ABSTRACT: At birth, the neonate’s temperature drops by 2°C to 4°C within minutes, and this is even greater without thermal protection. Hypothermia is present when the newborn’s axillary temperature is less than 36.5°C. Kangaroo mother care uses skin-to-skin contact (SSC) and has been a standard for more than 10 years for stable low-birth-weight (LBW) newborns. This randomized controlled study was undertaken to evaluate the effect of early SSC on the incidence of hypothermia in term and late-preterm newborns.
Stable neonates weighing 1800 g or greater and delivered vaginally were eligible. They received either early SSC (intervention group) or conventional care (control group). In the intervention group, mothers started SSC at 30 minutes to 1 hour after delivery and continued for as long as possible during the initial 24 hours with each session lasting 60 minutes or more. Skin-to-skin contact was discontinued after 24 hours. In the control group, after providing routine care under a radiant warmer, newborns were kept clothed, with a cap, and covered with a blanket with their mother for the first 48 hours. Newborns in both groups were exclusively breast-fed. Temperatures and heart rates in the both groups were recorded at 30 minutes and at 1, 2, 3, 4, 5, 6, 12, 24, and 48 hours. Differences in the mean temperature between the 2 groups were assessed using the independent-samples t test. Relative risk was used to estimate the effect of SSC on the incidence of hypothermia.
For the 50 newborns in each group, the mean baseline heart rate was 140.95 ± 7.28 (range, 128–159 beats/min), and mean baseline temperature was 36.88°C ± 0.25°C (range, 36.6°C–37.6°C). The 2 groups were similar in other baseline clinical characteristics. The mean time for starting SSC in the intervention group was 43 ± 12.5 minutes after birth, and mean total time of SSC was 16.98 ± 0.28 hours (range, 16.5–17.5 hours) during the first 24 hours. Sixteen control newborns (32%) developed hypothermia during the initial 48 hours, and of these, 10 (62.5%) were LBW, and 5 (31.2%) were late preterm. All 16 newborns became hypothermic within 6 hours; 11 had a single episode, 4 had 2 episodes, and 1 had 3 episodes of hypothermia. Only 2 SSC newborns (4%) developed hypothermia, and of these, 1 newborn had 2 episodes. One of these newborns was LBW and preterm. No newborns in the SSC group had hypothermia after 3 hours. The mean temperature was significantly higher in the SSC group as compared with the control group at all the time points from 1 hour through 48 hours (P < 0.05). The relative risk of developing hypothermia in the control group was 8 times higher (95% confidence interval, 1.94–32.99) compared with the SSC group. The study was conducted during the summer, winter, and monsoon seasons, but season was not associated with development of hypothermia in either group.
The incidence of hypothermia with conventional care was significantly higher compared with SSC. Many infants are born in regions without the availability of incubator or radiant warmer care. Skin-to-skin contact is an alternative to reduce heat loss in stable newborns, and early SSC may reduce mortality due to hypothermia.
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, India