Bonding effect of skin-to-skin contact in preterm infants

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Skin-to-skin contact between parent and infant has positive effects for the infant’s development, writes MedicalBrief. But for parents who children have had to spend a lot of time in ICU, it may come as relief to find that a Swedish study shows it does not lead to significantly better interaction between the mother and the infant.

Following a premature birth it is important that the parents and the infant quickly establish a good relationship. Researchers at Linköping University have studied the relationship between mothers and infants who have continuous skin-to-skin contact during the entire period from birth to discharge from the hospital. The results show that continuous skin-to-skin contact does not lead to better interaction between the mother and the infant.

Every year some 15m infants worldwide are born prematurely. Because the infants often require intensive care, it is common that they are separated from their parents, which can negatively affect the attachment between mother and infant.

For the parents, this separation can result in guilt and a sense of emptiness at not being able to be close to their newborn child. For the infant, losing closeness to the parents is one of the largest stress factors in early life. But skin-to-skin care against the parent’s chest, instead of care in an incubator, can reduce stress.

“Skin-to-skin contact between parent and infant has proved to have positive effects for the infant’s development – but there are no clear results regarding the effect on the interaction between mother and infant. Which is why we wanted to study this,” says Charlotte Sahlén Helmer, doctoral student at Linköping University, Sweden.

In the study, the researchers investigated the interaction between mothers and infants born prematurely – between weeks 32 and 36. The study was carried out at two Swedish hospitals, where the parents are able to be with their infant around the clock. Thirty-one families took part. The families were split into two groups: one where the mother was to give the infant continuous SSC from birth until discharge, and one where the mother was to give the infant as much or as little SSC as she wanted to, or was able to.

After four months, the researchers followed up how the mothers interacted with their preterm infants. They found no significant differences in interaction between the continuous and the intermittent skin-to-skin contact groups. As regards the mother’s attachment to the infant, the researchers could not see that skin-to-skin contact had any effect in terms of (the mother’s acceptance of or sensitivity to the infant). Nor was there a correlation between the number of hours of skin-to-skin contact and the quality of the interaction.

“Some people say that skin-to-skin contact automatically results in good attachment between mother and infant. Our study shows that this may not be the case. It may be a relief for the parents who are not able to keep their infant against their skin around the clock, to know that they can still have good interaction. But these results must be followed up with further studies,” says Charlotte Sahlén Helmer.

The study is part of a larger project investigating the effects of skin-to-skin contact in preterm infants.

Background: Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers.
Purpose: The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose–response effect between time in SSC and quality of interaction.
Methods: Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months’ corrected age. Face-to-face interaction was coded according to Ainsworth’s Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose–response correlations were calculated between mean time spent in SSC and each of the interaction scales.
Results: There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction.
Implications for Practice: Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother–infant interaction between preterm infants and their mothers at 4 months’ corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group.
Implications for Research: Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.

Charlotte Sahlén Helmer, Ulrika Birberg Thornberg, Anneli Frostell, Annica Örtenstrand, Evalotte Mörelius

Linköping University material

Advances in Neonatal Care abstract

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