BIRTH KANGAROO MOTHER CARE RANDOMISED CONTROLLED TRIAL
Written by Bergman N. J. MB ChB, MPH, MD
(article copyright Acta Paediatrica)

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(6): 779-785.

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 predetermined 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.