BIRTH KANGAROO MOTHER CARE

            RANDOMISED CONTROLLED TRIAL

ABSTRACT

Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of maternal-infant skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200g to 2199g newborns.

Acta Paediatr 2004; 93: 779-785. Stockholm. ISSN 0803-5253

Aim: Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal-infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low birth weight infants. SSC from birth was therefore compared to incubator care for infants between 1200-2199g at birth.

Methods: This was a prospective, unblinded, randomized controlled clinical trial; potential subjects were identified before delivery, and randomized by computerized minimization technique at 5 minutes if eligible. Standardized care and observations were maintained for six hours. Stability was measured in terms of a set of pre-determined physiological parameters, and a composite cardio-respiratory stabilization score (SCRIP).

Results: 34 infants were analyzed in comparable groups: 3/18 SSC compared to 12/13 incubator babies exceeded the pre-determined parameters (p<0.001). Stabilization scores were 77.11 for SSC versus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI 0.3 – 5.46, p = 0.031). All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. 8/13 incubator subjects experienced hypothermia.

Conclusion: Newborn care provided by skin-to-skin contact on the mother’s chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first six hours is consistent with mammalian “protest-despair” biology, and with “hyper-arousal and dissociation” response patterns described in human infants: newborns should not be separated from their mothers.

Key Words:   Skin-to-skin contact, separation, prematurity, stability, hypothermia.