Early essential newborn care for cesarean section newborns in China: study protocol for a multi-centered randomized controlled trial

Abstract

Background Early essential newborn care (EENC) is a package of evidence-based and cost-effective interventions delivered around birth mainly including delayed cord clamping, immediate and sustained skin-to-skin contact, and early initiation of exclusive breastfeeding. EENC is proven effective in promoting breastfeeding and improving women’s and newborns’ health. However, there is little evidence on implementation of EENC on newborns born by cesarean section in China. Therefore, the objective of this study is to assess the effectiveness of EENC intervention on rates of exclusive breastfeeding and early initiation of breastfeeding for cesarean section newborns in China. Methods This is a multi-centered, randomized controlled trial conducted in 4 tertiary hospitals in China. A total of 720 eligible women who will receive cesarean section are being randomized into four groups: control group (n=180), intervention group 1 (skin-to-skin contact for 30 min, n=180), intervention group 2 (skin-to-skin contact for 60 min, n=180), and intervention group 3 (skin-to-skin contact for 90 min, n=180). The control group will receive routine care, whereas the intervention groups will receive EENC with different duration of skin-to-skin contact. Demographic characteristics, clinical information, and breastfeeding outcomes will be collected. The primary outcome is rates of exclusive breastfeeding and early initiation of breastfeeding, and the secondary outcomes include maternal and neonatal morbidity and admissions. Discussion This study will provide evidence of the impact of EENC on improvement of breastfeeding outcomes and maternal and neonatal health for cesarean section newborns in China, and evidence-based recommendation to inform optimal duration of skin-to-skin contact for cesarean deliveries. The results of this study have potential to inform national-level guidelines and policy-making for optimizing EENC implementation for cesarean section newborns. Trial registration Chinese Clinical Trial Registry ChiCTR2100048997. Retrospectively registered on 19 July 2021

Implementation of early essential neonatal care for newborns delivered by cesarean section in Jiaxing: a single-center prospective randomized controlled trial

“…The World Health Organization (WHO) recommends that mother-infant skin-to-skin contact (SSC) should begin with direct contact with the mother's bare skin within 1 minute of birth [1]. Multiple randomized controlled studies have found the importance of cesarean SSC for breastfeeding [2][3][4]. CUI Xiaomei et al [5] conducted a randomized controlled study on the effectiveness of SSC immediately after birth and SSC within 1 hour after birth on breastfeeding duration, initiation and duration of first breastfeeding, time to initiation of lactation II, breastfeeding self-efficacy scores, breastfeeding acceptance and satisfaction scores, and rates of exclusive breastfeeding at 24, 48, 72 hours and 42 days postpartum were significantly better in the spontaneous delivery immediate SSC group than that in the 30-minof-birth initiation SSC control group.…”