Skin-to-Skin Contact for Transferring Preterm Infants from the Delivery Room to the Neonatal Intensive Care Unit Is Promising Despite Moderate Heat Loss during the Procedure

Abstract

Objective The principal aim of this prospective observational study was to assess the feasibility of skin-to-skin contact (SSC) with fathers during the transfer of preterm infants from the delivery room to the neonatal intensive care unit (NICU) in comparison with incubator transfers.

Study Design The study population comprised preterm singletons born between May and December 2019 in our maternity ward who did not require invasive ventilation. Physiological parameters (axillary temperature, heart rate, and fraction of inspired oxygen) of the newborns were recorded at prespecified steps during the transfers. The impact of the transfer mode on early blood glucose level, blood gas, and neonatal morbidities and mortality and the delay in the first SSC in the NICU and breastfeeding implementation and maintenance were also analyzed.

Results Twenty-eight preterm infants were transferred in incubators, and 29 infants were transferred using SSC. The SSC transfer induced heat loss (mean, −0.45°C; standard deviation [SD], 0.58). However, the decrease in temperature was similar to that observed during transfer in the incubator (mean, −0.30°C; SD, 0.49; p = 0.3). The transfer using SSC was not an independent factor associated with hypothermia at admission in the NICU (adjusted odds ratio, 2.6 [0.68–9.75]; p = 0.16). Neonatal morbidities and mortality were similar regardless of the transfer mode. The SSC transfer promoted early SSC in the neonatal unit (median hour [range], incubator 26 [2–126] vs SSC 13 [1–136], p = 0.03) and breastfeeding at discharge (incubator 35.7% vs SSC 69%, p = 0.01).

Conclusion The SSC transfer of preterm infants was feasible and promoted earlier SSC and breastfeeding. Nevertheless, the SSC transfer, like the transfer in the incubator, induced moderate heat losses that exacerbated hypothermia at admission in the NICU. The improvement of thermal conservation during infant positioning and the continuation of SSC in the unit could help in preventing hypothermia.

Key Points

• The SSC transfer was associated with heat loss during the transfer procedure.

• The SSC transfer promoted earlier SSC in the neonatal unit.

• The SSC transfer was likely to encourage breastfeeding.

Keywords

newborn - preterm newborns - intensive care - kangaroo-mother care - hypothermia - breastfeeding

Ethics

The SSC transfer was exclusively performed by the infant's father. Oral insformation was provided to the parents in the delivery room about the two modes of transfer and the data collection. Supplementary written information was also provided to them during the first days of the infant hospitalization, and written consent was obtained from them for the use of their children's data. The local ethics committee (2019–082) and the local data protection authority (2019–054) approved the protocol.

Note

A preliminary version of this study was first posted in March 2021 on Research Square at the following address: https://www.researchsquare.com (doi:10.21203/rs.3.rs-324905/v1). The authors confirm that if their article is published in the American Journal of Perinatology, they will notify the relevant parties accordingly so that the preprint version can be linked to the published record.

Authors' Contributions

G. F. and N. C. designed the study protocol. G. F. and L. C. obtained the ethics approval. C. J., G. F., L. C., and N. C. collected the data. G. F., N. C., and L. C. performed the final data analysis. G. F. and N. C. wrote the manuscript. C. J., L. C., and S. A. S. contributed to the writing and the critical reading of the manuscript.

