Immediate skin-to-skin contact after birth ensures stable thermoregulation in very preterm infants in high-resource settings

Aim To investigate the impact of immediate skin-to-skin contact with a parent after birth on thermal regulation in very preterm infants. Methods This clinical trial was conducted in three neonatal intensive care units in Scandinavia from 2018 to 2021. Infants born between 28 + 0 and 32 + 6 weeks and days of gestation were randomised to immediate skin-to-skin contact or conventional care in an incubator during the first 6 postnatal hours. We report on a secondary outcome: serial measurements of axillary temperature. Results Ninety-one infants were randomised to skin-to-skin contact or conventional care. Mean (range) gestational ages were 31 + 2 (28 + 6, 32 + 5) and 31 + 0 (28 + 4, 32 + 6) weeks and days, mean birth weights were 1572 (702, 2352) and 1495 (555, 2440) grams, respectively. Mean (95%CI, p-value) temperatures were within the normal range in both groups, 0.2°C (−0.29, −0.14, p < 0.001) lower in the skin-to-skin contact group. The skin-to-skin contact group had a lower relative risk (95%CI, p-value) of developing events of hyperthermia, RR = 0.70 (0.50, 0.99, p = 0.04). Conclusions Very preterm infants, irrespective of clinical stability, do not develop hypothermia during immediate skin-to-skin contact after birth. Immediate skin-to-skin contact did protect against events of hyperthermia. Concerns about thermal regulation should not limit implementation of immediate skin-to-skin contact in high-resource settings.publishedVersio

Factors Influencing Implementation of Family-Centered Care in a Neonatal Intensive Care Unit

Background: Approximately 10% of all births worldwide are preterm. Often these infants are admitted at a Neonatal Intensive Care Unit (NICU). The NICU environment with periods of unnatural light, noise and repeated disturbances is very stressful for infants admitted to the NICU. In addition separation of parents causes stress for both infant and parents. A way to support and include parents in the care for their infants is Family-Centered Care (FCC). FCC is an approach of planning, delivery and evaluation of healthcare, based on a partnership between healthcare professionals and families of patients. Parents of infants who were admitted to an FCC unit were less stressed compared to parents at a Standard Care unit. Aim: Although FCC is beneficial to families and patients, implementation can be challenging. Therefore it is important to know which factors can contribute or withhold the implementation of FCC. This study explored factors that influence implementation of FCC in NICU's according to healthcare professionals that work in a NICU with the concept FCC. Method: A descriptive generic qualitative design with semi-structured interviews and inductive thematic analyses was used. This international multi-center study was conducted in three hospitals in three European countries: Sweden, Norway, and The Netherlands. Results: Seven neonatal care nurses, one nurse assistant, five neonatologists, and three managers participated in this study. Four aspects were identified, when analyzing the data, namely: Behavioral change in staff, Family needs, Environment, and Communication. Most important is that almost all healthcare professionals described that the mind-set of the professional influences the implementation of FCC. Conclusion: The mind-set of healthcare professionals in seeing parents as primary caregiver influences the way FCC is practiced and how parents are involved in the care for their infant

Parent–infant closeness after preterm birth and depressive symptoms : A longitudinal study

Background: Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents. Methods: This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14  days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4  months corrected age of the infant. Results: The study included 684 mothers and 574 fathers. The median presence was 469   min (Q1 258 and Q3 1,087) per 24   h for the mothers and 259   min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4  months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted). Conclusion: No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.© 2022 Lehtonen, Lilliesköld, De Coen, Toome, Gimeno, Caballero, Tameliene, Laroche, Retpap, Grundt, Van Hoestenberghe, Skene, Pape and Axelin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.fi=vertaisarvioitu|en=peerReviewed

Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study

Background: Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents.Methods: This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14  days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4  months corrected age of the infant.Results: The study included 684 mothers and 574 fathers. The median presence was 469   min (Q1 258 and Q3 1,087) per 24   h for the mothers and 259   min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4  months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted).Conclusion: No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.</p

Skin-to-skin contact after birth : Developing a research and practice guideline

Funding Information: Funding for the two in‐person meetings (one of the Steering Group and one of the Expert Panel) was provided through a grant from Healthy Children Project, Inc., a not‐for‐profit (501c3) non‐governmental organisation (NGO) located in the United States. Publisher Copyright: © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica. © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.Aim: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. Methods: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. Results: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. Conclusion: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.Peer reviewe

Immediate skin-to-skin contact after a very preterm birth : supporting the parent-infant relationship

