The Journal of Pediatrics
Volume 145, Issue 5 , Pages 683-684, November 2004

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

Department of Pediatrics, Shaare Zedek Medical Center Jerusalem 91031, Israel

Article Outline

 

Ferber SG, Makhoul IR. Pediatrics 2004;113:858-65

Context The method of skin-to-skin contact (kangaroo care [KC]) has shown physiologic, cognitive, and emotional gains for preterm infants; however, KC has not been studied adequately in term newborns.

Objectives To evaluate the effect of KC, used shortly after delivery, on the neurobehavioral responses of the healthy newborn.

Design Randomized, controlled trial.

Setting Large urban medical center in northern Israel.

Participants 47 healthy mother-infant pairs.

Interventions After consent, the mothers were assigned to 1 of 2 groups: KC shortly after delivery or a no-treatment standard care (control group). KC began at 15 to 20 minutes after delivery and lasted for 1 hour. Control infants and KC infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth, respectively.

Main outcome measure One 60-minute infant behavioral observation spanning all neurobehavioral subsystems of autonomic, motor, state, and attention regulation.

Results During a 1-hour-long observation, starting at 4 hours postnatally, the KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements.

Conclusions KC seems to influence state organization and motor system modulation of the newborn infant shortly after delivery. The significance of our findings for supportive transition from the womb to the extrauterine environment is discussed. Medical and nursing staff may be well advised to provide this kind of care shortly after birth.

Comment Kangaroo care of premature infants has been repeatedly demonstrated to improve respiratory status, thermal regulation, weight gain rate, and maternal milk production.1 Recently it has been documented to improve neonatal state organization, autonomic behavior, and maternal-infant interaction.2., 3., 4. The study of Ferber and Makhoul has extended these observations to the term infant and notes in an elegant prospective randomized study that KC in the delivery room leads to improved state organization and more mature motor tone and posture in the immediate postpartum period.

Why should there be a need to study the effects of such care in the otherwise healthy mature infant? Unfortunately, current “standard” care practices in all too many hospitals interfere with the normal mammalian sequence of labor delivery and neonatal care. Rather than facilitating the expression of the genetically endowed maternal instincts,5 infants are spirited away from their mothers, delivered to the care of the nursing staff, washed, injected, swaddled and put to bed for hours before returning to their mother's care. As such, the critical postpartum period wherein the infant should be placed skin to skin on the mother's chest so as to stimulate maternal oxytocin so as to play its role in the development the maternal infant attachment process is disrupted.6 In turn, rather than being provided with the calming, soothing, and regular stimuli of KC, which enhances adaptive behavior to extrauterine life, the infants are subjected to random intrusive stimuli, which can only interfere with the development and synchronization of state.7

It is not clear from the described experimental model if the infants were only provided with opportunity for skin-to-skin contact or were allowed to initiate suckling. The initiation of breast-feeding itself provides a stimulus to the normal maternal infant dyadal relationships, and it is not clear if the tactile stimulus of kangaroo care is full substitute. Thus, further studies are needed to compare the relative contribution of these two processes. However, it is clear that persisting in nursery practices that do not allow for sustained maternal infant contact in the immediate postpartum period and delaying the initial breast-feeding to 6 hours has potentially negative consequences for both maternal and infant behavior.

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References 

  1. Anderson GC. Current knowledge about skin-to-skin (kangaroo) care for preterm infants. J Perinatol. 1991;11:216–226
  2. Feldman R, Weller A, Sirota L, Eidelman AI. Skin-to-skin contact (kangaroo care) promotes self regulation in premature infants: sleep wake cyclicity, arousal modulation, and sustained exploration. Dev Psychol. 2002;38:194–207
  3. Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm development. Pediatrics. 2002;110:16–26
  4. Feldman R, Eidelman AI. Skin-to-skin contact (kangaroo care) accelerates autonomic and behavioral maturation in premature infants. Dev Med Child Neurol. 2003;45:1–8
  5. Leckman J, Feldman R, Swain JE, Eicher V, Thompson N, Mayes LC. Primary parental preoccupations: circuits, genes, and the crucial role of environment. J Neural Trans. 2004;111:753–771
  6. Matthiessen AS, Ransjo-Arvidson AB, Nissen E, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: effect of infant hand massage and sucking. Birth. 2001;28:13–19
  7. Christensson K, Cabrera T, Christensson E, Uvnas-Moberg K, Winberg J. Separation distress call in the human neonate in the absence of maternal body contact. Acta Pediatr. 1995;84:468–473

PII: S0022-3476(04)00758-9

doi:10.1016/j.jpeds.2004.08.039

The Journal of Pediatrics
Volume 145, Issue 5 , Pages 683-684, November 2004

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