Systematic Review of the Effects of Skin-to-Skin Care on Short-Term Physiologic Stress Outcomes in Preterm Infants in the Neonatal Intensive Care Unit.

BACKGROUND: Infants in the neonatal intensive care unit (NICU) are exposed to many stressors. There is growing evidence that chronic stress early in life has long-term neurodevelopmental implications. Skin-to-skin care (SSC) is an intervention used to reduce stress in the NICU. CLINICAL QUESTION: In premature infants in the NICU, what is the available evidence that SSC improves short-term physiologic stress outcomes compared with incubator care? SEARCH STRATEGY: PubMed and CINAHL were searched for terms related to SSC, stress, physiology, and premature infants. Of 1280 unique articles, 19 were identified that reported on research studies comparing SSC with incubator care in the NICU and reported stress-related physiologic outcome measures. RESULTS: Although there have been some mixed findings, the research supports that SSC improves short-term cardiorespiratory stress outcomes compared with incubator care. The evidence is clearer for studies reporting stress hormone outcomes, with strong evidence that SSC reduces cortisol and increases oxytocin levels in preterm infants. IMPLICATIONS FOR PRACTICE AND RESEARCH: SSC is safe and has stress-reducing benefits. SSC should be considered an essential component to providing optimal care in the NICU. More research is needed to determine the timing of initiation, duration, and frequency of SSC to optimize the stress-reducing benefits. Future research should include the most fragile infants, who are most likely to benefit from SSC, utilize power analyses to ensure adequate sample sizes, and use sophisticated data collection and analysis techniques to more accurately evaluate the effect of SSC on infants in the NICU.

Randomised controlled trial on the impact of kinesthetic stimulation on early somatic growth of preterm infants in Kangaroo position.

AIM: Evaluation of early growth in preterm infants receiving kinesthetic stimulation with massage in Kangaroo position or in incubator. METHODS: A cohort of 66 infants between 30 and 33 weeks of gestational age (GA), born at a university hospital in 2013 in Bogota, were randomised when eligible to intervention. We measured weight gain (g/kg/day) at five days and 15 days postrandomisation and weight at 40 weeks, according to chronological age at randomisation. RESULTS: Daily weight gain was significantly higher (p = 0.02) with kinesthetic stimulation in Kangaroo position with a growth at five days of 11.0 g/kg/day (95% CI 5.7;16.3) and at 15 days of 12.1 g/kg/day (95% CI 10.4;13.7) versus 2.1 g/kg/day (95% CI -3.1;7.4) at five days and 9.4 g/kg/day (95% CI 7.7;11.1) at 15 days in incubator. Weight at 40 weeks was higher (p = 0.05) in Kangaroo position group (2.904 g) than in incubator group (2.722 g) (95% CI 2.784;3.007). Daily weight gain according to chronological age at randomisation was higher when kinesthetic stimulation initiates before five days of life in Kangaroo position with 1.53 g/kg/day (95% CI 5.9;9.0) versus -11.9 g/kg/day (95% CI -19.0;-4.8) in incubator. CONCLUSION: Early kinesthetic stimulation in Kangaroo position reduces the initial weight loss in infants between 30-33 weeks born without major health problems.

Systematic Review of Skin-to-Skin Care for Full-Term, Healthy Newborns.

OBJECTIVE: To determine the effect of skin-to-skin mother-infant holding, touch, and/or massage on full-term, healthy newborns and their primary caregivers. DATA SOURCES: A seven-member scientific advisory panel searched the databases PubMed, CINAHL, and Scopus using the search terms massage, skin-to-skin contact, kangaroo care, touch, therapeutic touch, and full-term newborns for research with human participants published in English with no date parameters. STUDY SELECTION: The initial search yielded 416 articles. After reviewing titles and retaining only articles that met the review criteria, 280 articles remained. The panel co-chairs reviewed and discussed the abstracts of these articles and retained 90 for review. DATA EXTRACTION: Each article was assigned to one panel member and one co-chair for review. Members of the panel met via teleconference to present articles and to determine whether they had scientific merit and addressed the research question. Articles that did not meet these standards were eliminated. Forty articles included relevant evidence: 33 articles on skin-to-skin holding and 7 on infant massage. DATA SYNTHESIS: We created a table that included the purpose, design, and findings of each study. This information was synthesized into a feasibility report by the co-chairs. CONCLUSION: Evidence supports recommendations for skin-to-skin care for all full-term, healthy newborns. Although there is inadequate evidence to recommend massage as standard care for all newborns, massage has been shown to help consolidate sleep patterns and reduce jaundice.

Newborn care practices at home and in health facilities in 4 regions of Ethiopia.

BACKGROUND: Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. METHODS: We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. RESULTS: The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. CONCLUSIONS: Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.