The Somatic Connection  |   July 2013
Further Demonstration of the Benefit of Osteopathic Manipulative Therapy in Pediatric Care
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   July 2013
Further Demonstration of the Benefit of Osteopathic Manipulative Therapy in Pediatric Care
The Journal of the American Osteopathic Association, July 2013, Vol. 113, 570-571. doi:
The Journal of the American Osteopathic Association, July 2013, Vol. 113, 570-571. doi:
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 Pediatrics. 2013;13:65. doi: 10.1186/1471-2431-13-65.  
In an exploratory study that I reviewed in the October 2011 issue of The Journal of the American Osteopathic Association (JAOA),1 a group of researchers in Pescara, Italy, demonstrated a possible benefit of osteopathic manual therapy (OMTh) in a high-risk population (ie, preterm infants). Their results showed statistically significant reductions both in instances of gastrointestinal dysfunction and in length of stay (LOS) in the neonatal intensive care unit (NICU) among premature infants who received OMTh compared with infants who received routine care. Several of these researchers from Italy then joined other colleagues in conducting a more recent single-blind, randomized controlled trial to confirm the effectiveness of OMTh in reducing LOS in preterm infants. 
To be eligible for inclusion in this study, male and female preterm infants had to have been born at Santo Spirito Hospital in Pescara, Italy, and admitted to the NICU between August 2008 and October 2009. They also had to be free of medical complications. Infants were excluded if their gestational age was younger than 29 weeks or older than 37 weeks; if OMTh was performed more than 14 days after birth; if they were transferred to or from another hospital; if their mothers were addicted to drugs or were seropositive for human immunodeficiency virus (or both); if they had genetic disorders, congenital abnormalities, cardiovascular abnormalities, neurologic disorders, proven or suspected abdominal obstruction, respiratory distress syndrome, or pneumoperitoneum or atelectasis (or both); and if they had a preoperative or postoperative status (or both). 
After a power analysis was used to determine the number of participants required for this study, a total of 110 patients were randomly assigned to 1 of 2 groups: the experimental group (n=55), which received standard care plus osteopathic evaluation and OMTh, or the control group (n=55), which received standard care plus osteopathic evaluation only. Eight different osteopaths (4 who performed evaluations only and 4 who performed evaluations and OMTh) visited the infants in the NICU at different times. They were aware of and recorded the osteopathic evaluation and OMTh they provided to avoid the possibility of confounding and to provide blinding. Osteopathic evaluation and OMTh occurred twice per week and consisted of 10 minutes of evaluation and 10 minutes of OMTh involving myofascial release, balanced ligamentous tension, balanced membranous tension, indirect fluidic techniques, and v-spread. Osteopaths visiting the control group provided approximately 10 minutes of evaluation only and then stood in front of the incubators for the following 10 minutes. 
The primary outcome measures were LOS and weight gain. Intent-to-treat analysis was used to evaluate study data because only 47 of the 55 patients in the experimental group and 54 of the 55 patients in the control group completed the study. The authors found no statistically significant difference between the experimental and the control groups with regard to gestational age (P<.98), sex (P<.89), or birth weight (P<.24). They did note a statistically significant difference, however, between the 2 groups with regard to LOS (mean [standard deviation (SD)] LOS for the experimental group, 26.1 [16.4] days; mean [SD] for the control group, 31.3 [20.2] days; difference in LOS, 5.9 days; P<.03). The association between OMTh and weight gain was not statistically significant (P<.06). 
After surveying the available cost data for care provided to preterm infants in the region of Italy where the study was performed and then correlating these costs with LOS data, the authors determined that their osteopathic intervention would substantially reduce NICU costs for families of preterm infants and society in general. The cost savings would be approximately €3000 per patient per LOS. These savings do not include any savings resulting from reductions in either potential morbidities related to preterm delivery or special services that may be required for medical, mental, or psychological disabilities addressed long after preterm infants leave the NICU. The authors speculate as to why OMTh may be beneficial to preterm infants and people in general. They cite possible anti-inflammatory effects and benefits to the autonomic nervous system that improve visceral function, especially cardiac function, as possible mechanisms of action. Having worked for several years with Viola Frymann, DO, at the Osteopathic Center for Children and Families in San Diego, California, providing osteopathic manipulative treatment to preterm infants, I have observed that application of such treatment can enhance the vitality of preterm infants. The enhancement of vitality produced by osteopathic manipulative treatment reinforces the tenet of osteopathic medicine that the body is self-regulating and self-healing, thus providing benefit to the patient. 
King HH. Osteopathic manual therapy reduces gastrointestinal dysfunction and length of stay for premature infants in neonatal intensive care unit [abstract of 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]. J Am Osteopath Assoc. 2011;111(10):570-571.