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A Randomized-Controlled Trial Pilot Study Examining the Neurodevelopmental Effects of a 5-Week M Technique Intervention on Very Preterm Infants

Smith, Joan R. PhD, RN, NNP-BC; McGrath, Jacqueline PhD, RN; Brotto, Marco PhD, RN; Inder, Terrie MD, MBChB

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000093
Original Research

PURPOSE: To systematically test the cumulative effect of the M Technique on infant neurodevelopment in hospitalized very preterm infants.

DESIGN: A pilot randomized controlled trial (RCT).

SUBJECTS: Twenty very preterm infants (<30 weeks gestation with average birth weights <1000 g) were randomly assigned to nontreatment or treatment groups. The study period began once the infants reached 30 weeks postmenstrual age (PMA).

METHODS: Each infant received standard neonatal intensive unit (NICU) care or standard NICU care plus a 7-minute M Technique session, 6 times per week for 5 weeks. Neurobehavioral development (using the NICU Network Neurobehavioral Scale [NNNS]) and growth velocity (difference in infant weight at the beginning and end of protocol) were compared between the 2 groups. Physiologic parameters (heart rate, respiratory rate, and oxygen saturations) and infant behavioral states were measured 5 minutes before, during, and up to 10 minutes postintervention continuously on all infants in the treatment group at 3 different gestational time points (30, 32, and 34 weeks PMA) over the 5-week period.

RESULTS: Mann-Whitney U analyses revealed no differences between the 2 groups on all 12 NNNS summary score domains but a difference in growth velocity between the 2 groups (P = 0.005). Repeated-measures analysis of variance revealed significant physiologic differences of mean heart rate, respiratory rate, and SaO2 (F = 41.116, P < 0.0005) and behavioral states (F = 38.564, P < 0.0005) from baseline to 10 minutes after the M Technique intervention across all 3 time points. State scores decreased from baseline (M = 6.11) to post intervention (M = 1.4) at all 3 time points.

CONCLUSIONS: This pilot RCT demonstrates the utility of the M Technique in hospitalized very preterm infants starting at 30 weeks PMA with notable evidence of positive weight, physiological, and behavioral state adaptations. Additional research is needed with a larger, randomized design to determine short- and long-term effects specifically related to neurological outcomes.

Division of Nursing and Newborn Intensive Care, St Louis Children's Hospital, Missouri (Dr Smith); School of Nursing, University of Connecticut, Nursing Research, Connecticut Children's Medical Center, Hartford (Dr McGrath); School of Nursing and Medicine, University of Missouri Kansas City (Dr Brotto); and Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts (Dr Inder).

Correspondence: Joan R. Smith, PhD, RN, NNP-BC, Division of Nursing and Newborn Intensive Care, St Louis Children's Hospital, St Louis, MO 63110 (

The authors thank Mary Raney, NNP-BC, Patricia Coffelt, MOT, OTR/L, and Sandy Conner, BS, PT, for actively participating in patient enrollment, intervention delivery, and/or data collection. In addition, we thank the developer of the M Technique, Jane Buckle, PhD, RN, statistician; An-Lin Cheng, PhD, University of Missouri Kansas City, School of Nursing; and the neonatal intensive care unit families and staff for their willingness to participate.

This study was supported in part by the National Association of Neonatal Nurses Small Grants Award and the St Louis Children's Hospital Foundation.

At the time this study was conducted, Dr Inder was with the Department of Pediatrics and Newborn Medicine, Washington University School of Medicine in St Louis, Missouri.

The authors declare no conflict of interest.

© 2014 by The National Association of Neonatal Nurses