The power of touch: skin-to-skin contact and kangaroo mother care for newborns

Born_too_soon_and_too_small_-_Ediths_twin_boys_(7497732174)

Source: Lindsay Mgbor/Department for International Development [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

Early skin-to-skin contact: What is it?

Early skin-to-skin contact (SSC) involves a parent (although it’s usually a mother) holding their baby to their bare chest, ideally beginning right at birth. Kangaroo mother care (KMC) goes a couple of steps further, with three parts: skin-to-skin contact, exclusive or nearly exclusive breastfeeding, and early discharge from hospital.

What is it used for?

Kangaroo mother care is often used in developing countries, where resources are in short supply, to prevent morbidity and mortality in preterm and low birth weight (LBW) babies. In developed countries, skin-to-skin contact has been proposed to have beneficial effects on breastfeeding, physiological adaptation (thermoregulation; respiratory, cardiac, and metabolic function; neurobehaviour), and behaviour (maternal-infant bonding/attachment) in healthy mother-newborn pairs.

Does it work?

Two Cochrane systematic reviews have looked at this question: one on kangaroo mother care and one on early skin-to-skin contact.

Kangaroo_and_joey03

Source: Fir0002/Flagstaffotos.com.au – http://www.flagstaffotos.com.au/, via Wikimedia Commons

Kangaroo care:

  • 18 randomized controlled trials (2,751 infants) comparing KMC and conventional neonatal care, or early and late onset KMC in LBW infants, were included.
  • There was variation in hospital conditions and implementation, but KMC was defined extremely consistently across studies.
  • At discharge or 40-41 weeks postmenstrual age, KMC was associated with reduced:
    • mortality
    • nosocomial infection/sepsis
    • hypothermia
    • length of hospital stay
  • At latest follow up, the risk of mortality and severe infection/sepsis was significantly reduced.

The authors conclude:

“The evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care mainly in resource-limited settings.”

Early skin-to-skin contact:

  • 34 randomized controlled trials (2,177 mother-infant dyads) comparing SSC with usual hospital care were included.
  • There was a lot of variation in how SSC was implemented, in terms of duration, time initiated, and opportunity for and assistance with breastfeeding, as well as in the amount of separation experienced in the control groups, but the results consistently supported SSC.
  • Benefits included:
    • increased likelihood and length of breastfeeding at one to four months postbirth
    • improved blood glucose levels
    • improved cardio-respiratory stability in late preterm infants
  • There were no significant differences between groups in duration of breastfeeding and infant axillary temperature.

In this review, the authors concluded:

“The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects.”

Comment

Both reviews were well conducted, and despite heterogeneity in some of the factors related to the implementation of the intervention, consistently found moderate treatment effects supporting the use of skin-to-skin contact to improve outcomes for the infant and the mother. Neither identified any negative effects. While some of the issues like timing and technique that differed across studies may still need to be sorted out, this evidence supports early skin-to-skin contact for newborns.

As highlighted in The Lancet’s Every Newborn series, published in May 2014 in concert with UNICEF’s six month countdown to the 25th anniversary of the Convention on the Rights of the Child, one of the most effective interventions in saving newborns is kangaroo care. According to Dr. Mickey Chopra, head of UNICEF’s global health programs, “We have seen tremendous progress in saving children under five, but where the world has stumbled is with the very youngest, most vulnerable children. This group of children needs attention and resources. Focusing on the crucial period between labour and the first hours of life can exponentially increase the chances of survival for both mother and child.”

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