Immediate skin-to-skin contact with mom: Does it enhance interaction in very preterm infants at 4 months?

Immediate skin-to-skin contact with mom: Does it enhance interaction in very preterm infants at 4 months?

The first few months of life are a critical period for development, including the formation of parent-infant bonds. For very preterm infants, who are born before 37 weeks of gestation, these early interactions are particularly important. Immediate skin-to-skin contact (SSC) between a mother and her very preterm infant is a practice that has been shown to have a number of benefits, including improved bonding, stress reduction, and better sleep.

Immediate skin-to-skin contact with mom: Does it enhance interaction in very preterm infants at 4 months?
Immediate skin-to-skin contact with mom: Does it enhance interaction in very preterm infants at 4 months?

In addition to these immediate benefits, there is also growing evidence that SSC can have a positive impact on long-term development.

A recent study published in JAMA Network Open investigated the effects of immediate skin-to-skin contact (SSC) after delivery on the quality of mother-infant interactions at four months of corrected age in extremely preterm infants.

SSC is a common practice for preterm newborns, especially those at risk of immaturity. The World Health Organization (WHO) recommends SSC immediately after birth due to its association with increased survival rates.

However, research on the long-term developmental implications of SSC in very preterm newborns is limited. High-quality interactions between parents and their infants are essential for the infant’s socioemotional, behavioral, and cognitive development.

SSC has been shown to promote positive mother-preterm newborn interaction patterns; however, there has been limited research on its effects when initiated immediately after delivery.

About the Study

This study investigated whether SSC between parents and their very preterm infants immediately after delivery was more effective than regular incubator care in improving mother-infant interactions at four months.

The study analyzed data from the Immediate Parent-Infant Skin-to-Skin Study (IPISTOSS), a randomized controlled trial (RCT) conducted between April 1, 2018, and June 30, 2021, at three neonatal care units in Norway and Sweden.

Very preterm neonates (gestation week 28 to week 33) and their mothers and fathers were followed for four months until December 2021.

The data were analyzed on 16 March and 18 September 2023. The team excluded infants with congenital malformations, infections, or contraindications to participate in the study.

Infants were randomized to receive either regular incubator care (control group, n=37) or skin-to-skin contact with one of the parents (intervention group, n=34) beginning at delivery and continued through six hours post-birth.

The study outcome was the quality of mother-infant interactions, assessed using the Parent-Child Early Relational Assessment (PCERA) scores and five-minute mother-infant free-play video recordings at four months of age.

Multilevel regressions were performed to estimate the effects of the dichotomous SSC vs. control variable on PCERA subscales and total skin contact time.

Research Results

In total, 56 mothers and 71 infants (31 twins) were analyzed. The mean values for infant gestational age and birthweight were 31.3 weeks and 1,535 g, respectively; 59% (n=42) were male, and 41% (n=29) were female. The mean maternal age was 32, and 57% (n=32) were primiparous. SSC was initiated 15 minutes post-birth (median).

At follow-up, 22% (n=20) of randomized infants withdrew from the study; however, no differences were found between analyzed infants and dropouts, minimizing attrition bias risk in the study.

Fathers showed higher SSC durations during the six hours post-birth than mothers, with median values of 3.3 hours and 0.8 hours, respectively.

The team observed significant differences in the third PCERA subscale (neonatal positive affect, social, and communicative skills), with maternal-neonatal interactions of higher quality in the skin-to-skin contact group at four months. This effect was significant post-adjustment for child sex, primiparity, and observational settings (clinic versus home).

Post-intervention, the total SSC duration for infants was higher in the SSC group during the initial 72 hours, with median values of 17 hours vs. 10 hours among controls. This group’s total SSC duration was also higher in the initial eight days, with median values of 52 hours vs. 37 hours.

No statistically significant effects were observed in the mediation analyses performed to investigate whether the impact of SSC versus the control on the third PCERA subscale was mediated by the total SSC duration at 72 hours and eight days post-birth.

Benefits of Immediate Skin-to-Skin Contact

In addition to the benefits for mother-infant bonding and interaction quality, immediate SSC has also been shown to have a number of other benefits for very preterm infants, including:

  • Improved temperature regulation: SSC helps to keep infants warm and stable, which can help to prevent hypothermia, a common problem in preterm babies.
  • Reduced risk of infection: SSC has been shown to reduce the risk of infection in preterm infants.
  • Improved weight gain: SSC has been shown to help preterm infants gain weight more quickly.
  • Reduced stress: SSC has been shown to reduce stress levels in both mothers and infants.
  • Improved long-term outcomes: SSC has been shown to improve long-term outcomes for preterm infants, including cognitive development, language development, and social-emotional development.

How to Practice Immediate Skin-to-Skin Contact

If you are the parent of a very preterm infant, you may be wondering how to practice immediate SSC. Here are a few tips:

  • Start as soon as possible: SSC can be initiated as soon as the infant is stable enough to leave the incubator.
  • Find a comfortable position: You can hold your infant in a variety of positions, such as lying down, sitting, or standing. The most important thing is to find a position that is comfortable for both you and your baby.
  • Skin-to-skin contact: Dress yourself and your baby in warm, loose-fitting clothing. Remove your shirt and your baby’s diaper so that your skin is touching your baby’s skin.
  • Cover your baby: You can cover your baby with a blanket or warm towel to help them stay warm.
  • Continue SSC for as long as possible: SSC can continue for as long as you and your baby are comfortable.


Overall, the study findings showed that SSC could enhance mother-infant bonding, and healthcare procedures should encourage it after birth. There is an early sensitive time after delivery for extremely preterm infants, with good affect, social, and communicative abilities most favorable in mother-infant dyads assigned to immediate SSC.

After adjusting for observation conditions, dyadic interaction was more ideal in the SSC group. The contributions of mothers to interaction quality were not different among groups.

Immediate SSC is a safe and effective way to bond with your very preterm infant and to promote their development. If you are the parent of a very preterm infant, talk to your doctor about how to practice immediate SSC.

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