Osteopathic Treatment for Gastrointestinal Disorders in Term and Preterm Infants: A Systematic Review and Meta-Analysis
Francesca Buffone1 2 3, Domenico Monacis2 4, Andrea Gianmaria Tarantino1 2, Fulvio Dal Farra 2 5, Andrea Bergna2, Massimo Agosti 6, Luca Vismara 1 2 7 8
1Division of Paediatric, Manima Non-Profit Organization Social Assistance and Healthcare, 20125 Milan, Italy 2Department of Research, SOMA—Istituto Osteopatia Milano, 20126 Milan, Italy 3PPCR, Harvard T.H. Chan School of Public Health—ECPE, Boston, MA 02115, USA 4Department of Humanities, Literature, Cultural Heritage, Education Sciences, University of Foggia, 71122 Foggia, Italy5Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
The aim of this systematic review and meta-analysis is to evaluate the effectiveness of osteopathic manipulative treatment (OMT) for gastrointestinal disorders in term and preterm infants. Eligible studies were searched on PubMed, Scopus, Embase, Cochrane, Cinahl, and PEDro. Two reviewers independently assessed if the studies were randomized controlled trials (RCTs) and retrospective studies with OMT compared with any kind of control in term or preterm infants to improve gastrointestinal disorders. Nine articles met the eligibility criteria, investigating OMT compared with no intervention, five involving term infants, and the remaining treating preterm infants. Five studies showed low risk of bias. In the meta-analysis, two studies were included to analyze the hours of crying due to infantile colic, showing statistically significant results (ES = −2.46 [−3.05, −1.87]; p < 0.00001). The quality of evidence was “moderate”. The other outcomes, such as time to oral feeding, meconium excretion, weight gain, and sucking, were presented in a qualitative synthesis. OMT was substantially safe, and showed efficacy in some cases, but the conflicting evidence and lack of high-quality replication studies prevent generalization. High-quality RCTs are recommended to produce better-quality evidence.
Conclusions: Concerning gastrointestinal disorders in term and preterm infants, OMT is overall safe and provides many clinical and research insights. In terms of safety, no included study reported serious sequelae even when treating a sensitive population such as preterm infants. Among AEs, only one study reported a mild one, which resolved spontaneously in a short time . To date, OMT effectiveness has not been shown yet due to the lack of high-quality and replication studies; further RCTs with OMT as an add-on therapy compared to the usual care alone can help to clarify its support in clinical practice, and possibly provide material to establish future guidelines accordingly. OMT may be a new field of clinical study and treatment in GI disorders in the pediatric sector.