Science

Skin-to-skin reduces mortality by 25% in premature babies

It is a special moment between the young parents and the baby. Barely born, the children are placed skin to skin with their parents. An intimate gesture that not only allows them to share their first moments of life but also has many benefits for the child, such as better regulation of body temperature. A recent study has just shown that skin to skin is also very beneficial for premature babies. Arrived well before the term, the latter are most often placed in an incubator (also called an incubator). It keeps the child warm and also partially protects him from infectious agents, without being sterile. According to this new study carried out by the Karolinska Institutet in Sweden and published in the New England Journal of Medicine, skin to skin would be even more beneficial.

Also called the “kangaroo method“, skin to skin is considered one of the most effective techniques for preventing infant mortality. For the moment, the World Health Organization (WHO) recommends the kangaroo method for all premature infants as soon as their condition is considered stable in the neonatal ward, which may take several days for those who weigh less than two kilograms at birth.

The idea of ​​putting very small, still unstable babies skin-to-skin directly after childbirth has not yet caught on. But 75% of deaths occur before the child has been considered stable enough“, explains Dr. Nils Bergman, researcher in women’s and children’s health at the Karolinska Institutet in a press release. The first days of life are crucial, since in general 45% of neonatal deaths occur within 24 hours after birth, and 80% during the first week of life according to a study by Lancet.

17 hours of skin to skin per day

With his team, this time they conducted a study to assess the benefits of skin to skin in featherweight babies, weighing 1 to 1.8 kilograms. This work was carried out on 3,211 underweight babies born in Ghana, India, Malawi, Nigeria and Tanzania. To ensure that the five hospitals would have the same level of care for the patients, the neonatal teams were trained to practice skin-to-skin treatment with babies who were still physiologically unstable (in terms of respiratory rhythms, heart rates, etc.) in completely safe. Special equipment was sent to them, such as equipment to measure the level of oxygen in the blood as well as to provide assisted ventilation.

The children were then separated into two groups. Those in the first group were immediately put skin to skin in specialized care units for 17 hours a day during their first three days of life with their mother. Those in the second group were treated in the classic way, with 1.5 hours of daily contact after their first 24 hours of life. Comparing the mortality in the two groups, the researchers found that children who received skin-to-skin treatment over a long period of time had a 25% lower risk of dying in their first month of life. During the first 28 days, mortality was 12% in babies with whom skin-to-skin was performed for a long time compared to 15.7% in the control group. Babies in the kangaroo method group were also less likely to have low body temperatures or neonatal infections.

How can simple bodily contact between mother and child promote the survival of the baby? The study puts forward several explanations. “Since mother and baby are in close contact from birth, the baby is more likely to be colonized by the mother’s protective microbiome and receive early breastfeeding. There is also less manipulation of the baby by other people, thus reducing the risk of infection.In addition, frequent monitoring of the infant’s blood sugar and an absence of stress associated with separation from parents could also help reduce mortality.

150,000 babies could be saved each year

This study therefore suggests that the current recommendations are too strict and that babies are separated from their mothers too soon. Conversely, hospitals could set up mother-child care units in which medical staff could take care of mother and child at the same time. A solution that would also allow them to practice skin to skin. “Low birth weight newborns should receive skin-to-skin contact immediately after birth, then in a mother-child care unit, where mothers and babies are cared for together without having to be separated“says Björn Westrup, consultant and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet and co-initiator of the study with Nils Bergman.”Our results suggest that this model of care, which in itself does not require resources, could have significant health effects.The researchers estimate that this method could save up to 150,000 underweight babies each year, especially in low-income countries.

Other studies have already shown the benefits of the Kangaroo method. Work published in the specialized journal Pediatrics by a Colombian team in 2017 suggests that premature babies who have benefited from skin to skin would have a better developed brain and better social integration at the age of 20. This method was initially proposed in 1978 in Colombia to compensate for the lack of artificial incubators. According to the team of researchers, this permanent contact, the heat and the smell of the mother would meet the needs of the premature baby while respecting his hypersensitivity to stimuli and pain. In addition, the risks of death or infections appear to be significantly reduced.

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