Skin-to-skin contact in the delivery room for very preterm infants: a randomised clinical trial

Abstract

ObjectiveEvaluating safety, feasibility and effects on physiological parameters of skin-to-skin contact (SSC) from birth between mothers and very preterm infants in a high-income setting.DesignOpen-label randomised controlled trial.SettingThree Norwegian neonatal units.PatientsPreterm infants at gestational age (GA) 280–316weeks and birth weight >1000g delivered vaginally or by caesarean section (C-section).InterventionTwo hours of early SSC between the mother and the infant compared to standard care (SC) where the infant is separated from the mother and transferred to the neonatal unit in an incubator.Results108 infants (63% male, 57% C-section, mean (SD) GA 30.3 weeks (1.3) and birth weight 1437 g (260)) were included. Median (IQR) age at randomisation was 23 min (17–30). During the first 2 hours after randomisation, 4% (2 of 51) and 7% (4 of 57) were hypothermic (<36.0°C) in the SSC and SC group, respectively (p=0.68, OR 0.5, 95% CI 0.1 to 3.1). Significantly fewer infants in the SSC group had hyperthermia (>37.5°C) (26% (13 of 57) vs 47% (27 of 51), respectively, p=0.02, OR 0.4, 95% CI 0.2 to 0.9). No infant needed mechanical ventilation within the first 2 hours. Median (IQR) duration of SSC was 120 (80–120) min in the intervention group. There was no difference in heart rate, respiratory rate and oxygen saturation between groups during the first 24 hours.ConclusionThis study from a high-income setting confirmed that SSC from birth for very preterm infants was safe and feasible. Physiological parameters were not affected by the intervention. The long-term effects on neurodevelopment, maternal–infant bonding and maternal mental health will be collected.Trial registration numberNCT02024854.

Neonatal skin health and associated dermatological conditions

“…Skin-to-skin contact between the mother and the neonate shortly after birth has been associated with numerous potential health benefits. Several studies have investigated these positive outcomes among preterm neonates in particular, finding associations between skin-to-skin contact and decreased rates of hypothermia [22], improved thermoregulation [23], greater cardiorespiratory stability [24], and decreased dopamine and cortisol levels in this population [25]. Among healthy, full-term infants, a randomized controlled trial of daily skin-to-skin contacts for the first 5 weeks after birth described decreased crying and increased sleep in the infants [26].…”

New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

“…The method, practicalities and techniques do not differ. Second, the term “skin-to-skin contact” is not restricted for all (full-term) newborns, it is widely used for preterm and low birthweight infants ( Forde et al, 2022 ; Kristoffersen et al, 2023 ), including when begun immediately and provided continuously ( Linnér et al, 2022 ). In the Cochrane review it is identified as the primary component of KMC and called “skin-to-skin contact” ( Conde-Agudelo and Díaz-Rossello, 2016 ).…”

Early skin‐to‐skin contact and the risk of intraventricular haemorrhage and sepsis in preterm infants

“…One of the studies found a positive effect on cardiorespiratory stabilisation 5 as well as normal thermoregulation 6,7 and the other did not find any difference between the groups. 8 Bedetti et al similarly concluded that physiological parameters remain stable when comparing oxygen saturation, heart rate and respiratory rate in preterm infants before and during sessions of SSC. 9 Despite a growing body of evidence supporting early SSC also for preterm infants in high-resource settings, only a minority of EPT and VPT infants were exposed to SSC on their first postnatal day according to a report based on data from the Swedish Neonatal Quality Register (SNQ).…”