Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability

Abstract

Objective: Providing skin-to-skin care (SSC) to preterm infants is standard practice in many neonatal intensive care units. There are conflicting reports on the stability of oxygen saturation (SpO₂) during SSC, which may create a barrier to a wider implementation of SSC to infants receiving respiratory support. Regional cerebral oxygenation (rcO₂) measured using near-infrared spectroscopy can serve as a surrogate parameter for cerebral oxygen delivery and consumption. We hypothesised that rcO₂ during SSC would be similar to standard care in preterm infants receiving respiratory support.

Design: Prospective observational non-inferiority study.

Setting: Single tertiary perinatal centre in Australia.

Patients: Forty preterm infants (median (IQR) of 27.6 (26.0-28.9) weeks' gestation) receiving respiratory support were studied on day 8 (5-18).

Interventions: Ninety minutes of SSC, with infants in incubators acting as their own control. Parents and caregivers were blinded to the measurements.

Main outcome measures: Mean difference in rcO₂ between SSC and incubator care; as well as heart rate (HR), SpO₂, fraction of inspired oxygen (FiO₂) and temperature, were compared using a paired t-test.

Results: rcO₂ was similar during SSC (mean (SD) 74.9 (6.5)%)% compared with incubator care (74.7 (6.1)%, mean difference (95% CI) 0.2 (-0.8 to 1.1)%, p=0.71). No clinically important differences in HR, SpO₂, FiO₂ or temperature were observed in the whole cohort and by mode of respiratory support (endotracheal tube mechanical ventilation, continuous positive airway pressure and high-flow nasal cannulae).

Conclusions: Cerebral oxygenation and other physiological measurements in ventilated preterm infants did not differ between SSC and incubator care.

Trial registration number: 12615000959572.

Keywords: Intensive Care; Neonatology; Neurology; Physiology.