237 - Initiation, frequency, and duration of skin-to-skin care (SSC) in a research cohort of preterm infants

Publication Number: 237.5215

Louie M. Swander, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Scott P. Oltman, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Rebecca J.. Baer, UCSF, San Francisco, CA, United States; Lydia Lee, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Kelleen Nelson, UCSF Benioff Children's Hospital San Francisco, San Mateo, CA, United States; John M. Dagle, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Allison M. Momany, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; Kelli K. Ryckman, Indiana University, Bloomington, IN, United States; Laura L. Jelliffe-Pawlowski, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Elizabeth E. Rogers, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: While skin-to-skin care (SSC) has been shown to reduce the incidence of major morbidities and support neurodevelopment in preterm infants, its use varies significantly due to lingering questions about its implementation and impact.

Objective: To explore patterns of SSC and their association with infant outcomes.

Design/Methods: This study included very preterm infants ( < 32 weeks gestation) from the PROMPT (Predicting Maturity, Mortality, & Morbidity in Preterm Newborns) Study at UCSF Benioff Children’s Hospital who completed study protocol. Linear regression was used to examine the association between time to first SSC, gestational age (GA), birth weight (BW), maternal age (MA), ethnicity, mode of delivery, and insurance payor, with subsequent regressions adjusting for most significant predictors. ANOVA was used to examine time to first SSC by racial group and mode of respiratory support at 36 hours. Partial correlation was used to assess the relationship between frequency/duration of SSC in the first week of life and across the NICU stay. The association between initiation, frequency, and duration of SSC and neurodevelopmental (ND) outcomes at 16-24 months of age was explored using logistic regression.

Results: All 58 infants received some level of SSC. Mean time (SD) to first SSC was 87.3 (151.2) hrs, with an average of 4.4 (3.5) instances and 6.6 (5.6) hrs during the first week of life. Delayed SSC initiation was significantly associated with GA (B: -18.54, p = 0.028) and with public insurance (B: 98.48, p = 0.019). BW, racial/ethnicity group, and respiratory support were not associated with SSC initiation. Adjusting for GA and payor, older MA was associated with later initiation of SSC (B: 7.53, p = 0.008). Adjusting for length of stay, first week SSC frequency was positively related with total frequency of SSC (r: 0.45, p = 0.0004), and first week duration was positively associated with total duration (r: 0.49, p = 0.002). ND assessment was available for 21/58 participants. Initiation, frequency, and duration were not significantly associated with ND outcomes in this small subcohort.

Conclusion(s): The associations between timing of first SSC and GA, insurance payor, and MA emphasize the need for tailored approaches to SSC practices. The positive relationship between first week frequency, duration, and total SSC suggest that early and consistent SSC can lead to its sustained practice and associated benefits for preterm infants. Future research should investigate the long-term impacts of delayed SSC in a larger group of preterm infants.

Table 1: Participant Demographics


Table 2: Results