Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience

Abstract

Background: Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals. Aims: To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals. Design: Prospective observational monocentric study. Methods: Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis. Results: In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23–33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25–34 weeks), 10 days (range 1–20 days), and 1131 g (range 631–2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported. Conclusions: These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.

COMFORTneo scale in preterm infants during live performed music therapy—Difference between close physical contact and hand touch contact

“…It is generally acknowledged that close physical contact improves the behavioral state of preterm and term born neonates, including routine care such as feeding and during invasive procedures ( Bera et al, 2014 ; Özdel and Sarı, 2020 ; Todil and Cetinkaya, 2022 ) and is beneficial for the preterm infants and their parents ( Bedetti et al, 2023 ). Different kinds of physical contact exert different effects on preterm infants: dynamic touch reduced physiological arousal and decreases heart rates until 5 min after the touch in randomized controlled study.…”

“…Live performed music therapy benefits preterm infants' vital signs and behavioral state. During CPC 2023). Preterm infants are usually treated in the neonatal intensive care unit (NICU) for medical support immediately after birth.…”

Essential components of an educational program for implementing skin-to-skin contact for preterm infants in intensive care units: an integrative literature review

“…SSC has been shown to have positive effects on preterm infants in intensive care units. Several studies found that it is associated with a reduction in neonatal mortality rate, improved growth, neurodevelopmental outcomes, and breastfeeding [ 6 , 7 ]. SSC has been shown to alleviate maternal anxiety, reshape the maternal role, promote active breast pumping, and build maternal confidence in the care of the baby.…”

Italian Modena NIDCAP Training Centre

“…The findings were rewarding, and they were published in two different articles. 1,2 In 2023 we celebrate 10 years since the opening of our center in Modena and we are honored to be part of the amazing and supportive community of the global NIDCAP community.…”