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Meta-Analysis
. 2016 Nov 25;11(11):CD003519.
doi: 10.1002/14651858.CD003519.pub4.

Early skin-to-skin contact for mothers and their healthy newborn infants

Elizabeth R Moore  1 , Nils Bergman, Gene C Anderson, Nancy Medley
Affiliations
Meta-Analysis

Early skin-to-skin contact for mothers and their healthy newborn infants

Elizabeth R Moore et al. Cochrane Database Syst Rev. .

Abstract

Background: Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.

Objectives: To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.

Selection criteria: Randomized controlled trials that compared immediate or early SSC with usual hospital care.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.

Main results: We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).

Authors' conclusions: Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.

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Conflict of interest statement

Dr Anderson, Dr Bergman and Dr Moore have conducted trials that have been included in this review.

Anderson 2003 was conducted by Dr Anderson. Chwo 1999, Punthmatharith 2001, Shiau 1997 and Syfrett 1993 were conducted by students of Dr Anderson’s at Case Western Reserve University. Risk of bias for all these trials was assessed by T Dowswell, Research Associate, Cochrane Pregnancy and Childbirth, Dr Moore and Dr Bergman.

Dr Bergman conducted Bergman 2004 and was a consultant for Luong 2015. T Dowswell, Dr Anderson and Dr Moore evaluated Bergman 2004 for Risk of Bias and N Medley, Research Associate, Cochrane Pregnancy and Childbirth, Dr Anderson and Dr Moore evaluated Luong 2015 for risk of bias. Dr Bergman has received lecture fees for teaching and demonstrating on Skin‐to‐Skin Contact theory and techniques, and produces promotional products for sale. Further, he has participated on a South African patent in the name of the University of Cape Town for a neonatal autonomic nervous system monitoring device. He is an active trialist working on skin‐to‐skin contact for low birth weight newborns.

Dr Moore conducted Moore 2005 while a student of Dr Anderson’s at Vanderbilt University. Moore 2005 was evaluated for risk of bias by T Dowswell and Dr Bergman.

Nancy Medley's work was financially supported by the University of Liverpool's Harris‐Wellbeing of Women Preterm Birth Centre research award and by a grant to University of Liverpool from the World Health Organization.

