Foot Reflexology and Massage in Neonates Receiving Phototherapy

Neonatal hyperbilirubinemia is one of the most common conditions requiring hospitalization in the early neonatal period. Although phototherapy is the standard treatment, it may be associated with potential short- and long-term adverse effects, including dehydration, thermoregulation disturbances, and increased stress responses. Therefore, there is growing interest in complementary, non-invasive interventions that may enhance treatment effectiveness and improve neonatal outcomes.

Massage therapy and foot reflexology are commonly used complementary interventions in neonatal care. These interventions are thought to stimulate the gastrointestinal system, increase bowel movements, and facilitate bilirubin excretion. In addition, they may contribute to improved physiological stability and reduced stress levels through tactile stimulation.

This study is designed as a randomized controlled trial to evaluate the effects of foot reflexology and body massage on total serum bilirubin levels, physiological parameters, and stress levels in neonates receiving phototherapy. Physiological parameters include heart rate, respiratory rate, oxygen saturation, and body temperature.

The study will be conducted in a neonatal intensive care unit and will include 105 neonates diagnosed with indirect hyperbilirubinemia. Participants will be randomly assigned to one of three groups: foot reflexology group, body massage group, and control group. Interventions will be administered prior to phototherapy sessions.

Data will be collected using standardized tools, including a Neonatal Information Form, Neonatal Follow-up Form, and a validated Neonatal Stress Scale. Outcome measures will be assessed before and after the interventions.

The findings of this study are expected to provide evidence on the effectiveness of complementary non-pharmacological interventions in reducing bilirubin levels, improving physiological stability, and decreasing stress in neonates. These results may contribute to the integration of evidence-based complementary practices into neonatal care.

Inclusion criteria

• Neonates whose parents/legal guardians have signed the informed consent form and agreed to participate in the study
• Neonates born between 34 and 41 weeks of gestation
• Birth weight of 2500 g or above
• Not mechanically ventilated
• No nasogastric tube
• Stable vital signs
• No elevated acute phase reactants during phototherapy treatment
• Indirect bilirubin level between 12 and 28 mg/dL at admission to the neonatal intensive care unit
• Not receiving antibiotic treatment during the study
• Aged between 2 and 10 days
• No health problems other than indirect hyperbilirubinemia.

Exclusion criteria

• Presence of any neurological anomaly
• Presence of any congenital anomaly
• Jaundice due to ABO incompatibility
• Jaundice due to Rh incompatibility
• Presence of dermal anomalies
• Diagnosis of hyperbilirubinemia within the first 24 hours after birth
• Diagnosis of direct hyperbilirubinemia