Introduction
Skin-to-skin contact (SSC) or Kangaroo Mother Care between mothers and preterm infants is strongly recommended by the WHO,1 2 and has been shown to have positive effects on neonatal as well as maternal outcomes.3–8 The most recent Cochrane review7 supports SSC as an effective and safe alternative to standard care (SC), especially in resource-limited settings. A recent randomised controlled trial (RCT) of more than 3000 infants with a birth weight between 1.0 and 1.8 kg from Ghana, India, Malawi, Nigeria and Tanzania reported a reduction of mortality of 25% when SSC between the mother and infant was initiated shortly after delivery.6 However, research from high-income settings is scarce.
The availability of human and technical resources and drugs contributes to low mortality among preterm infants in high-income countries. It is unlikely that SSC after delivery in these settings influences mortality or major prematurity-related complications. However, parent–infant bonding,9 10 cardiorespiratory stability and breastfeeding11 12 may all improve with early SSC regardless of resources.11–14
Current delivery room practice for very preterm infants (gestational age (GA) 280–316 weeks) is to stabilise and place the infant in an incubator before transfer to the neonatal intensive care unit (NICU). After caesarean section (C-section), the mother and infant can be in separate departments for many hours. In one recent qualitative study, mothers who had their infants skin-to-skin described how they were immediately comforted by the infant’s vitality, while mothers who were separated from their infant described feelings of fear, guilt, and frustration.15 A study comparing 60 min delivery room SSC with 5 min of visual contact between mothers and infants born at GA 25–32 weeks, found an improved mother–child interaction at 6 months corrected age and less maternal depression in the SSC group.8
There has been a shift towards family oriented neonatal intensive care, and the family is now considered a central part of the NICU team.16 Whether this translates into improved long-term outcomes has not been established, but another intervention to enhance parental coping in the NICU has shown a significant increase in IQ points at five years of age.17
There is a need to identify barriers to early SSC for very preterm infants in high-resource settings as well as any harm or benefit. This study presents outcomes on feasibility, safety, and the effects on physiological parameters in very preterm infants randomised to early SSC in the delivery/operating room or SC in an incubator.18