Preterm neonates face a heightened risk of neurodevelopmental impairments, and understanding protective factors against the adverse effects of preterm birth is critical. Recent study aimed to determine if immediate skin-to-skin contact (SSC) provides beneficial neurodevelopmental outcomes in these infants during early childhood. A total of 108 very preterm neonates, aged 28 to 31 weeks at birth, were randomly assigned to either immediate SSC or standard care. The median age for the Bayley Scales of Infant and Toddler Development (BSID-III) assessment at follow-up was approximately 24 months in the SSC group and 25 months in the standard care group, with no significant differences in cognitive composite scores between the groups. The analysis was carried out to detect differences in neurodevelopmental outcomes, yet results showed no clinically relevant distinctions.
Statistical methods incorporated two-sample t-tests and adjusted mean differences via linear regression considering the neonates' sex and maternal education. Follow-up was challenging, with an 80% retention rate, and assessments were performed across multiple criteria, including the Ages & Stages Questionnaire (ASQ) and General Movement Assessment (GMA).
Breastfeeding practices were notably more favorable in the SSC group; more neonates were breastfed at discharge, and the duration of exclusive breastfeeding was longer compared to the standard care group. Despite these positive breastfeeding outcomes, there was no significant difference in identified risks for developmental delays between the two groups at the 2-3 year follow-up.
Implications of Findings
The study found that while SSC did not lead to improved neurodevelopmental outcomes, the increased rates of breastfeeding may suggest an indirect benefit related to maternal-infant bonding. The nonseparation approach, which promotes immediate contact post-delivery, aligns with global recommendations, highlighting the importance of nurturing environments for preterm infants.
Limitations and Future Directions
Limitations of the study included the exclusion of the sickest neonates and challenges in follow-up due to the COVID-19 pandemic. The absence of a healthy full-term control group also constrained comparative analyses. Despite these limitations, the results suggest that while immediate SSC does not significantly change long-term neurodevelopmental trajectories, it can enhance breastfeeding initiation and duration, thus fostering closer maternal bonds. Future resource allocation may benefit from emphasizing the practical implementation of SSC rather than focusing solely on neurodevelopmental outcomes, as the intervention holds promise for improving maternal-infant interactions.
Key Points
- -Target Population and Objective-: The study focused on 108 very preterm neonates (ages 28 to 31 weeks at birth) to evaluate the effects of immediate skin-to-skin contact (SSC) on neurodevelopmental outcomes during early childhood, given the increased risk of neurodevelopmental impairments in preterm infants.
- -Randomization and Assessment-: Participants were randomly assigned to either an SSC group or a standard care group, with follow-up assessments of neurodevelopmental outcomes conducted at a median age of approximately 24 months for the SSC group and 25 months for the standard care group, revealing no significant differences in cognitive composite scores.
- -Statistical Methods-: Statistical analysis employed two-sample t-tests and adjusted mean differences through linear regression, accounting for variables such as neonate sex and maternal education, although follow-up faced challenges with an 80% retention rate.
- -Breastfeeding Practices-: The SSC group exhibited significantly improved breastfeeding outcomes, including higher rates of breastfeeding at discharge and longer durations of exclusive breastfeeding compared to the standard care group; however, there were no significant differences in developmental delays (assessed at 2-3 years) between groups.
- -Implications for Maternal-Infant Bonding-: Although immediate SSC did not enhance neurodevelopmental outcomes, the noted increase in breastfeeding rates suggests potential benefits for maternal-infant bonding, aligning with global health recommendations for nurturing environments for preterm infants.
- -Study Limitations and Future Directions-: Limitations included exclusion of the sickest neonates, the impact of the COVID-19 pandemic on follow-up, and the lack of a healthy full-term control group. The findings suggest that SSC may enhance maternal-infant interaction rather than significantly alter long-term neurodevelopmental trajectories, indicating that future resource allocation could prioritize the implementation of SSC over solely focusing on neurodevelopmental outcomes.
Reference –
L. Kristoffersen et al. (2025). Immediate Skin-To-Skin Contact In Very Preterm Neonates And Early Childhood Neurodevelopment. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.5467.
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