Effects of parent-administered massage-based multimodal interventions on health outcomes in preterm infants: a systematic review and meta-analysis

Background Parent-administered massage-based interventions are increasingly used in family-centered care for preterm infants, but their effects across infant and parental outcomes remain uncertain. Objective To systematically evaluate the effects of parent-administered massage-based interventions on growth, feeding, hospitalization, neurodevelopmental, and parental psychological outcomes in preterm infants. Methods We conducted a PRISMA 2020-compliant systematic review and meta-analysis of randomized controlled trials. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to 26 May 2026. Eligible studies compared parent-administered massage alone or combined with tactile, kinesthetic, oral, or other developmental sensory components against routine care or non-massage controls. Random-effects models with restricted maximum-likelihood estimation were used. Parental psychological outcomes were synthesized narratively because of substantial heterogeneity. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADE. Results Twenty-four randomized controlled trials were included. Moderate-certainty evidence indicated that massage-based interventions were associated with higher odds of breastfeeding or human-milk feeding at discharge (OR 5.42, 95% CI 2.44–11.94), shorter time to full oral feeding (MD −2.04 days, 95% CI −3.95 to −0.13), and shorter hospital length of stay (MD −4.68 days, 95% CI −7.79 to −1.57). Weight-gain velocity was greater in the primary meta-analysis (MD 5.55 g/day, 95% CI 1.71–9.38), but certainty was low, heterogeneity was very high (I 2 = 97.87%), significant small-study effects were detected, and the trim-and-fill adjusted estimate was attenuated and no longer statistically significant (MD 3.45 g/day, 95% CI −1.67 to 8.56). Parent-related psychological findings were generally favorable but were supported by low-certainty evidence. Effects on length growth, head-circumference growth, and motor development were not statistically significant; certainty for length and head-circumference growth was very low. Conclusion Moderate-certainty evidence suggests that parent-administered massage-based interventions may improve selected feeding outcomes and reduce hospital length of stay in preterm or low-birth-weight infants. The effect on weight-gain velocity remains uncertain because of very high heterogeneity, low certainty of evidence, and possible small-study effects. However, many interventions were multimodal and heterogeneity was substantial; therefore, the findings should be interpreted as effects of parent-delivered developmental-care interventions that include massage rather than massage alone, and the independent effect of massage requires confirmation. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261435482 , identifier CRD420261435482.