Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns.
OBJECTIVE
Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal-infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low-birthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth.


METHODS
This was a prospective, unblinded, randomized controlled clinical trial; potential subjects were identified before delivery and randomized by computerized minimization technique at 5 min if eligible. Standardized care and observations were maintained for 6 h. Stability was measured in terms of a set of pre-determined physiological parameters, and a composite cardio-respiratory stabilization score (SCRIP).


RESULTS
34 infants were analysed in comparable groups: 3/18 SSC compared to 12/13 incubator babies exceeded the pre-determined parameters (p < 0.001). Stabilization scores were 77.11 for SSC versus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI: 0.3-5.46, p = 0.031). All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. Eight out of 13 incubator subjects experienced hypothermia.


CONCLUSIONS
Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian "protest-despair" biology, and with "hyper-arousal and dissociation" response patterns described in human infants: newborns should not be separated from their mothers.
Bergman
N J
NJ
Mowbray Maternity Hospital, Mowbray, South Africa. bergman@xsinet.co.za
Linley
L L
LL
Fawcus
S R
SR
D001010:Anxiety, Separation / Q000503:physiopathology*; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006339:Heart Rate; D006801:Humans; D007186:Incubators, Infant; D007224:Infant Care / Q000379:methods*; D007230:Infant, Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D009034:Mother-Child Relations; D010101:Oxygen Consumption; D012119:Respiration; D012867:Skin