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Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support
  1. Laila Lorenz1,2,
  2. Adriana Marulli1,3,
  3. Jennifer A Dawson1,3,4,
  4. Louise S Owen1,3,4,
  5. Brett J Manley1,3,
  6. Susan M Donath3,4,
  7. Peter G Davis1,3,4,
  8. C Omar F Kamlin1,3,4
  1. 1 Newborn Research Centre and Neonatal Services, The Royal Women’s Hospital, Melbourne, Australia
  2. 2 Department of Neonatology, University Children’s Hospital of Tübingen, Tübingen, Germany
  3. 3 University of Melbourne, Melbourne, Australia
  4. 4 Murdoch Childrens Research Institute, 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 Skin-to-skin care (SSC) has proven benefits in preterm infants, but increased hypoxic and bradycardic events have been reported. This may make clinicians hesitant to recommend SSC as standard care. We hypothesised that regional cerebral oxygenation (rStO2) measured with near infrared spectroscopy is not worse during SSC compared with standard incubator care.

Design Prospective, observational, non-inferiority study.

Setting Single tertiary perinatal centre in Australia.

Patients Forty preterm infants (median (IQR) 30.6 (29.1–31.7) weeks' gestation) not receiving respiratory support were studied on day 14 (8–38).

Interventions Recordings during 90 min of incubator care, followed by 90 min of SSC. Each infant acted as their own control and caregivers were blinded to the rStO2 measurements.

Main outcome measures The primary outcome was the mean difference in rStO2 between SSC and incubator care. The prespecified margin of non-inferiority was −1.5%. Secondary outcomes included heart rate (HR), peripheral oxygen saturation (SpO2), time in quiet sleep, temperature and hypoxic (SpO2 <80% for >5 s) or bradycardic events (HR <80 bpm for >5 s) and time spent in cerebral hypoxia (rStO2<55%) and hyperoxia (rStO2>85%).

Results Mean (SD) rStO2 was lower during SSC compared with incubator care: 73.6 (6.0)% vs 74.8 (4.6)%, mean difference (95% CI) 1.3 (2.2 to 0.4)%. HR was 5 bpm higher, SpO2 1% lower and time in quiet sleep 24% longer during SSC. Little evidence of a difference was observed in temperature. The number of hypoxic or bradycardic events as well as the proportion of time spent in cerebral hypoxia and hyperoxia was very low in both periods.

Conclusions Mean rStO2 was marginally lower during SSC without observed differences in hypoxic or bardycardic events but an increase in time spent in quiet sleep.

Trial registration number This trial is linked to Australian New Zealand Clinical Trials Registry: identifier 12616000240448. It was registered pre-results.

  • cerebral oxygenation
  • near-infrared spectroscopy
  • skin-to-skin
  • preterm
  • respiratory support

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  • Contributors LL, AM, JAD, LSO, BJM, SMD, PGD and COFK substantially contributed to the conception or design of the work, the acquisition, analysis or interpretation of data.

  • Funding Research fellowship from the German Research Society (DFG-grant nr. LO 2162/1-1) and TÜFFHabilitation Support (2459-0-0) for Dr Laila Lorenz. NHMRC funding Prof Peter G Davis (App ID 1059111), Dr C Omar F Kamlin (App ID 1073533), Dr L Owen (App1090678), Dr Brett Manley (App 1088279), NHMRC program grant for P.G.R,C.O.F.K, J.A.D., NHMRC CRE (App 1060733) Australia.

  • Competing interests None declared.

  • Ethics approval The Humen Research and Ethics Committee at the Royal Women’s Hopsital in Melbourne.

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