Immediate skin‐to‐skin contact is feasible for very preterm infants but thermal control remains a challenge

Abstract

Aim Current care of very preterm infants in an incubator implies separation of the mother‐infant dyad. The aim of this study was to determine whether skin‐to‐skin contact (SSC) between parent and very preterm infant from birth and during the first postnatal hour is feasible. Methods Infants born in 2014‐16 in Stockholm at gestational age 28 + 0‐33 + 6 weeks were randomised to care provided in SSC with a parent or on a resuscitaire and later in an incubator or bed during the first postnatal hour. Infant body temperature was measured on admission to the neonatal unit and at one postnatal hour. Data on respiratory support and breastfeeding were prospectively collected. Results We studied 55 infants at 32 + 0 ± 1.4 weeks (range 28 + 2‐33 + 6), with birthweight 1760 g ± 449 g (range 885‐2822). 60% were boys. Mean body temperature in the SSC group was 0.3°C lower 1 hour after birth, 36.3°C ± 0.52 (range 34.4‐37.2) vs 36.6°C ± 0.42 (range 36.0‐37.4, P = .03). No differences between groups were seen in respiratory support or breastfeeding. Conclusion Stabilisation of very preterm infants can be performed while in SSC with a parent, but caution needs to be paid to maintain normothermia.

Potential benefits and pitfalls of skin-to-skin contact transport from birth room to neonatal unit

“…Interestingly, the transfer back to the incubator induced a deeper and more prolonged decrease in skin temperature 5 . In parallel, lower body temperature during the first hour of life was recently observed in very preterm infants receiving SSC immediately after birth rather than being placed into an incubator 13 . This finding led to changes focusing on thermal conservation during installation in the NICU.…”

Delivery room cuddles for extremely preterm babies and parents: concept, practice, safety, parental feedback

“…It includes a first case report in a 23 +1 ‐week twin, 4 a small case series of 10 preterm babies (28–32 weeks’ gestation) 15 and two small randomised controlled trials (RCTs): Linnér et al reported 55 babies (gestational age range 28 +0 –33 +6 ) randomised to immediate stabilisation on maternal chest after birth with skin‐to‐skin contact for the first postnatal hour, or immediate stabilisation on a resuscitaire. Infants in the immediate skin‐to‐skin group were marginally cooler at 1 hour (mean: 36.3°C vs. 36.6°C, p = 0.03) 13 ; Mehler et al reported 88 babies (mean gestation 29 weeks, range 25–32) randomised to either 60 mins of delivery room maternal skin‐to‐skin contact or 5 minutes visual contact only. Intubated babies and those needing >40% oxygen were excluded.…”

Immediate parent-infant skin-to-skin study (IPISTOSS): study protocol of a randomised controlled trial on very preterm infants cared for in skin-to-skin contact immediately after birth and potential physiological, epigenetic, psychological and neurodevelopmental consequences

“…41 Our own work on 50 infants in Stockholm between 2014 and 2016 showed that iSSC could safely be provided for very preterm infants during the first postnatal hour but that in contrast to in previous studies, attention needs to be paid to prevent hypothermia. 34 There are indications that experiences early in life have implications on health and disease over the lifespan, partly governed by epigenetic mechanisms. 42 To our knowledge, no studies have explored the epigenetic consequences of SSC.…”

“…Data from our group has indicated that infants at this gestational age may have slightly lower body temperatures when cared for in SSC during the first postnatal hour. 34 Neonatal hypothermia is a risk factor for many morbidities. 49 In the methods section, we have described our strategy to maintain normothermia.…”