Skin to skin care: More than meets the eye

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Skin-to-skin care, often referred to as kangaroo care, was developed decades ago in South America as a supplement to the care of the preterm infant—primarily to provide warmth and facilitate earlier release from the hospital. Since then, skin-to-skin care has been associated with improved breastfeeding, reduced maternal stress, and improved maternal attachment and post-discharge confidence in the care of her preterm infant. In a previous volume of The Journal, Sehgal et al provide additional rationale indicating that skin-to-skin care directly improves physiologic stability of the preterm infant. Sehgal studied 40 spontaneously breathing, preterm infants (mean gestational age of 30.5 weeks and birth weight of 1378 ± 133 grams) at a median age of 12 days by echocardiography before and one hour after skin-to-skin care. Skin-to-skin care reduced pulmonary vascular resistance, improved contractility of the right ventricle, increased stroke volume, and increased superior vena cava and cerebral blood flow. It will be important to determine whether these powerful physiologic benefits are due to reduced stress/cortisol levels, reduced sympathetic tone, or other physiologic adaptations (Figure), and whether these findings might apply to smaller and sicker infants requiring mechanical ventilation support.

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FigurePutative mediators of the effect of skin-to-skin contact on cardiovascular system. AV, atrioventricular; LV, left ventricular; PNS, peripheral nervous system; SNS, sympathetic nervous system.

See article in J Pediatr 2020:222;91-7.e2 ▸

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