title: A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding.
abstract: OBJECTIVE
  To evaluate the effects of almost continuous skin-to-skin contact (SSC) on salivary cortisol, parental stress, parental depression, and breastfeeding.
  
  
  METHODS
  This is a randomised study engaging families of late preterm infants (32-35 weeks gestation). Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age, and in infants and mothers during still-face at four month corrected age. Both parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at one month and the Edinburgh Postnatal Depression Scale (EPDS) at one and four months. Ainsworth's sensitivity scale was used to control for parental sensitivity.
  
  
  METHODS
  Thirty-seven families from two different neonatal care units in Sweden, randomised to either almost continuous SSC or standard care (SC).
  
  
  RESULTS
  Infants randomised to SSC had a lower salivary cortisol reactivity at one month (p=0.01). There was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months in the SSC group (ρ=0.65, p=0.005), but not in the SC group (ρ=0.14, p=0.63). Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC (p<0.05).
  
  
  CONCLUSIONS
  Almost continuous SSC decreases infants' cortisol reactivity in response to handling, improves the concordance between mothers' and infants' salivary cortisol levels, and decreases fathers' experiences of spouse relationship problems.
authors.affiliation: Department of Social and Welfare Studies, Division of Health, Activity and Care, Linköping University, Norrköping, Sweden; Department of Pediatrics, County Council of Östergötland, Linköping, Sweden. Electronic address: Evalotte.morelius@liu.se.
authors.forename: Evalotte
authors.initials: E
authors.lastname: Mörelius
authors.affiliation: Department of Woman and Child Health, Division of Neonatology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Örtenstrand
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Clinical Chemistry, Linköping University, Linköping, Sweden.
authors.forename: Elvar
authors.initials: E
authors.lastname: Theodorsson
authors.affiliation: Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden.
authors.forename: Anneli
authors.initials: A
authors.lastname: Frostell
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology*; D003863:Depression / Q000517:prevention & control* / Q000523:psychology; D005220:Fathers / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000523:psychology*; D060127:Kangaroo-Mother Care Method / Q000523:psychology*; D008297:Male; D009035:Mothers / Q000523:psychology; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000517:prevention & control* / Q000523:psychology
chemical_list: D006854:Hydrocortisone
keywords: Cortisol; Kangaroo Mother Care; Neonatal Care; Preterm infants; Stress