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Skin-to-skin care alters regional ventilation in stable neonates
  1. Nicholas F Schinckel1,2,
  2. Leah Hickey1,2,3,
  3. Elizabeth J Perkins1,
  4. Prue M Pereira-Fantini1,
  5. Sienna Koeppenkastrop1,2,
  6. Isabella Stafford1,4,
  7. Georgie Dowse1,2,
  8. David G Tingay1,2,3
  1. 1 Neonatal Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  2. 2 Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Department of Neonatal Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  4. 4 Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  1. Correspondence to Nicholas F Schinckel, Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; nick.schinckel{at}


Objective Skin-to-skin care (SSC) has proven psychological benefits; however, the physiological effects are less clearly defined. Regional ventilation patterns during SSC have not previously been reported. This study aimed to compare regional ventilation indices and other cardiorespiratory parameters during prone SSC with supine and prone position cot-nursing.

Design Prospective observational study.

Setting Single quaternary neonatal intensive care unit in Australia.

Patients 20 infants spontaneously breathing (n=17) or on non-invasive ventilation (n=3), with mean (SD) gestational age at birth of 33 (5) weeks.

Interventions Thirty-minute episodes of care in each position: supine cot care, prone SSC and prone cot care preceding a 10 min period of continuous electrical impedance tomography measurements of regional ventilation.

Main outcome measures In each position, ventral–dorsal and right–left centre of ventilation (CoV), percentage of whole lung ventilation by region and percentage of apparent unventilated lung regions were determined. Heart and respiratory rates, oxygen saturation and axillary temperature were also measured.

Results Heart and respiratory rates, oxygen saturation, temperature and right-left lung ventilation did not differ between the three positions (mixed-effects model). Ventilation generally favoured the dorsal lung, but the mean (95% CI) ventrodorsal CoV was −2.0 (−0.4 to –3.6)% more dorsal during SSC compared with prone. Supine position resulted in 5.0 (1.5 to 5.3)% and 4.5 (3.9 to 5.1)% less apparently unventilated lung regions compared with SSC and prone, respectively.

Conclusions In clinically stable infants, SSC generates a distinct regional ventilation pattern that is independent of prone position and results in greater distribution of ventilation towards the dorsal lung.

  • respiratory
  • neonatology
  • monitoring
  • nursing

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  • Twitter @lmhickey, @DavidTingay

  • Contributors NFS, LH, DGT, EJP and PMP-F developed the concept, designed the experiment and interpreted the data. NFS, SK, IS, GD and EJP were involved in the data collection. NFS, LH and DGT supervised all aspects of the study and subsequent data analysis. NFS and GD performed the EIT analysis. All authors participated in data interpretation under supervision of NFS, LH and DGT. NFS wrote the first draft and all authors contributed to redrafting the manuscript.

  • Funding This study is supported by the Victorian Government Operational Infrastructure Support Programme (Melbourne, Australia). NFS, GD and SK were supported by a MCRI Honours Programme scholarship. DGT is supported by a National Health and Medical Research Council Clinical Career Development Fellowship (Grant ID 1053889) and the Royal Children’s Hospital Foundation. All EIT hardware was purchased by Murdoch Children’s Research Institute.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Royal Children's Hospital Human Research Ethics Committee (HREC 36159B).

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

  • Data availability statement All data, including raw data used for all figures and analysis, are available on reasonable request to the corresponding author.