Introduction: Background: Preterm infants have high rates of morbidity such as intraventricular hemorrhage (IVH). Routine caregiving procedures undertaken in critically ill preterm neonates can contribute to cerebral hypoxia, which plays a role in the development of IVH. Skin-to-skin contact (SSC) has a positive impact on a preterm infant’s neurological development. The objective of this systematic review was to report on the effect of SSC on cerebral oxygenation in preterm infants.
Methods: The Cochrane Library, PROSPERO, MEDLINE, Embase, and CINAHL were electronically searched using keywords. Studies were included if they were randomized, quasi-randomized, or observational studies which reported on brain-based measures of cerebral oxygenation. Main outcomes included were regional cerebral oxygenation (rSO2), oxyhemoglobin (HbO2), cerebral blood flow (CBF) and others. Quality assessment was done with the Cochrane ROB tool or ROBINS-I tool as appropriate. Data was extracted and analyzed by two reviewers.
Results: Out of 2621 studies screened, 27 full texts were evaluated and 6 studies, all observational, met inclusion criteria. Infants were between 5 and 38 days old during the studies, see Table 1 for characteristics. Four studies (n=283) reported on RcSO2 values. Meta-analysis of these 4 studies showed no difference in RcSO2 values pre- and post skin-to-skin care [Mean difference -0.47%, 95% CI -1.88 to 0.94%; I2=0%]. Korraa et al. concluded that CBF improves during SSC. Olsson et al. reported a smaller increase in HbO2 during venepuncture when infants were receiving SSC. No studies reported on medications received during the study period. There were no reports on morbidity such as IVH or neurodevelopmental outcomes.
Conclusion: High quality evidence suggests that skin-to-skin contact during NICU stay does not affect RcSO2 in preterm infants. There is limited evidence on the effect of skin-to-skin contact in extremely preterm infants in the first week of life when the risk of IVH is the greatest.
Brianna Richardson– PhD in Nursing Student, Faculty of Nursing, Dalhousie University
Marsha Campbell-Yeo– Professor and Clinician Scientist, Faculty of Nursing, Dalhousie University AND Division of Neonatal Perinatal Medicine, IWK Health Centre
Souvik Mitra– Assistant Professor and Neonatologist, Faculty of Medicine, Dalhousie University AND Division of Neonatal Perinatal Medicine, IWK Health Centre