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Skin-to-skin care in Premies?

October 2016

Autonomous control of thermoregulation is one of the most common concerns by health care professionals during the use of skin-to-skin care (SSC).  SSC has been shown, in full term infants, to reduce hypothermia in multiple studies, but concern rises when the infant is in the preterm period.  In a 2016 study of 90 infants born between 32 weeks 0 days and 34 weeks 6 days, the results suggest that early SSC in the delivery room for these infants may be feasible and safe.

baby feet 

In these preterm but otherwise healthy singleton or twin infants, skin-to-skin care was initiated after a very brief examination by the pediatrician. Once the okay was given, half of the infants were placed upright, between their mothers' breasts, with their heads covered by a cap, and monitored for oxygen saturation levels, heart rate, and respiration rate, receiving their first feeding of 5-10 ml/kg of donor breast milk via oral syringe or through a feeding tube within the first hour. They were allowed to remain in safe SSC for up to two hours prior to transfer to the NICU, averaging a total of 65 mins. Body temperatures were measured within the first 30 minutes of delivery. The remaining half were placed into an incubator immediately after delivery and transferred to the NICU. As soon as the parents could come into the NICU, SSC was initiated in the same manner for these infants.

The results are interesting, to say the least, and hopeful. More infants in the incubator group had lower body temperatures than those in the SSC group. Although not routinely performed, safe SSC for the latter part of the preterm period should be considered in the right circumstances. Not only is thermoregulation better, but multiple studies show better breastfeeding, reduced neonatal sepsis, and reduced readmission to the hospital. It is especially important for frequent monitoring and assessment of this higher risk infant population, which might be expected to be more staff intensive than usual. No adverse events occurred in the SSC infants during this study.

The authors conclude with, "We demonstrated that moderately preterm infants can be safely cared for with SSC with their mothers during the first hours after birth...[and when compared with immediate transferred to the NICU in an incubabor]...found no differences in body temperature or blood glucose level between the groups. Therefore, SSC after birth instead of immediate transfer to the NICU seems feasible and safe for preterm infants with gestational ages of 32 weeks 0 days to 34 weeks 6 days,” (Kristoffersen, Stoen, Hansen, Wilhelmsen, and Bergseng, 2016).

As your facility gets closer and closer to designation as a Baby-Friendly hospital, you might consider expanding the provision of safe skin-to-skin care to the preterm population.

Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step2Education International



Kristoffersen, L., Stoen, R., Hansen, L. F., Wilhelmsen, J., and Bergseng, H.  (2016).  Skin-to-skin care after birth for moderately preterm infants.  JOGNN, 45, 339-345.  doi: 10.1016/j.jogn.2016.02.007

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