Most infants are diagnosed with hyperbilirubinemia in the first day of life. Although phototherapy is the most common treatment used in hyperbilirubinemia, different alternative therapies such as massage are also used. This systematic review and meta-analysis was designed to evaluate the effect of massage on serum bilirubin levels, defecation frequency, and length of hospital stay in neonates with hyperbilirubinemia receiving phototherapy. A review of randomized controlled trials published in English from 2008 to November 2023 was conducted using PubMed-Medline, Academic Search Ultimate-EBSCOhost, Web of Science, and Scopus databases. From 217 identified trials, six randomized controlled studies were included, with a total sample of 394 term infants. Infant massage was effective in increasing defecation frequency (MD: 0.52, 95% CI: Min: 0.29– Max: 0.76, p < 0.0001), reducing serum bilirubin levels on the 3rd and 4th days (MD: −1.19, 95% CI: Min: −1.50- Max: −0.89, p < 0.0001) (MD:−2.33, 95% CI: Min: −2.88– Max: −1.79, p < 0.0001), and shortening hospital stay (MD:-13.66, 95% CI: Min: −16.74– Max: −10.59, p < 0.0001). This systematic review and meta-analysis suggest that infant massage is a safe and effective intervention for term neonates with hyperbilirubinemia, contributing to a shorter hospital stay by lowering serum bilirubin levels and increasing defecation frequency.
AkdoganR.YildizS. (2025). The effect of SPA and massage applied on babies on colic symptoms: A randomized controlled trial. Journal of Pediatric Nursing, 82(2025), e164–e174. https://doi.org/10.1016/j.pedn.2025.04.008
3.
BabaeiH.VakiliaminiM. (2018). Effect of massage therapy on transcutaneous bilirubin level in healthy term neonates: Randomized controlled clinical trial. Iranian Journal of Neonatology, 9(4), 41–46. https://doi.org/10.22038/ijn.2018.28906.1386
4.
Basiri-MoghadamM.Basiri-MoghadamK.KianmehrM.JaniS. (2015). The effect of massage on neonatal jaundice in stable preterm newborn infants: A randomized controlled trial. JPMA. The Journal of the Pakistan Medical Association, 65(6), 602–606.
5.
BhardwajU.KohliV.ThukralA. (2023). Management of hyperbilirubinemia in newborn infants 35 or more weeks of gestation: American academy of pediatrics, 2022. Indian Pediatrics, 60(1), 63–66. https://doi.org/10.1007/s13312-023-2697-4
6.
ChenJ.SadakataM.IshidaM.SekizukaN.SayamaM. (2011). Baby massage ameliorates neonatal jaundice in full-term newborn infants. Tohoku Journal of Experimental Medicine, 223(2), 97–102. https://doi.org/10.1620/tjem.223.97
7.
ÇobanA.Kaynak TürkmenM.GürsoyT. (2022). Türk Neonatoloji Derneği Yenidoğan Sarılıklarında Yaklaşım, İzlem ve Tedavi Rehberi.
8.
ÇobanA.TürkmenM. K.GürsoyT. (2018). Turkish neonatal society guideline to the approach, follow-up, and treatment of neonatal jaundice. Turk Pediatri Arsivi, 53(Suppl 1), S172–S179. https://doi.org/10.5152/TurkPediatriArs.2018.01816
9.
DağY. S.YayanE. H. (2019). The effect on bilirubin levels of massage, tub bath, and sponge bath in newborns with hyperbilirubinemia: A randomized controlled trial. European Journal of Integrative Medicine, 27(March), 70–74. https://doi.org/10.1016/j.eujim.2019.03.003
10.
DaliliH.SheikhiS.ShariatM.HaghnazarianE. (2016). Effects of baby massage on neonatal jaundice in healthy Iranian infants: A pilot study. Infant Behavior and Development, 42(6), 22–26. https://doi.org/10.1016/j.infbeh.2015.10.009
11.
DehghaniK.NourooziE.MandegariZ.SalmaniN.ShakibaM. (2019). Comparison of the effectiveness of Bath and massage in bilirubin levels in neonates. Iranian Journal of Neonatology, 10(3), 45–50. https://doi.org/10.22038/ijn.2019.33607.1484
12.
DiegoM. A.FieldT.Hernandez-ReifM. (2005). Vagal activity, gastric motility, and weight gain in massaged preterm neonates. The Journal of Pediatrics, 147(1), 50–55. https://doi.org/10.1016/j.jpeds.2005.02.023
13.
DoğanE.KayaH. D.GünaydinS. (2023). The effect of massage on the bilirubin level in term infants receiving phototherapy. Explore, 19(2), 209–213. https://doi.org/10.1016/j.explore.2022.05.001
14.
EghbalianF.RafienezhadH.FarmalJ. (2017). The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized, double-blind clinical trial. Infant Behavior and Development, 49(2017), 31–36. https://doi.org/10.1016/j.infbeh.2017.05.002
15.
Eka Sari SantosoS.KaruniawatiB.Nur FauziandariE. (2022). The effect of field massage on bilirubin levels in neonates with hyperbilirubinemia. KnE Life Sciences, 7(2), 335–344. https://doi.org/10.18502/kls.v7i2.10327
16.
