Initiation and duration of skin‐to‐skin contact for extremely and very preterm infants: A register study

Abstract

Skin-to-skin contact (SSC) between the newborn infant and a parent is an evidence-based method of care. In the term infant, it has beneficial effects on breastfeeding, 1 thermal control 1 and parent-infant bonding. 2 In the preterm infant, SSC similarly is associated with better breastfeeding outcomes, 3 bonding, 4 protection against infections, 5 stable cardiorespiratory parameters 6 and reduced mortality in low-and middle-resource settings. 5 Globally, SSC initiation is recommended when the preterm or low birthweight infant is stable, which is defined as not needing oxygen or intravenous fluids. 7 Evidence for SSC derive mainly from research in low-resource settings and studies on early SSC in high-resource settings are scarce. 8 There are reports on the potential risks of SSC. Thermal control in very preterm (VPT) infants may be a challenge when SSC is initiated immediately after birth, 9 although most publications describe that SSC has a positive impact on infant temperature. 10 SSC in infants with invasive technological support, such as an umbilical catheter or endotracheal tube, may be difficult because of the risk of dislocation. Fear of catheter-associated infections may also be

Immediate skin‐to‐skin contact after birth ensures stable thermoregulation in very preterm infants in high‐resource settings

“…The existing evidence for SSC is inconsistently translated into clinical practice. 13 A Norwegian prospective study of preterm infants born between GA 32 + 0-34 + 6 and who received immediate SSC during the first 2 h after vaginal birth, showed no difference in the first measured body temperature at admission compared to when in conventional care. 14 In contrast, in a Swedish study, immediate SSC in very preterm infants was related to lower temperature at 1 h after birth, 36.3°C versus 36.6°C.…”

“…Authority: 2017/1135-31/3, 2018/213-32/1 and 2019-03361, and the Norwegian Regional Ethical Committee: 2015/889. When the study protocol was elaborated in 2014-2015 and the trial started in 2018 the gold standard of care during the first hours oflife for preterm infants born between GA 28 + 0-32 + 6 was conventional care in incubator or cot 13,15.…”

The Delicate Skin of Preterm Infants: Barrier Function, Immune-Microbiome Interaction, and Clinical Implications

“…A pragmatic approach may be given by 80% humidity in infants <28 weeks’ gestation in the first week of life and a decrease by 1–5% per day until a humidity of 40% is reached. This strategy of care inside the incubator should, however, not interfere with promoting maternal kangaroo-mother-care even in the most vulnerable babies [61, 62]. Thermal stress needs to be avoided by servo control settings of the incubator temperature.…”

“…Furthermore, psychosocial stress reduces AMP expression in the epidermis leading to more severe skin infections [89, 90]. Hence, more research is needed to study the impact of kangaroo care on skin health and long-term outcome of preterm infants [62].…”

Skin-to-Skin Contact at Birth for Very Preterm Infants and Mother-Infant Interaction Quality at 4 Months

“…For infants born preterm, the timing of SSC initiation can vary greatly . In a Swedish population-based register study, only a minority of infants born before gestational week 32 received SSC within their first day of life . Recent guidelines from the World Health Organization recommend immediate postnatal initiation of SSC for preterm or low-birth-weight infants, due to the increase in survival rates .…”