Publication History

Received: 08 April 2022

Accepted: 09 November 2022

Accepted Manuscript online:
16 November 2022

Article published online:
21 December 2022

• References

• 1 Hucklenbruch-Rother E, Vohlen C, Mehdiani N. et al. Delivery room skin-to-skin contact in preterm infants affects long-term expression of stress response genes. Psychoneuroendocrinology 2020; 122: 104883
• 2 Moberg KU, Handlin L, Petersson M. Neuroendocrine mechanisms involved in the physiological effects caused by skin-to-skin contact - with a particular focus on the oxytocinergic system. Infant Behav Dev 2020; 61: 101482
• 3 Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016; 11 (11) CD003519
• 4 Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002; 110 (1, pt. 1): 16-26
• 5 Jones H, Santamaria N. Physiological benefits to parents from undertaking skin-to-skin contact with their neonate, in a neonatal intensive special care unit. Scand J Caring Sci 2018; 32 (03) 1012-1017
• 6 Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2014; 75 (01) 56-64
• 7 Lorenz L, Marulli A, Dawson JA. et al. Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support. Arch Dis Child Fetal Neonatal Ed 2018; 103 (02) F137-F142
• 8 Blomqvist YT, Karlsson V, Dawit F, Sindelar R, Ågren J. Physiological stability in very preterm infants during skin-to-skin contact as assessed by near-infrared spectroscopy. Adv Neonatal Care 2020; 20 (06) 495-498
• 9 World Health Organization. Essential Elements of Obstetric Care at First Referral Level. World Health Organization; 1991
• 10 Lyu Y, Shah PS, Ye XY. et al; Canadian Neonatal Network. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr 2015; 169 (04) e150277
• 11 Wilson E, Maier RF, Norman M. et al; Effective Perinatal Intensive Care in Europe (EPICE) Research Group. Admission hypothermia in very preterm infants and neonatal mortality and morbidity. J Pediatr 2016; 175: 61-67.e4
• 12 Trevisanuto D, Testoni D, de Almeida MFB. Maintaining normothermia: why and how?. Semin Fetal Neonatal Med 2018; 23 (05) 333-339
• 13 Alebachew Bayih W, Assefa N, Dheresa M, Minuye B, Demis S. Neonatal hypothermia and associated factors within six hours of delivery in eastern part of Ethiopia: a cross-sectional study. BMC Pediatr 2019; 19 (01) 252
• 14 McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2018; 2 (02) CD004210
• 15 Sontheimer D, Fischer CB, Buch KE. Kangaroo transport instead of incubator transport. Pediatrics 2004; 113 (04) 920-923
• 16 Hennequin Y, Grevesse L, Gylbert D, Albertyn V, Hermans S, Van Overmeire B. Skin-to-skin back transfers provide a feasible, safe and low-stress alternative to conventional neonatal transport. Acta Paediatr 2018; 107 (01) 163-164
• 17 Wyllie J, Perlman JM, Kattwinkel J. et al; Part 7: neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. 2015; 95: e169-e201
• 18 Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013; 13: 92
• 19 Linnér A, Klemming S, Sundberg B. et al. Immediate skin-to-skin contact is feasible for very preterm infants but thermal control remains a challenge. Acta Paediatr 2020; 109 (04) 697-704
• 20 Clénet N, Carneiro L, Jeanneaud C, Favrais G. Potential benefits and pitfalls of skin-to-skin contact transport from birth room to neonatal unit. Accessed November 25, 2022 at https://www.researchsquare.com/article/rs-324905/private/draft
• 21 Maastrup R, Greisen G. Extremely preterm infants tolerate skin-to-skin contact during the first weeks of life. Acta Paediatr 2010; 99 (08) 1145-1149
• 22 Karlsson V, Heinemann AB, Sjörs G, Nykvist KH, Ågren J. Early skin-to-skin care in extremely preterm infants: thermal balance and care environment. J Pediatr 2012; 161 (03) 422-426
• 23 Madar J, Roehr CC, Ainsworth S. et al. European Resuscitation Council Guidelines 2021: newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161: 291-326
• 24 Travers CP, Ramani M, Gentle SJ. et al. Early skin-to-skin care with a polyethylene bag for neonatal hypothermia: a randomized clinical trial. J Pediatr 2021; 231: 55-60.e1
• 25 Hu XJ, Wang L, Zheng RY. et al. Using polyethylene plastic bag to prevent moderate hypothermia during transport in very low birth weight infants: a randomized trial. J Perinatol 2018; 38 (04) 332-336
• 26 Doglioni N, Cavallin F, Mardegan V. et al. Total body polyethylene wraps for preventing hypothermia in preterm infants: a randomized trial. J Pediatr 2014; 165 (02) 261-266.e1
• 27 Bauer K, Uhrig C, Sperling P, Pasel K, Wieland C, Versmold HT. Body temperatures and oxygen consumption during skin-to-skin (kangaroo) care in stable preterm infants weighing less than 1500 grams. J Pediatr 1997; 130 (02) 240-244
• 28 Aghdas K, Talat K, Sepideh B. Effect of immediate and continuous mother-infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: a randomised control trial. Women Birth 2014; 27 (01) 37-40
• 29 Marín Gabriel MA, Llana Martín I, López Escobar A, Fernández Villalba E, Romero Blanco I, Touza Pol P. Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn. Acta Paediatr 2010; 99 (11) 1630-1634
• 30 Uslu S, Ozdemir H, Bulbul A. et al. A comparison of different methods of temperature measurements in sick newborns. J Trop Pediatr 2011; 57 (06) 418-423
• 31 Mayfield SR, Bhatia J, Nakamura KT, Rios GR, Bell EF. Temperature measurement in term and preterm neonates. J Pediatr 1984; 104 (02) 271-275
• 32 Laptook AR, Salhab W, Bhaskar B. Neonatal Research Network. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics 2007; 119 (03) e643-e649
• 33 Yitayew YA, Aitaye EB, Lechissa HW, Gebeyehu LO. Neonatal hypothermia and associated factors among newborns admitted in the neonatal intensive care unit of Dessie Referral Hospital, Amhara Region, Northeast Ethiopia. Int J Pediatr 2020; 2020: 3013427
• 34 Mank A, van Zanten HA, Meyer MP, Pauws S, Lopriore E, Te Pas AB. Hypothermia in preterm infants in the first hours after birth: occurrence, course and risk factors. PLoS One 2016; 11 (11) e0164817
• 35 Nyandiko WM, Kiptoon P, Lubuya FA. Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya. PLoS One 2021; 16 (03) e0248838
• 36 Glenn T, Price R, Culbertson L, Yalcinkaya G. Improving thermoregulation in transported preterm infants: a quality improvement initiative. J Perinatol 2021; 41 (02) 339-345
• 37 Donnellan D, Moore Z, Patton D, O'Connor T, Nugent L. The effect of thermoregulation quality improvement initiatives on the admission temperature of premature/very low birth-weight infants in neonatal intensive care units: a systematic review. J Spec Pediatr Nurs 2020; 25 (02) e12286
• 38 Bhatt DR, Reddy N, Ruiz R. et al. Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight less than 1000 g: single-center experience over 6 years. J Investig Med 2020; 68 (07) 1256-1260