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(As submitted to Thrasher Research Fund at completion of study.)
The goal of this project was based on the theory (based on a considerable body of research and direct observations) that the newborn infant has an inborn behaviour immediately after birth, which is dependent on being on the mother’s chest. Further, the theory is that separation from mother causes the newborn harm, with brain reactions called “hyperarousal – dissociation”, with physiological instability.
The objective was to randomize premature newborn infants (between 1200g and 2200g) to care in two different places: the one being the incubator (Conventional Method of Care, CMC) and the other being on the mother’s chest (Skin-to-Skin Contact, SSC), and then to do identical standardized care and observations on all of them, for a period of six hours. The observations then looked at the stabilization of the infants, using two different “measures”. The one looked at how many infants in each group destabilized so badly that they needed medical intervention of some kind, based on objective and pre-defined electronic monitoring criteria. The second, called the “SCRIP score”, detected more subtle evidence of instability: continuous monitoring of heart rate, respiratory rate and apnoea over a 5 minute period gave a graded score, which was repeated at predetermined intervals and added for a total score during the six hours (evidence of “stabilizing”), and more intensively during the sixth hour (evidence of “stabilized”).
The study took place between February 2001 and September 2002, during which period 35 mother-infant dyads were enrolled, recruitment was stopped halfway through after interim analysis. One of the mothers required a Caesarean section for a second twin and fell out, all the remainder were analysed. Three infants (2 of 20 from SSC and 1 of 14 from CMC, no statistical difference) were so unstable they were transferred to intensive care. Of the remainder that completed 6 hours observation, 3 of 18 SSC compared to 12 of 13 CMC babies required medical assessment; highly significant in favor of Skin-to-Skin Contact. The SCRIP score showed 2 of 13 CMC babies having perfect stability scores compared to 10 of 18 SSC babies, and during the sixth and final hour of the study, 6 of 13 CMC babies had fully stabilized, compared to 18 of 18 (100%) SSC babies. On plotting the mean SCRIP scores over time, all the SSC babies stabilized by 6 hours, while the CMC babies showed no trend toward stabilization. An exploratory sub-analysis of the infants between 1200g and 1800g (i.e. the smaller babies) showed even greater numerical differences, and statistically significant results despite the smaller numbers.
The results of this study show that for low birth weight newborns, Skin-to-Skin Contact from birth is not just safe, it is superior and safer than incubator care.
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