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Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability
  1. Laila Lorenz1,2,
  2. Jennifer A Dawson1,3,4,
  3. Hannah Jones1,
  4. Susan E Jacobs1,3,4,
  5. Jeanie L Cheong1,3,4,
  6. Susan M Donath3,4,
  7. Peter G Davis1,3,4,
  8. C Omar F Kamlin1,3,4
  1. 1Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Australia
  2. 2Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany
  3. 3Murdoch Childrens Research Institute, Melbourne, Australia
  4. 4University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Laila Lorenz, Newborn Research Centre, The Royal Women's Hospital, Locked Bag 300, Grattan St & Flemington Road, Parkville VIC 3052, Australia; laila.lorenz{at}


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.

  • Intensive Care
  • Neonatology
  • Neurology
  • Physiology

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  • Funding Research fellowship from the German Research Society for Dr Laila Lorenz (DFG-grant nr. LO 2162/1-1). The National Health and Medical Research Council (NHMRC) funding Professor Peter G Davis (App ID 1059111), Dr C Omar F Kamlin (App ID 1073533), Associate Professor Jeanie Cheong (App 1053787), Associate Professor Susan Jacobs (App 1073103), NHMRC programe grant for PGD, COFK, JAD, Australia.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Royal Womens Hospital Human Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.