Effect of Skin-To-Skin Contact on Preterm Infant Skin Barrier Function and Hospital-Acquired Infection

Abstract

BackgroundThe preterm infants' skin is structurally and functionally immature at birth because of immature stratum corneum barrier function, leading to problems with fluid loses, thermoregulation, and infection. Two parameters of barrier function can be non-invasively assessed: Stratum Corneum Hydration (SCH) and Transepidermal Water Loss (TEWL). Skin-to-Skin Care (SSC) is the proposed independent variable that might affect barrier function by decreasing TEWL and increasing SCH, thereby improving stratum corneum barrier function and consequently decreasing the rate of infection. No study of SSC's effects on TEWL and SCH of preterm infants could be found. The purpose of the study was to determine the effect of 5 daily Skin-to-Skin Contact sessions on infant skin hydration (SCH), transepidermal evaporated water loss (TEWL), and on SCH when TEWL was controlled, and on the presence of hospital acquired infection.MethodsA one-group pretest-test-posttest design with 10 preterm infants (28 - 30 wks GA < 32 wks postmenstrual age, and no infection at entry). Test = 90 minutes of SSC; pre-test and post-test = 30 minutes each of prone positioning in an incubator. SCH and TEWL were taken on Days 1 and 5 at the beginning, middle and end of each period using Multi-Probe Adaptor. A 3 X 3 X 2 Repeated Measures Mixed Models Design, including a covariate, was used to analyze level of Skin Hydration. Specifically, the model tested comparisons in SCH made across repetitions, time, and days, as well as all possible interactions while controlling for TEWL. Descriptive statistics described the number of positive blood cultures during hospitalization and the presence of infections four weeks post-discharge.ResultsSignificant differences in skin hydration were found across TIME (Pre-SSC, SSC, Post-SSC) (F = 21.86; p < 0.001). One infant had a positive blood culture during hospitalization; no infants had signs of infection by 4 weeks post-discharge. ConclusionsThe study has begun fulfilling the recommendation that SSC be tested as a strategy to improve skin hydration, but reveals that evaporative loss may be higher during SSC than during incubator care, and that the higher transepidermal evaporated water loss values may not necessarily be detrimental because few infections occurred even in its presence. A definitive randomized controlled trial is recommended.KeywordsSkin-to-skin contact; Skin hydration; Transepidermal water loss; Infection; Preterm

Practical application of kangaroo mother care in preterm infants: clinical characteristics and safety of kangaroo mother care

“…In contrast, most previous studies have shown that infection rate decreases in infants who experience KMC [8,10,18]. Abouelfettoh et al [1] suggested that the fewer infections in preterm infants during KMC could be attributed to the improved skin barrier function and decreased transepidermal water loss.…”

Potential NICU Environmental Influences on the Neonate's Microbiome

“…28 None of the mothers had any signs or symptoms of infection during the first thirty days post discharge. 28 …”

“…No studies were found that examined the relationship between skin-to-skin contact and the infant microbiome, however one study did examine infection rates after mother skin-to-skin care in preterm infants. 28 After 5 consecutive days of skin-to-skin care for 90 minutes, only one infant developed a hospital-acquired infection within 7 days after the skin-to-skin care ended. 28 None of the mothers had any signs or symptoms of infection during the first thirty days post discharge.…”

“…28 After 5 consecutive days of skin-to-skin care for 90 minutes, only one infant developed a hospital-acquired infection within 7 days after the skin-to-skin care ended. 28 None of the mothers had any signs or symptoms of infection during the first thirty days post discharge. 28 …”

“…37). 28 Skin-to-skin care (SSC) allows for positive touch between the infant and mother as well as transfer of microbes. No studies were found that examined the relationship between skin-to-skin contact and the infant microbiome, however one study did examine infection rates after mother skin-to-skin care in preterm infants.…”