The Relationship Between Skin-to-Skin Contact and Prevention of Neonatal Hypoglycemia

CQ #289 - November 27, 2023

by Anne Eglash MD, IBCLC, FABM

#LactFact

Skin-to-skin contact likely reduces the risk of neonatal hypoglycemia.

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis
BMC Pregnancy and Childbirth 23, 744 (2023)

What is the relationship between skin-to-skin, newborn hypoglycemia, and other newborn health risks?

Many newborns have risk factors for low blood sugars early postpartum. According to the Academy of Breastfeeding Medicine’s Protocol #1 on glucose monitoring and treatment of hypoglycemia in newborns, screening and supplementing for hypoglycemia both have a negative impact on the establishment of breastfeeding. Therefore, strategies to prevent hypoglycemia treatment can benefit breastfeeding.

The research study for this week is a systematic review and meta-analysis of the impact of skin-to-skin on newborn hypoglycemia and other health conditions.

The researchers included studies where the intervention was skin-to-skin contact during the birth hospitalization, and the comparator was standard care or other treatment without skin-to-skin.

Among the 108 studies that included 84,900 infants, 65 were randomized controlled trials (RCTs), 16 were quasi-RCTs, 7 non-randomized interventions, 17 cohort studies, and 3 case-control studies, all conducted between 1978-2021. The RCTs were evenly distributed between high-income, upper-middle-income, and lower-middle-income countries.

The researchers found that among 7 RCTs or quasi-RCTs involving 922 infants, skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycemia.

What were the other benefits of skin-to-skin? See the question!

What do you think are accurate statements, based on this systematic review and meta-analysis, regarding the benefit of skin-to-skin contact during the birth hospitalization? Choose 1 or more:

Skin-to-skin contact prevents all-cause admission to neonatal intensive care nursery.
Skin-to-skin was found to reduce the risk of hyperthermia.
Skin-to-skin was found to decrease the duration of initial hospital stay after birth.
Skin-to-skin was strongly associated with an increased rate of exclusive breastmilk feeding at hospital discharge.
Skin-to-skin may increase the likelihood of exclusive breastfeeding until 6 months of age.
Skin-to-skin contact has been found to increase infant temperature when compared to standard care only when the skin-to-skin contact lasted longer than 60 minutes.
Skin-to-skin increased newborn blood glucose concentration if initiated within the first 10 minutes after birth, but not if it was initiated 24 hours after birth.

Click here to view the answer to this question.

Correct Answers: B, E, F, and G (not A, C, or D)

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis
BMC Pregnancy and Childbirth 23, 744 (2023)
Libby G. Lord, Jane E Harding, Caroline A. Crowther, and Luling Lin

Abstract

Background

Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this.

Methods

Published randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case–control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12th, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322).

Results

This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case–control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I2 = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25–1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I2 = 90%, p for Egger’s test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain.

Conclusions

Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

This systematic review and meta-analysis found that skin-to-skin contact early postpartum may be associated with a large decrease in risk of neonatal hypoglycemia. The term ‘may be’ must be used because of the low level of evidence. There is also low-certainty (not strong) evidence for increased breastmilk feeding at hospital discharge. The researchers found that the evidence for most outcomes related to skin-to-skin contact was of such low certainty that conclusions could not be made on its impact, including admission to neonatal special care, duration of birth hospitalization and exclusive breastmilk feeding at discharge.

Two studies found no adverse effects related to skin-to-skin contact such as apnea, desaturations, or regurgitations.

Higher quality research is clearly needed on this topic to impact hospital policy and practices.

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Comments (3)

Nikki Lee

November 27, 2023 at 10:48 AM

So strange to read this, as the evidence for premature infants is strong enough to lead to the WHO recommendation for kangaroo mother care as one of several strategies (along with use of CPAP, early initiation of breastfeeding, and caffeine use prn) for health and survival in premature infants.

Yet somehow in term infants, the evidence is not as strong?

Njoku Faustina

November 28, 2023 at 4:50 AM

can we use rooming-in i.e. placing the baby beside the mother on the same bed instead of putting the baby on the cot as a way to promote skin-to-skin contact?

Early post-partum skin-skin contact, does it have any gynecological benefit to the mother?

Nikki Lee

November 28, 2023 at 10:53 AM

1) “These infant behaviors increase maternal levels of oxytocin contributing to the contraction of the uterus which minimizes maternal blood loss and speeding the expulsion of the placenta.”

Widström, A. M., Brimdyr, K., Svensson, K., Cadwell, K., & Nissen, E. (2020). A plausible pathway of imprinted behaviors: Skin-to-skin actions of the newborn immediately after birth follow the order of fetal development and intrauterine training of movements. Medical hypotheses, 134, 109432. https://doi.org/10.1016/j.mehy.2019.109432

2) “The movements of these steps of the feet over the mother’s uterus may contribute to the contractions of the uterus, and the decreased time to expel the placenta and decreased blood loss during skin‐to‐skin.”

Widström, A. M., Brimdyr, K., Svensson, K., Cadwell, K., & Nissen, E. (2019). Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta paediatrica (Oslo, Norway : 1992), 108(7), 1192–1204. https://doi.org/10.1111/apa.14754

The Relationship Between Skin-to-Skin Contact and Prevention of Neonatal Hypoglycemia

#LactFact

What do you think are accurate statements, based on this systematic review and meta-analysis, regarding the benefit of skin-to-skin contact during the birth hospitalization? Choose 1 or more:

Correct Answers: B, E, F, and G (not A, C, or D)

Abstract

Background

Methods

Results

Conclusions

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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Comments (3)

Nikki Lee

Njoku Faustina

Nikki Lee

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