Preterm skin-to-skin contact does not improve neurodevelopment at 2–3 years | Image Credit: © Colin - © Colin - stock.adobe.com.

In a newly-published randomized clinical trial, investigators found that 2 hours of mother-to-neonate skin-to-skin contact (SSC) in the delivery room did not affect neurodevelopment at age 2 to 3 years.¹

The Norway-based study, published April 16, 2025 in JAMA Network Open, was led by Laila Kristoffersen, RN, PhD, of the Department of Neonatology, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway. The investigative team did find that improved breastfeeding practices for up to a year were observed in the SSC intervention group.

Skin-to-skin contact among neonates

Neonates are faced with increased risk for long-term health issues such as cerebral palsy, motor, cognitive, and language delay, behavioral problems, as well as visual and hearing impairments compared to full-term neonates.² According to the study authors, several early intervention programs have been discovered and developed to compensate for preterm birth-associated negative consequences. SSC is the primary component of kangaroo mother care (KMC), which is known to be associated with reduced morbidities among neonates, parental stress, and improved parental mental health.¹

"The first hours after birth are considered an early sensitive period that is important for mother-neonate interaction and secure attachment," wrote Kristoffersen and authors. "This has led to an increased focus on a nonseparation approach and immediate SSC following delivery between preterm neonates and their mothers or caregivers." The investigative team noted that the World Health Organization amended recommendations for care of preterm infants and advises immediate SSC "as soon as possible after birth."

Few hospitals, according to the study, facilitate immediate SSC. Thus, the investigators sought to determine if immediate SSC improves cognitive outcomes at ages 2 to 3 years.

Study design and neonate participants

In an open-label design, the trial was conducted in 3 Norwegian neonatal units, with participants born at 28 weeks and 0 days' to 31 weeks and 6 days' gestation. Birth weights were greater than 1000 g and no major congenital malformations or need for intubation or oxygen supplementation more than 40%. The neonates were randomized at a 1:1 ratio to immediate SSC in the delivery room for 2 hours or standard care with direct transport to the neonatal unit in an incubator. Measured by the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), the primary outcome of the study was cognitive development at 2 to 3 years of age.

Skin-to-skin contact and later neurodevelopment

Of the 108 neonates in the study, the mean gestational age was 30 weeks and 3 days, of which 63% were male. Of the total study population, 51 received SSC and 57 had standard care. A total of 86 had follow-up at 2 to 3 years, while 81 completed the BSID-III and were studied for the primary outcome.

Authors reported that mean difference in BSID-III cognitive composite scores was 0.21 (95% CI, −5.26 to 5.68; P = .94), with no difference between groups regarding proportional risk of developmental delay at the 2 to 3 year follow-up (21 of 41 [51%] and 22 of 45 [49%] in the SSC and standard care groups, respectively [odds ratio, 1.10; 95% CI, 0.47-2.56; P = .83]).

Breastfeeding improvements in skin-to-skin group

Though neurodevelopment outcomes did not differ between treatment groups, more neonates in the SSC group were breastfed at discharge (42 of 50 [84%], vs 36 of 54 [67%] in standard care; P = .04). Exclusive breastfeeding duration was longer in the SSC group, with 18 of 41 neonates breastfed compared to 11 of 42 in the standard group (P = .07).

Conclusion

"Although immediate SSC did not translate into improved neurodevelopment, a nonseparation approach might still have an impact on breastfeeding outcomes," concluded the investigative team. "Instead of doing more studies on immediate SSC, resources should be focused on implementing this important, feasible, and low-cost intervention," they wrote.

Reference:

1. Kristoffersen L, Støen R, Bergseng H, et al. Immediate Skin-to-Skin Contact in Very Preterm Neonates and Early Childhood Neurodevelopment: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e255467. doi:10.1001/jamanetworkopen.2025.5467

2.
Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261-269. doi:10.1016/S0140-6736(08)60136-1