Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

doi:10.1016/j.earlhumdev.2010.11.012

Early Human Development

Volume 87, Issue 3, March 2011, Pages 151-157

https://doi.org/10.1016/j.earlhumdev.2010.11.012 Get rights and content

Abstract

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120–160 bpm significantly faster than very early SSC group by Kaplan–Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.

Section snippets

Study subjects

This study protocol was approved by the Ethics Review Committee of the Nagoya University School of Medicine, Nagoya, Japan. We conducted a non-experimental study of 147 consecutive newborn infants who were born spontaneously at two maternity hospitals in Aichi Prefecture, Japan, from January to October in 2009. The parents gave written informed consent to participate in this study and the use of individual information concerning pregnancy and delivery in Medical records and laboratory data when

Study group comparability in analysis of SSC initiation time after birth

The characteristics of study infants and their mothers according to the SSC initiation time after birth are shown in Table 1. The mean (standard deviation: SD) times until SSC started in birth and very early SSC groups were 1.60 (1.10) and 26.3 (4.97) min, respectively. All SSCs for the study infants began less than approximately 30 min post birth [mean (SD) 14.7 (13.0) min]. The duration of SSC was significantly shorter in the birth SSC group than the very early SSC group (P < 0.001), but the mean

Discussion

In our study of healthy full-term infants, we found that birth SSC led to the stability of HR earlier than very early SSC. In addition, SSC continuing for more than 60 min significantly decreased salivary cortisol levels as a marker for stress between 60 min and 120 min post birth compared with SSC for only 60 min or less. The present study provided further evidences of early SSC for full-term infants.

As for the basic efficacies of SSC, some previous studies showed strong evidences of increasing

Conclusions

We found physiological and biochemical evidences that earlier SCC beginning within 5 min post birth and longer SSC continuing for more than 60 min until 2 hours post birth are both beneficial for the reduction of stress during the early period after birth. Moreover, no subjects had medical problems in the course of this study. Our results thus further underscore the importance of early SSC, particularly in healthy full-term infants.

Conflict of interest statement

This study was supported by grants from Meijiyasuda Mental Health Foundation and Yamajifumiko Nursing Research Fund. The study sponsors had no involvement.

Acknowledgments

This study was supported by Meijiyasuda Mental Health Foundation and Yamajifumiko Nursing Research Foundation. We appreciate the cooperation of Mitsuhisa Yamada, MD, Shinya Michigami, MD, Haruomi Kondo, MD, Tadayuki Ishimaru, MD, Fusako Niimi, RN, NM, Ritsuko Maetsu, RN, and staff nurses in generously collecting data for our study. We are also most thankful to all infants and parents participating in this study.

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Stress-exposed infants had less negative emotionality if SSC is provided immediately after delivery, less than 10 min after birth. The effect of SSC on effortful control in relation to chronic perinatal stress was not statistically significant. The impact of timing of SSC on negative emotionality or effortful control in relation to chronic perinatal depressive symptoms was not statistically significant.
This work implies that very early SSC may play a role in later infant emotion regulation process and could act as a protective factor in chronically stressed pregnant women.
Neuroendocrine mechanisms involved in the physiological effects caused by skin-to-skin contact – With a particular focus on the oxytocinergic system
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The positive clinical effects caused by skin-to-skin contact immediately after birth or after repeated skin-to-skin contact of premature infants (kangaroo care) or fullterm infants are well documented in the literature. However, information regarding the physiological mechanisms mediating these effects are surprisingly scarce and incomplete. In this article the oxytocinergic system and the cutaneous sensory pathways by which the oxytocinergic system is activated in response to skin-to-skin contact are presented in more detail. In addition, we discuss how the effects of skin-to-skin treatment can be attributed to different aspects of the effect spectrum of the oxytocinergic or calm and connection system.
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The sensory pathways, which include visual, auditory, olfactory and tactile stimuli, given and received by both mother and newborn and which activate the oxytocinergic system in response to skin-to-skin contact, are reviewed. A special emphasis is placed on the role of cutaneous sensory nerves and their activation by touch, light pressure and in particular warmth. The important role of the rise and the pulsatility of maternal temperature in mediating the positive effects of skin-to-skin contact in the newborn is highlighted. The concept of maternal giving of warmth and its possible link to the experience of trust and safety in the newborn is discussed from an evolutionary perspective.
The effects induced by skin-to-skin contact can be attributed to the different functions of the oxytocinergic system. Ameliorated social interaction (e.g., more tactile and auditory interaction, more sensitive and synchronous interaction between mother and baby, the baby’s crawling behavior) are expressions of oxytocin’s ability to stimulate social interaction. The decreased levels of fear and stress are expressions of oxytocin’s ability to reduce the activity of the amygdala and of the stress system, e.g. the activity in the HPA-axis and the sympathetic nervous system. Increased HRV, increased activity in endocrine system of the gastrointestinal tract as well as stimulation of growth and maturation are examples of oxytocin’s ability to stimulate the activity of the parasympathetic nervous system and other peripheral and central mechanisms related to restoration and growth.
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It is of clinical importance to be aware of the mechanisms by which skin-to-skin contact induces short and longterm positive effects in parents and newborns. If ward routines are adapted to ascertain a maximal stimulation of these mechanisms, the function of the oxytocinergic system will be optimized, which will be linked to a better clinical outcome for parents and newborns.
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Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Abstract

Background

Aim

Study design

Subjects

Outcome measures

Results

Conclusions

Section snippets

Study subjects

Study group comparability in analysis of SSC initiation time after birth

Discussion

Conclusions

Conflict of interest statement

Acknowledgments

Midwifery

J Pediatr

J Obstet Gynecol Neonatal Nurs

Early contact versus separation: effects on mother-infant interaction one year later

Birth

Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status

J Midwifery Womens Health

Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study

Acta Paediatr

Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying

Birth

Separation distress call in the human neonate in the absence of maternal body contact

Acta Paediatr

Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot

Acta Paediatr

Randomized controlled trial of early skin-to-skin contact: effects on the mother and the newborn

Acta Paediatr

Immediate maternal thermal response to skin-to-skin care of newborn

Acta Paediatr

Kangaroo care at birth for full term infants: a pilot study

MCN Am J Matern Child Nurs

Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg

Acta Paediatr

The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial

Pediatrics

Crying in separated and non-separated newborns: sound spectrographic analysis

Acta Paediatr