Complementary, Holistic, and Integrative Medicine: Therapies for Neurodevelopment in Preterm Infants

Abstract

1. Elaine Galicia-Connolly, MD* 2. Larissa Shamseer, MSc* 3. Sunita Vohra, MD, MSc* 1. *Department of Paediatrics, CARE Program for Integrative Health and Healing, University of Alberta, Edmonton General Hospital, Edmonton, Alberta, Canada. * Abbreviations: CCT: : controlled clinical trial CI: : confidence interval DHA: : docosahexanoic acid fVEP: : flash visual evoked potential IQR: : interquartile range LBW: : low birthweight LCPUFA: : long-chain polyunsaturated fatty acid MDI: : Mental Developmental Index RCT: : randomized controlled trial WMD: : weighted mean difference Preterm birth is defined as birth occurring at age <37 weeks, with extremely preterm birth occurring at <26 weeks. (1) Children born prematurely have been shown to have significantly lower cognitive scores compared with children born at term by age 5 years, with scores being significantly positively correlated to both birthweight and gestational age. (2) In addition, preterm children are significantly more likely to develop attention deficit hyperactivity disorder and other behavioral problems at school age than children born at term. Complementary and alternative medicine therapies are used to help alleviate long-term consequences of preterm birth. In this article, we review commonly used complementary and alternative medicine therapies (long-chain polyunsaturated fatty acid [LCPUFA] supplementation, massage therapy, and music therapy) and their effects on the neurodevelopment of preterm infants. The following electronic bibliographic databases were searched: MEDLINE, EMBASE, Cochrane’s Database of Systematic Reviews and Register of Controlled Trials (CENTRAL), and PsycInfo. The search was limited to systematic reviews and clinical trials. Search terminology included neurodevelopment, premature infant, nutritional supplementation, massage therapy, music therapy, and their respective synonyms according to database. No language limits were imposed. Included studies were restricted to clinical studies. ### Long-chain Polyunsaturated Fatty Acids The n-3 LCPUFA, docosahexanoic acid (DHA), is a major brain lipid believed to play a role in brain development. It is thought that preterm infants may receive less DHA than full-term infants due to a shortened third trimester. (3)(4) A systematic review included 32 randomized controlled trials (RCTs) of which 10 studies were meta-analyzed. The RCTs examined the effect of enteral feeds of LCPUFA-supplemented formulas on neurodevelopment …