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Safety and Effectiveness of Skin-to-Skin Contact in the NICU to Support Neurodevelopment in Vulnerable Preterm Infants

Carbasse, Aurélia MD; Kracher, Sylvie RN; Hausser, Martine RN; Langlet, Claire MD; Escande, Benoît MD; Donato, Lionel MD; Astruc, Dominique MD; Kuhn, Pierre MD, PhD

The Journal of Perinatal & Neonatal Nursing: July/September 2013 - Volume 27 - Issue 3 - p 255–262
doi: 10.1097/JPN.0b013e31829dc349
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Skin-to-skin contact (SSC) is a cornerstone of neurodevelopmentally supportive and family-oriented care for very low-birth-weight preterm infants (VPIs). However, performing SSC with unstable and/or ventilated VPIs remains challenging for caregiving teams and/or controversial in the literature. We first aimed to assess the safety and effectiveness of SSC with vulnerable VPIs in a neonatal intensive care unit over 12 months. Our second aim was to evaluate the impact of the respiratory support (intubation or not) and of the infant's weight (above or below 1000 g) on the effects of SSC. Vital signs, body temperature, and oxygen requirement data were prospectively recorded by each infant's nurse before (baseline), during (3 time points), and after their first or first 2 SSC episodes. We compared the variations of each parameter from baseline (analysis of variance for repeated measures with post hoc analysis when appropriate). We studied 141 SSCs in 96 VPIs of 28 (24-33) weeks’ gestational age, at 12 (0-55) days of postnatal age, and at a postmenstrual age of 30.5 (±1.5) weeks. During SSC, there were statistically significant increases in oxygen saturation (Sao2) (P < .001) with decreases in oxygen requirement (P = .043), a decrease in heart rate toward stability (P < .01) but a transient and moderate decrease in mean axillary temperature following the transfer from bed to mother (P < .05). Apneas/bradycardias requiring minor intervention occurred in 19 (13%) SSCs, without need for SSC termination. These variations were similar for intubated newborns (18%) as compared with newborns on nasal continuous positive airway pressure (52%) or breathing room air (30%). However, ventilated infants exhibited a significant increase in transcutaneous partial pressure of carbon dioxide (TcPco2) (P = .01), although remaining in a clinically acceptable range, and a greater decrease in oxygen requirements during SSC (P < .001) than nonventilated infants. Skin-to-skin contact in the neonatal intensive care unit seems safe and effective even in ventilated VPIs. Recording physiologic data of infants before, during, and after SCC provides data needed to secure changes of practice in SCC.

Médecine et Réanimation néonatale, Service de Pédiatrie 2, Pôle médico-chirurgical pédiatrique, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Avenue Molière, Strasbourg, France (Drs Carbasse, Langlet, Escande; Donato, Astruc, and Kuhn, Ms Kracher, and Mr Hausser); and Laboratoire de Neurosciences Cognitives et Adaptatives UMR 7364, Centre National de la Recherche Scientifique/Université de Strasbourg, France (Dr Kuhn).

Corresponding Author: Pierre Kuhn, MD, PhD, Médecine et Réanimation néonatale, Service de Pédiatrie 2, Pôle médico-chirurgical pédiatrique Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 28 Ave Molière 67098, Strasbourg, France (pierre.kuhn@chru-strasbourg.fr).

The authors are especially grateful to the infants and their parents who participated in this research program. They thank the NIDCAP team and the developmental care working group of Strasbourg for their invaluable help and great involvement in implementing developmental care and promoting SSC practice in our department with the stimulating assistance of Nathalie Ratynski (MD, NIDCAP trainer; Brest, France). The authors are also very grateful to the whole nursing team for their compliance and help acquiring data during the study period and their continuous commitment in the care of newborns. Finally, the authors thank Kathleen Philbin for her valuable comments to structure this manuscript and Karina Aberg for her fast and valuable help in English language editing.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: April 13, 2013; accepted for publication: May 27, 2013.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins.