ORLANDO – Early skin-to-skin contact between mothers and their newborns was associated with higher rates of exclusive breastfeeding in a retrospective study presented at the annual meeting of the American Academy of Pediatrics.
Of the 150 mothers included in the study, 72% intended to breastfeed exclusively, but only 28% did so. After adjustment for maternal age, mode of delivery, parity, and gestational age, the only factor significantly associated with exclusive breastfeeding other than intention to breastfeed exclusively was early skin-to-skin contact (odds ratio, 3.7), which occurred in 53% of cases, Dr. Darshna Bhatt of Cohen Children’s Medical Center of New York, New Hyde Park, reported.
For the study, Dr. Bhatt and her colleagues reviewed electronic medical records of consecutive admissions to the well baby nursery, including only singleton, late preterm, or term newborns whose records contained documentation regarding whether the newborn had early skin-to-skin contact with the mother. Early skin-to-skin contact is generally defined as mother-baby bare skin contact for a period of time right after delivery; exclusive breastfeeding was defined as receipt of no formula feedings during the hospital stay.
Early skin-to-skin contact between mother and infant in the delivery room has previously been shown to be associated with breastfeeding success, but not all newborns receive skin-to-skin contact in the critical postbirth period, Dr. Bhatt noted. The current findings suggest that promoting skin-to-skin contact in the delivery room may improve exclusive breastfeeding rates, she concluded.
Indeed, during a plenary session at the conference, Dr. Jae Kim, associate professor of pediatrics at the University of California, San Diego (UCSD), said that skin-to-skin contact promotes breastfeeding and provides a "rich experience in the first few minutes of life."
The benefits during this "early golden hour" are believed to be at least threefold, providing physical interaction that regulates the baby’s temperature and provides sensory stimuli; promoting an early breastfeeding response with access to colostrum, which improves both short- and long-term breastfeeding; and allowing for emotional bonding, which is difficult to measure but is "very, very critical to early infant development," he said.
Data suggest that this contact promotes body temperature regulation and physiological stability in the baby with respect to heart rate, breathing response, blood pressure, and blood sugar levels. It also is associated with less crying and a better breastfeeding response, Dr. Kim said, noting that a Cochrane review showed improved breastfeeding at 1 and 4 months, with trends toward longer duration of breastfeeding overall, in healthy term infants who experience early skin-to-skin contact. Improvement in terms of cardiorespiratory stability and blood glucose control also was seen in late pre-term infants.
Although better data – particularly on long-term effects – are needed, it is clear that skin-to-skin contact can "dramatically improve the breastfeeding success rate, halve the time to actually start breastfeeding, improve the satisfaction of both the mother and the family, and also [lead to] an increased amount of exclusive breastfeeding in those babies," he said.
Many hospitals, including his own institution, have moved toward a model that promotes early skin-to-skin contact, he said, adding that most babies at UCSD are coupled with their mother for early skin-to-skin contact.
The incidence of early skin-to-skin contact and establishment of breastfeeding at UCSD is very high for normal vaginal-birth babies and normal cesarean-section babies.
"We as pediatricians play an incredible role in really affecting this change. It’s not just the medical nurses that deliver this care, but it’s about the physicians sending a strong message about how important it is," he said, noting that the pediatricians at his hospital "make a very special point" to get babies back to their moms immediately after the physical examination and to emphasize the importance of skin-to-skin time.
Skin-to-skin contact can also be promoted in the neonatal intensive care unit (NICU), he said.
Data suggest that preterm and low-birth-weight infants do dramatically better with skin-to-skin contact, with improvements in mortality, sepsis, hypothermia, growth, mother-infant attachment, motor development, long-term cognitive development, stress and pain response, colic, sleep response, pain, breastfeeding, and length of stay.
This is an excellent model in limited-resource settings, and benefits have also been seen at UCSD.
"I think we can make a very strong case right now, especially in a family-centered model, the NICU, that we should be pushing for more and more skin-to-skin [contact time]," he said, noting that parents should be encouraged to request daily skin-to-skin therapy in the NICU.
A program at UCSD – the SPIN (Supporting Preterm Infant Nutrition) Program, which was designed to promote better preterm infant nutrition – has harnessed the benefits of early skin-to-skin contact and early human milk intake to move this approach from a regional program to a national platform, "where we can standardize how we deal with preterm infants and their nutrition," he said. Dialogue is encouraged to help improve standardization across the country, he said.