Original Articles

THE EFFECT OF MASSAGE STIMULATION TO REDUCTION OF TUMOR NECROTIC FACTOR-ALFA (TNF-α) AND INTERLEUKIN-6 (IL-6) IN PRETERM, LOW BIRTH WEIGHT APPROPRIATE WITH GESTATIONAL AGE INFANTS

I G. A. Trisna-Windiani , Soetjiningsih Soetjiningsih, N. Mantik-Astawa, Kusnandi Rusmil

I G. A. Trisna-Windiani
Department of Child Health Faculty of Medicine Udayana University, Bali-Indonesia. Email: igatwindiani@gmail.com

Soetjiningsih Soetjiningsih
Department of Child Health Faculty of Medicine Udayana University, Bali-Indonesia

N. Mantik-Astawa
Veterinary Medicine Department Faculty of Veterinary Medicine Udayana University, Bali-Indonesia

Kusnandi Rusmil
Department of Child Health Faculty of Medicine Padjajaran University, West Java-Indonesia
Online First: July 04, 2015 | Cite this Article
Trisna-Windiani, I., Soetjiningsih, S., Mantik-Astawa, N., Rusmil, K. 2015. THE EFFECT OF MASSAGE STIMULATION TO REDUCTION OF TUMOR NECROTIC FACTOR-ALFA (TNF-α) AND INTERLEUKIN-6 (IL-6) IN PRETERM, LOW BIRTH WEIGHT APPROPRIATE WITH GESTATIONAL AGE INFANTS. Indonesia Journal of Biomedical Science 9(2). DOI:10.15562/ijbs.v9i2.15


Preterm condition gives a new stressful environment to infants. This condition needs a good and gradual adaptation. External environmental conditions, treatment, care and good nutrition are needed. Massage stimulation in preterm infants is a method that can prepare preterm infants’ adaptation through the critical post-birth period. A good adaptation of the system will provide better organ homeostasis including the immune system.

There are three paths of mechanisms that can explain how massage stimulation can regulate pro-inflammatory cytokines TNF-α and IL-6. The first: the hypothalamus pathway, massage stimulation act as a comfort stimulation that can control (inhibit) the release of pro-inflammatory cytokines TNF-α  and IL-6 by macrophages; second: through activation of vagus nerve, massage stimulation act as a tactile stimulation which activates vagal system and the immune system; third: the hypothalamic-pituitary pathway, massage stimulation act as a kinesthetic stimulation that activates the hypothalamic-pituitary to release cortisol, GH (Growth hormone) and IGF-1 (Insulin-like Growth Factor 1). A randomized controlled trial about massage stimulation on preterm infants was performed in Sanglah Hospital Denpasar on 2011. The study revealed a different level of cytokine pro-inflammation TNF-α (p=0.025) and IL-6 (p=0,001) comparing before and after condition massage stimulation. Outcome of body weight were also different at before and after massage stimulation, with p value 0.042.

Mechanisms of massage stimulation affect the immune system of preterm infants through regulation of inhibition the release of pro-inflammatory cytokine TNF-α, IL-6 by macrophages, through three main pathways: the hypothalamic; activation of the vagus nerve and the hypothalamic-pituitary-adrenal axis.

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