress in research related to osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in pediatrics. These studies were highlighted in the First Global Congress on Pediatric Osteopathy in September 2015 in Montreal, Canada. In his presentation at the Congress, Francesco Cerritelli, MsC, DO, announced that because of the recent randomized controlled studies, a systematic review and meta-analysis had been conducted and submitted for publication. According to Cerritelli, the analysis showed benefit of OMTh in the neonatal population. 
The studies reviewed herein add to the growing literature on osteopathic manipulative treatment (OMT) and OMTh in neonatal conditions. Lund et al1 showed OMT benefit in premature infants with nipple feeding dysfunction. Improvement in plagiocephaly has been shown,2 as well as in postural asymmetry3 and otitis media.4,5 Preceding the Pizzolorusso et al and Cerritelli et al studies reviewed in this edition of “The Somatic Connection” were 3 studies6-8 that set the stage for the Cerritelli systematic review. 
I am gratified to see the evidence base for pediatric osteopathy come to the fore in such strong fashion, and I am pleased to bring this research to the attention of US-trained osteopathic physicians. 
Cerritelli F, Pizzolorusso G, Renzetti C, et al. A multicenter, randomized trial of osteopathic manipulative treatment on preterms. PLoS ONE. 2015;10(5):e0127370. doi:10.1371/journal.pone.0127370. 
Expanding on previous published studies on the effect of osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) on preterm infants in the neonatal intensive care unit (NICU),1-3 Italian researchers replicated these previous studies in a 3-site multicenter study. A total of 695 newborns were randomly assigned to the study group (n=352) or control group (n=343). Inclusion criteria were gestational age between 29 and 37 weeks without congenital complications. Exclusion criteria included lack of parental consent; any genetic disorder; neoplasms; neurologic, cardiovascular, urinary, or hematologic abnormalities; proven or suspected necrotized enterocolitis or abdominal obstruction; birth trauma; operation; pneumoperitoneum; atelectasis; HIV; newborn from an HIV-seropositive or drug-addicted mother; and transfer status to or from another hospital. 
The study group received standard pediatric care plus 2 OMTh sessions per week for the total time in the hospital. Each OMTh session was 30 minutes: 10 minutes for evaluation and 20 minutes for treatment. Myofascial release, balanced ligamentous tension, and balanced membrane tension were used. The control group received standard pediatric care and 2 osteopathic structural evaluations per week. The evaluation took 10 minutes, and then the osteopath stood in front of the incubator for 20 minutes with his or her hands near but not touching the infant “to maintain blinding of the NICU personnel.” There were no perinatal deaths in either group, and no adverse events were recorded. 
The primary outcome of mean (SD) hospital length of stay (LOS) was 13.8 (8.1) days for the study group and 17.5 (14.5) days for the control group (P<.001). Gestational age was associated with LOS (P<.001), as was birth weight (P=.02). The cost per newborn was €6277.28 for the study group and €7863.29 for the control group, which was a significant difference (P<.001). 
As a multicenter study, these data are strong and confirm previous findings of the benefit of OMTh in the NICU. This study should be replicated in the United States. 
References
Lund GC, Edwards G, Medlin B, Keller D, Beck B, Carreiro JE. Osteopathic manipulative treatment of hospitalized premature infants with nipple feeding dysfunction. J Am Osteopath Assoc. 2011: 111(1): 44-48. [PubMed]
Lessard S, Gagnon I, Trottier N. Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract. 2011; 17(4): 193-198. doi:10.1016/j.ctcp.2011.02.001. [CrossRef] [PubMed]
Philippi H, Faldum A, Schleupen A, et al. Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol. 2006; 48(1): 5-9. doi:10.1017/S001216220600003X. [CrossRef] [PubMed]
Mills MV, Henley CE, Barnes LLB, Degenhardt BF. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med. 2003; 157(9): 861-866. [CrossRef] [PubMed]
Steele KM, Carreiro JE, Viola JH, Conte JA, Ridpath LC. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Am Osteopath Assoc. 2014; 114(6): 436-447. doi:10.7556/jaoa.2014.094. [CrossRef] [PubMed]
Pizzolorusso G, Turi P, Barlafante G, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropr Man Therap. 2011; 19(1): 15. doi:10.1186/2045-709X-19-15. [CrossRef] [PubMed]
Cerritelli F, Pizzolorusso G, Ciardelli F, et al. Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatr. 2013; 13: 65. doi:10.1186/1471-2431-13-65. [CrossRef] [PubMed]
Pizzolorusso G, Cerritelli F, Accorsi A, et al. The effect of optimally timed osteopathic manipulative treatment on length of hospital stay in moderate and late preterm infants: results from a RCT. Evid Based Complement Alternat Med. 2014; 2014: 243539. doi:10.1155/2014/243539. [CrossRef] [PubMed]
Pizzolorusso G, Cerritelli F, Barlafante G, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropr Man Therap. 2011; 19(1): 15. doi:10.1186/2045-709X-19-15. [CrossRef] [PubMed]
Cerritelli F, Pizzolorusso G, Ciardellie F, et al. Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatr. 2013; 13: 65. doi:10.1186/1471-24313-13-65. [CrossRef] [PubMed]
Pizzolorusso G, Cerritelli F, Accorsi A, et al. The effect of optimally timed osteopathic manipulative treatment on length of hospital stay in moderately and late preterm infants: results from a RCT. Evid Based Compl Alternat Med. 2014; 2014: 243539. doi:10.1155/2014/2433539.