Skin‐to‐skin contact of fullterm infants: an explorative study of promoting and hindering factors in two Nordic childbirth settings

Aim: To explore factors that promote or hinder skin‐to‐skin contact (SSC) during the first days after birth between parents and healthy fullterm infants. Methods: A total of 117 postnatal mothers and 107 fathers/partners attending two childbirth settings, where Kangaroo mother care (KMC) was implemented as a standard routine of care, one in Sweden and one in Norway, were recruited consecutively and answered questionnaires two weeks postpartum. Results: Satisfaction with support for SSC in postnatal care and being a mother in the Swedish setting was found to promote SSC during the first day postpartum; previous knowledge about SSC increased the practice also during the 2nd and 3rd days. Receiving visitors apart from partner and siblings emerged as a hindering factor. SSC was known of and practised to a larger extent in the Swedish setting, whereas parents in the Norwegian setting received more visitors and were more satisfied with the received information and support for SSC in postnatal care. Conclusions: The results highlight the need for caregivers to give parents adequate support for practising SSC with their newborn healthy fullterm infants and indicate the importance of developing information routines during the antenatal period as well as in relation to the birth of the child, to effectively introduce and implement SSC.     

Observation study showed that the continuity of skin‐to‐skin contact with low‐birthweight infants in Uganda was suboptimal

Aim

Kangaroo mother care (KMC) is a safe and effective method of reducing neonatal mortality in resource‐limited settings, but there has been a lack of data on the duration of skin‐to‐skin contact (SSC) in busy, low‐resource newborn units. Previous studies of intermittent KMC suggest the duration of SSC ranged from 10 minutes to 17 hours per day.

Methods

This was an observational study of newborn infants born weighing less than 2000 g, which collected quantitative data on SSC over the first week after birth. The study took place in July 2016 in the newborn unit of a low‐resource facility in Uganda.

Results

The mean daily duration of SSC over the first week after birth was three hours. This differed significantly from the World Health Organization recommendation of at least 20 hours of SSC per day. SSC was provided by mothers most of the time (73.5%), but other family members also took part, especially on the day of birth.

Conclusion

Our study found a disappointingly low daily duration of SSC in this Ugandan newborn unit. However, advocacy and community education of SSC may help to decrease the stigma of KMC, improve overall acceptance and reduce the age at SSC initiation.

     

State of the art and recommendationsKangaroo mother care: application in a high‐tech environment

Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent–infant skin‐to‐skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow‐up. In affluent settings, intermittent KMC with sessions of one or a few hours skin‐to‐skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high‐tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high‐tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents’ role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. Conclusion: Implementation of the original KMC method, with continuous skin‐to‐skin contact whenever possible, is recommended for application in high‐tech environments, although scientific evaluation should continue.     

Randomized controlled trial of early skin‐to‐skin contact: effects on the mother and the newborn

Objective: To estimate the influence of skin‐to‐skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin‐to‐skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. Methods: A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t‐test, Fisher test or chi‐square test as appropriate. Results: Greater thermal stability in the skin‐to‐skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin‐to‐skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin‐to‐skin care group. Conclusion: This study shows that skin‐to‐skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.     

重症监护病房新生儿皮肤管理指南(2021)

新生儿皮肤屏障功能弱,极易受损而导致局部或全身感染,增加死亡风险.保护新生儿皮肤完整性、预防皮肤损伤是新生儿重症监护病房管理的重要内容之一.该指南基于国内外相关证据,采用证据推荐分级的评估、制定与评价方法进行证据分级,制定新生儿重症监护病房新生儿皮肤管理指南,对皮肤常规管理、医源性皮肤损伤的预防及处理给出推荐意见,旨在...