Skin-to-Skin Contact for Transferring Preterm Infants from the Delivery Room to the Neonatal Intensive Care Unit Is Promising Despite Moderate Heat Loss during the Procedure

Abstract

Objective: The principal aim of this prospective observational study was to assess the feasibility of skin-to-skin contact (SSC) with fathers during the transfer of preterm infants from the delivery room to the neonatal intensive care unit (NICU) in comparison with incubator transfers. Study design: The study population comprised preterm singletons born between May and December 2019 in our maternity ward who did not require invasive ventilation. Physiological parameters (axillary temperature, heart rate and fraction of inspired oxygen) of the newborns were recorded at prespecified steps during the transfers. The impact of the transfer mode on early blood glucose level, blood gas, neonatal morbidities and mortality, the delay in the first SSC in the NICU and breastfeeding implementation and maintenance were also analyzed. Results: Twenty-eight preterm infants were transferred in incubators, and 29 infants were transferred using SSC. The SSC transfer induced heat loss (mean 0.45°C, SD 0.58). However, the decrease in temperature was similar to that observed during transfer in the incubator (mean −0.30°C, SD 0.49, p = 0.3). The transfer using SSC was not an independent factor associated with hypothermia at admission in the NICU (adjusted OR 2.6 [0.68−9.75], p = 0.16). Neonatal morbidities and mortality were similar regardless the transfer mode. The SSC transfer promoted early SSC in the neonatal unit (median hour [range] incubator 26 [2−126] vs. SSC 13 [1−136], p = 0.03) and breastfeeding at discharge (incubator 35.7% vs. SSC 69%, p = 0.01). Conclusion: The SSC transfer of preterm infants was feasible and promoted earlier SSC and breastfeeding. Nevertheless, the SSC transfer like the transfer in the incubator induced moderate heat losses that exacerbated hypothermia at admission in the NICU. The improvement of thermal conservation during infant positioning, and the continuation of SSC in the unit could help in preventing hypothermia.

Skin-to-skin transfer from the delivery room to the neonatal unit for neonates of 1,500g or above: a feasibility and safety study

“…We did not compare these findings with a control group transported in an incubator, therefore cannot affirm that SSC is more efficient in preventing heat loss. However, our findings seem to align with studies that showed that heat loss was recorded both during SSC and incubator transfers, calling for additional heat conservation methods by maintaining an acceptable room temperature, stopping air drafts and wearing hats and covers as the main priority regardless of the type of transfer occurring ( 10 , 18 ). Additionally, our results showed that there was no difference in the occurrence of hypothermia between term and preterm neonates, suggesting that SSC transfers could be applied even in preterm neonates weighing more than 1,500 g.…”

“…In our study, only 4 neonates presented with glycemia lower than 35 mg/dl, with the lowest recorded at 31 mg/dl, and none of the neonates developed clinical signs of hypoglycemia. These findings align with guidelines recommending glycemic levels above Most of the studies assessing the safety and feasibility of SSC transfers to this day studied small cohorts of term or preterm neonates who did not require respiratory support, and some of those were in different settings such as ambulance transport (10)(11)(12).…”

“…This study is one of the first investigating SSC transfers from the delivery suite or the operating theater to the NICU for both term and preterm neonates requiring admission to the NICU, with or without respiratory support. Prior studies focused on smaller cohorts of neonates, and some of those were in different settings such as ambulance transport ( 10 – 12 ).…”

“…Most of the studies assessing the safety and feasibility of SSC transfers to this day studied small cohorts of term or preterm neonates who did not require respiratory support, and some of those were in different settings such as ambulance transport ( 10 – 12 ).…”

“…However, this study was conducted on neonates who did not require respiratory support whereas our study included neonates requiring respiratory support among other medical equipment. Another study by Carneiro et al compared SSC transfers on fathers to incubator transfers and showed that both transfers induced moderate heat loss ( 10 ). Kristoffersen and al.…”