Background: Preterm birth poses challenges that may negatively affect parental mental health and infant development. A well-functioning parent-infant relationship can mitigate the risk of preterm birth on infant development, and early interventions that foster close parent-infant contact and support parenthood from birth are therefore warranted. Skin-to-skin contact between parents and infants has been found to decrease distress in parents and improve parent-infant interaction behaviors, yet little is known regarding its benefits when initiated immediately after birth for more vulnerable infants. Further, there is a lack of knowledge regarding the difference in effects of SSC provided during the first postnatal hours and later in the neonatal period. The overall aim of this thesis was to gain knowledge about, and a deeper understanding of, the impact of skin-to-skin contact between parents and very preterm infants when practiced immediately after birth, as compared to later in the neonatal period, on parents’ mental health and the parent-infant relationship within the first year of life. Methods: The four studies in this thesis derive from two multicenter studies: a prospective longitudinal study, “The 2nd International Closeness Survey” (study I) and a randomized clinical trial, “The Immediate Parent-Infant Skin-to-Skin Study” (IPISTOSS) (study II-IV). Study I involved mothers (n=684) and fathers (n=574) to preterm infants born less than 35 gestational weeks of age from 23 neonatal units in 15 countries. In study I, associations between the amount of proximity between parents and infants in the neonatal unit, including time spent in skin-to-skin contact, and parents’ symptoms of depression (assessed with Edinburgh Postnatal Depression Scale, EPDS) at discharge and at 4 months were investigated. Study II-IV derived from the randomized controlled trial IPISTOSS that compared care in skin-to-skin contact immediately after birth with standard incubator care for very preterm infants (28–33 gestational weeks of age) in three neonatal units in Sweden and Norway. Study II included 73 parent couples to 91 infants and investigated the effect on parents’ symptoms of depression (EPDS) and anxiety (assessed with Spielberger State-Trait Anxiety Inventory, STAI) within the infants’ first year of life. Study III included 71 infants and their 56 mothers and investigated the effect on mother-infant interaction quality (measured with the Parent-Child Early Relational Assessment, PCERA) at 4 months. In study IV, 12 parents participated in individual interviews at the time of discharge to home to explore their experiences of immediate skin-to-skin contact and the care and support from healthcare staff. Results: Study I found no association between the duration of parent-infant proximity in the neonatal unit and symptoms of depression in parents at discharge and at 4 months. Study II found that immediate skin-to-skin contact after a very preterm birth decreased EPDS scores in mothers (mean [SD] 9.8 [6.0] vs 12.3 [5.9] in the control group, p <0.05) at one week after birth and EPDS (mean [SD] 3.0 [2.0] vs 6.4 [4.7] in the control group, p=0.02) and STAI scores (mean [SD] 27.7 [5.7] vs 36.1 [9.5] in the control group, p=0.002) in fathers at term-equivalent age of the infant. In study III, immediate skin-to-skin contact was found to enhance the infants’ expressions of positive affect, communication and social skills when interacting with their mothers at 4 months (PCERA subscale 3 score mean [SD] 3.60 [0.47] vs 3.27 [0.50] in the control group, p=0.01). In study IV, immediate skin-to-skin contact was described as an empowering experience that promoted feelings of connectedness with their newborns yet had challenges and required adequate support from healthcare staff. Conclusion: The main findings in this thesis suggest that the practice of skin-to-skin contact in the immediate postpartum period has an impact on the early parent-infant relationship following a very preterm birth, which is supported by the positive influence of immediate skin-to-skin contact on parents’ mental health and mother-infant interaction quality as well as by parents’ experiences. Beyond the immediate postpartum period, parent-infant proximity and skin-to-skin contact in the NICU need to be continued to be supported, along with other elements within infant- and family-centered developmental care that may further contribute to parental mental health after a preterm birt

Parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates

OBJECTIVE: To explore parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates and their perceptions regarding care and support from staff. DESIGN: A descriptive qualitative study. SETTING: Birth and neonatal units within a university hospital in Sweden. PARTICIPANTS: Six parent couples who co-cared for their very preterm neonates with skin-to-skin contact throughout the first 6 hours after birth. METHODS: We analyzed individual interviews using reflexive thematic analysis as described by Braun and Clarke. RESULTS: The parents' experiences of immediate skin-to-skin contact with their very preterm neonates were represented by the following three themes: A Pathway to Connectedness, Just Being in a Vulnerable State, and Creating a Safe Haven in an Unknown Terrain. Skin-to-skin contact helped the parents attain their roles as essential caregivers and provided a calming physical sensation that promoted parents' feelings of connectedness with their newborns. When parents provide skin-to-skin contact at birth, staff members need to recognize and address their vulnerability. A good relationship with nursing staff, which was mediated through staff behaviors and availability, facilitated skin-to-skin contact. CONCLUSION: Skin-to-skin contact initiated at birth with very preterm neonates was a valuable and empowering experience for parents and enhanced early bonding between parents and their newborns. Staff members should recognize that skin-to-skin contact between parents and neonates is an interactive process that has challenges and requires adequate support. Future research is warranted to understand the needs of nursing staff who provide initial care in the postpartum period. Furthermore, we recommend the implementation of maternal-neonatal couplet care