ErçelikZ. E.DoğanP.Bal YılmazH. (2022). The effect of massage on growth in premature babies: A systematic review and meta-analysis. Journal of Education and Research in Nursing, 19(2), 191–197. https://doi.org/10.5152/jern.2022.13285
FieldT.DiegoM.Hernandez-ReifM. (2010). Preterm infant massage therapy research: A review. Infant Behavior and Development, 33(2), 115–124. https://doi.org/10.1016/j.infbeh.2009.12.004
19.
GargB. D.KabraN. S.BalasubramanianH. (2019). Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: A review of clinical trials. Journal of Maternal-Fetal and Neonatal Medicine, 32(2), 301–309. https://doi.org/10.1080/14767058.2017.1376316
20.
GözenD.YılmazÖ. E.DurŞ.ÇağlayanS.TaştekinA. (2019). Transcutaneous bilirubin levels of newborn infants performed abdominal massage: A randomized controlled trial. Journal for Specialists in Pediatric Nursing: JSPN, 24(2), Article e12237. https://doi.org/10.1111/jspn.12237
21.
HematiZ.KeikhaM.KhoshhaliM.KelishadiR. (2022). Phototherapy and risk of childhood cancer: A systematic review and meta-analysis. Journal of Neonatal Nursing, 28(4), 219–228. https://doi.org/10.1016/j.jnn.2022.01.007
22.
HigginsJ.ThomasJ.ChandlerJ.CumpstonM.LiT.PageM. J.WelchV. A. (2020). Cochrane handbook for systematic reviews of interventions version 6.1(updated September 2020). Cochrane. https://www.training.cochrane.org/handbook (Accessed 26 December 2020).
23.
JazayeriZ.SajadiM.DalvandH.ZolfaghariM. (2021). Comparison of the effect of foot reflexology and body massage on physiological indicators and bilirubin levels in neonates under phototherapy. Complementary Therapies in Medicine, 59(1), Article 102684. https://doi.org/10.1016/j.ctim.2021.102684
24.
KemperA. R.NewmanT. B.SlaughterJ. L.MaiselsM. J.WatchkoJ. F.DownsS. M.GroutR. W.BundyD. G.StarkA. R.BogenD. L.HolmesA. V.Feldman-WinterL. B.BhutaniV. K.BrownS. R.Maradiaga PanayottiG. M.OkechukwuK.RappoP. D.RussellT. L. (2022). Clinical practice guideline revision: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 150(3), Article e2022058859. https://doi.org/10.1542/peds.2022-058859
25.
KenariR. L.AziznejadroshanP.Haghshenas MojaveriM.Hajian-TilakiK. (2020). Comparing the effect of kangaroo mother care and field massage on serum bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward. Caspian Journal of Internal Medicine, 11(1), 34–40. https://doi.org/10.22088/cjim.11.1.34
26.
KianmehrM.MoslemA.Basiri-MoghadamK.NaghaviM.Pasban-NoghabiS.Basiri-MoghadamM. (2014). The effect of massage on serum bilirubin levels in term neonates with hyperbilirubinemia undergoing phototherapy. Nautilus, 128(1), 36–41.
KorkmazG.EsenayF. I. (2020). Effects of massage therapy on indirect hyperbilirubinemia in newborns who receive phototherapy. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN, 49(1), 91–100. https://doi.org/10.1016/j.jogn.2019.11.004
29.
LeiM.LiuT.LiY.LiuY.MengL.JinC. (2018). Effects of massage on newborn infants with jaundice: A meta-analysis. International Journal of Nursing Sciences, 5(1), 89–97. https://doi.org/10.1016/j.ijnss.2018.01.004
30.
LinC. H.YangH. C.ChengC. S.YenC. E. (2015). Effects of infant massage on jaundiced neonates undergoing phototherapy. The Italian Journal of Pediatrics, 41, 94. https://doi.org/10.1186/s13052-015-0202-y
31.
MoherD.LiberatiA.TetzlaffJ.AltmanD. G.PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), Article e1000097. https://doi.org/10.1371/journal.pmed.1000097
32.
ShahbaziM.KhazaeiS.MoslehiS.ShahbaziF. (2022). Effect of massage therapy for the treatment of neonatal jaundice: A systematic review and dose-response meta-analysis. International Journal of Pediatrics, 2022, Article 9161074. https://doi.org/10.1155/2022/9161074
33.
ShorisI.GoverA.ToropineA.IofeA.Zoabi-SafadiR.TsuprunS.RiskinA. (2023). “Light” on phototherapy—Complications and strategies for shortening its duration, A review of the literature. Children, 10(10), 1699. https://doi.org/10.3390/children10101699
UncuB.GökH. (2025). The effect of newborn massage training on maternal attachment and postpartum depression: Randomized controlled trial. Nursing and Health Sciences, 27(2), Article e70112. https://doi.org/10.1111/nhs.70112
36.
ZhangM.WangL.WangY.TangJ. (2019). The influence of massage on neonatal hyperbilirubinemia: A meta-analysis of randomized controlled trials. The Journal of Maternal-Fetal & Neonatal Medicine, 32(18), 3109–3114. https://doi.org/10.1080/14767058.2018.1455183
