Skin-to-skin contact do not improve interaction between mother and preterm infant

January 23, 2020

Science Daily/Linköping University

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. The study is published in the scientific journal Advances in Neonatal Care.

Every year some 15 million 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 e.g. 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.

https://www.sciencedaily.com/releases/2020/01/200123095901.htm

For preterm infants, skin-to-skin contact affects hormone levels -- and may promote parental engagement

October 19, 2018

Science Daily/Wolters Kluwer Health

For premature infants in the neonatal intensive care unit (NICU), skin-to-skin contact with parents influences levels of hormones related to mother-infant attachment (oxytocin) and stress (cortisol) -- and may increase parents' level of engagement with their infants.

Promoting early contact and parental engagement might help to lessen the risk of neurodevelopmental delay associated with preterm birth and NICU care, according to the exploratory study by Dorothy J. Vittner, PhD, RN, CHPE, of University of Connecticut School of Nursing and colleagues. They write, "Parental touch, especially during skin-to-skin contact (SSC) has potential to reduce adverse consequences."

Study Attempts to Measure Benefits of Skin-to-Skin Contact for Preterm Infants

The pilot study included 28 preterm infants, average gestational age 33 weeks. All infants were in stable condition while receiving NICU care. Infants underwent periods of SSC on two consecutive days: once with the mother and once with the father. Saliva samples were collected from infants and parents to measure levels of oxytocin, a hormone that has been linked to maternal-infant attachment; and the stress-related hormone cortisol.

"Oxytocin facilitates social sensitivity and attunement necessary for developing relationships and nurturance for emotional and physical health," the researchers write. Cortisol plays an important role in the "fight or flight" reaction to fear or stress.

Levels of both hormones changed in response to SSC. "Oxytocin significantly increased and cortisol levels decreased for mothers, fathers, and infants during SSC as compared to baseline," Dr. Vittner and coauthors write. The changes indicate the "calming and beneficial impact of SSC for both parents and infants."

Parents also completed a questionnaire called the "PREEMI" (Parent Risk Evaluation and Engagement Model and Instrument) scale, designed to measure attachment between parents and their preterm infants. Overall PREEMI scores indicated a "moderate to high" level of parental engagement for all participants.

Increased oxytocin and decreased cortisol levels during SSC were associated with higher PREEMI scores by the time the infant was discharged from the hospital. "We believe these findings suggest that parents with a lower salivary cortisol as seen with SSC (decreased stress) may facilitate increased parental engagement," Dr. Vittner and colleagues write.

Mothers and fathers had similar increases in oxytocin during SSC. In mothers, the rise in oxytocin was related to increased parental engagement. Unexpectedly, however, increased oxytocin during SSC in fathers was negatively related to parental engagement. Dr. Vittner and colleagues note that for many fathers, the study SSC intervention was the first time they had held their infants.

The study provides new evidence of how SSC might work to promote attachment between parents and premature infants. "The changes in oxytocin and cortisol levels provide robust support to advocate for increased SSC during infancy, especially for the vulnerable infant in the NICU," the researchers write. They note that further studies will be needed to understand these relationships, and how they affect parent-infant relationships -- especially in overcoming the obstacles posed by having a premature infant who need NICU care.

The results also suggest that the PREEMI questionnaire can provide a "window into parent engagement," potentially useful in identifying parents who may need interventions to increase engagement with their premature infant. Dr. Vittner and coauthors conclude: "Uncovering the bio-behavioral basis of early parent-infant interactions is an important step in developing therapeutic modalities to improve infant health outcomes."

https://www.sciencedaily.com/releases/2018/10/181019100711.htm