Randomized clinical trial of the effect of the onset time of skin-to-skin contact at birth, immediate compared to early, on the duration of breastfeeding in full term newborns

Abstract

Background Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding. Methods A randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration. Results A total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28). Conclusions The percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators. Trial registration ClinicalTrials.gov NCT02687685.

Skin-to-skin contact and breastfeeding: A scoping review

“…The 13 studies included in the qualitative synthesis comprised different characteristics such as research designs. The research designs included a multi-center randomized controlled trial (RCT) (Agudelo et al, 2021;Gregson et al, 2016;Sharma, 2016), a quasi-experimental study design (Dalsgaard et al, 2019;Mansoori and Salmani, 2020;Yilmaz et al, 2020), exploratory cross-sectional design (Lau et al, 2018), longitudinal study (Linares et al, 2017), observational study (Marinelli et al, 2019), prospective longitudinal study (Oras et al, 2016), prospective, descriptive, and analytical study (Robiquet et al, 2016), observational retrospective study (Vila-Candel et al, 2018), and survey (Zhang et al, 2020). The authors relied on the research designs to gather different perspectives on how SSC affects breastfeeding in new mothers.…”

“…Comparatively, Dalsgaard et al (2019) associated the general effectiveness of SSC in limiting risks among infants with its non-pharmacological nature, particularly in cases of neonatal hypoglycemia. The author agreed with Agudelo et al (2021) on SSC being the foundation for breastfeeding within the first two hours of birth. New mothers and obstetric teams cannot risk low blood glucose levels within the first two hours and the ensuing period after six months.…”

“…Early or immediate SSC is a valuable procedure for the obstetric units aiming to optimize maternal and neonatal outcomes. A recent study has established that SSC is essential within the first two hours after to minimize risks facing newborns (Agudelo et al, 2021). The procedure involves continuous interactions mothers and their infants to initiate breastfeeding.…”

Immediate and Sustained Skin-to-Skin Contact for Healthy Late Preterm and Term Newborns After Birth: AWHONN Practice Brief Number 14

“…Healthy newborns who had immediate and sustained STS contact also demonstrated short-and long-term improvements in feeding, such as an increased likelihood of a successful first breastfeed (Cadwell et al, 2018;Moore et al, 2016), better suckling at the breast, and overall longer duration of exclusive breastfeeding (Agudelo et al, 2021;Moore et al, 2016;Neczypor & Holley, 2017). When immediate STS contact could not be safely facilitated, early STS contact (within 1 hour of birth) had similar outcomes (Agudelo et al, 2021).…”

“…The initial benefits of immediate STS contact after birth for the neonate include, decreased incidence of neonatal hypoglycemia (Hubbard & Gattman, 2017;Takahashi & Tamakoshi, 2018), improved thermoregulation, and improved cardiopulmonary stabilization (Hubbard & Gattman, 2017;Moore et al, 2016;Neczypor & Holley, 2017). Healthy newborns who had immediate and sustained STS contact also demonstrated short-and long-term improvements in feeding, such as an increased likelihood of a successful first breastfeed (Cadwell et al, 2018;Moore et al, 2016), better suckling at the breast, and overall longer duration of exclusive breastfeeding (Agudelo et al, 2021;Moore et al, 2016;Neczypor & Holley, 2017). When immediate STS contact could not be safely facilitated, early STS contact (within 1 hour of birth) had similar outcomes (Agudelo et al, 2021).…”