Figures

1
1
1 Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Skin‐to‐skin versus standard contact for healthy infants, outcome: 1.1 Breastfeeding 1 month to 4 months post birth.
1.1
1.1. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 1 Breastfeeding 1 month to 4 months post birth.
1.2
1.2. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 2 Duration of breastfeeding in days.
1.3
1.3. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 3 SCRIP score first 6 hours post birth.
1.4
1.4. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 4 Blood glucose mg/dL at 75‐180 minutes post birth.
1.5
1.5. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 5 Infant axillary temperature 90 minutes to 2.5 hours post birth.
1.6
1.6. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 6 Exclusive breastfeeding at hospital discharge to 1 month post birth.
1.7
1.7. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 7 Exclusive breastfeeding 6 weeks to 6 months post birth.
1.8
1.8. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 8 Breastfeeding status day 28 to 1 month post birth.
1.9
1.9. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 9 Breastfeeding 1 year post birth.
1.10
1.10. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 10 Success of the first breastfeeding (IBFAT score).
1.11
1.11. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 11 Successful first breastfeeding (IBFAT score 10‐12 or BAT score 8‐12).
1.12
1.12. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 12 Suckled during the first 2 hours post birth.
1.13
1.13. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 13 Mean variation in maternal breast temp. 30‐120 minutes post birth.
1.14
1.14. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 14 Breast engorgement ‐ pain, tension, hardness 3 days post birth.
1.15
1.15. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 15 Heart rate 75 minutes to 2 hours post birth.
1.16
1.16. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 16 Respiratory rate 75 minutes ‐ 2 hours post birth.
1.17
1.17. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 17 Infant did not exceed parameters for stability.
1.18
1.18. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 18 Transferred to the neonatal intensive care unit.
1.19
1.19. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 19 Infant body weight change (grams) day 14 post birth.
1.20
1.20. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 20 Infant hospital length of stay in hours.
1.21
1.21. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 21 Not crying for > 1 minute during 90 minutes.
1.22
1.22. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 22 Amount of crying in minutes during a 75‐minute observation period.
1.23
1.23. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 23 PCERA Maternal positive affective involvement and responsiveness 12 months post birth.
1.24
1.24. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 24 PCERA Dydadic mutuality and reciprocity 12 months post birth.
1.25
1.25. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 25 Mother's most certain preference for same postdelivery care in the future.
1.26
1.26. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 26 Maternal state anxiety 8 hours to 3 days post birth.
1.27
1.27. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 27 Maternal parenting confidence at 1 month post birth.
1.28
1.28. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 28 Breastfeeding 1 month to 4 months post birth: Sensitivity analysis.
1.29
1.29. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 29 Duration of breastfeeding in days: Sensitivity analysis.
1.30
1.30. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 30 Heart rate 75 minutes to 2 hrs post birth: Sensitivity analysis.
1.31
1.31. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 31 Respiratory rate 75 minutes to 2 hours post birth: Sensitivity analysis.
1.32
1.32. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 32 Exclusive bf discharge ‐ Marin 2010 sensitivity analysis.
1.33
1.33. Analysis
Comparison 1 Immediate or Early skin‐to‐skin versus standard contact for healthy infants, Outcome 33 NICU admission ‐ Marin 2010 sensitivity analysis.
2.1
2.1. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 1 Breastfeeding 1 month to 4 months post birth.
2.2
2.2. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 2 Exclusive breastfeeding at hospital discharge to 1 month post birth.
2.3
2.3. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 3 Exclusive breastfeeding 6 weeks to 6 months post birth.
2.4
2.4. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 4 Success of the first breastfeeding (IBFAT score).
2.5
2.5. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 5 Respiratory rate 75 minutes ‐ 2 hours post birth.
2.6
2.6. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 6 Maternal pain 4 hours post‐cesarean birth.
2.7
2.7. Analysis
Comparison 2 Immediate or Early skin‐to‐skin versus standard contact for healthy infants after cesarean birth, Outcome 7 Maternal state anxiety 8 hours to 3 days post birth.
3.1
3.1. Analysis
Comparison 3 Skin‐to‐skin versus standard contact by time of initiation, Outcome 1 Breastfeeding 1 month to 4 months post birth.
3.2
3.2. Analysis
Comparison 3 Skin‐to‐skin versus standard contact by time of initiation, Outcome 2 Duration of breastfeeding in days.
3.3
3.3. Analysis
Comparison 3 Skin‐to‐skin versus standard contact by time of initiation, Outcome 3 SCRIP score first 6 hours post birth.
3.4
3.4. Analysis
Comparison 3 Skin‐to‐skin versus standard contact by time of initiation, Outcome 4 Blood glucose mg/dL at 75‐90 minutes post birth.
3.5
3.5. Analysis
Comparison 3 Skin‐to‐skin versus standard contact by time of initiation, Outcome 5 Infant axillary temperature 90 minutes to 2.5 hours post birth.
4.1
4.1. Analysis
Comparison 4 Skin‐to‐skin versus standard contact by dosage (length of contact time), Outcome 1 Breastfeeding 1 month to 4 months post birth.
4.2
4.2. Analysis
Comparison 4 Skin‐to‐skin versus standard contact by dosage (length of contact time), Outcome 2 Duration of breastfeeding in days.
4.3
4.3. Analysis
Comparison 4 Skin‐to‐skin versus standard contact by dosage (length of contact time), Outcome 3 SCRIP score first 6 hours post birth.
4.4
4.4. Analysis
Comparison 4 Skin‐to‐skin versus standard contact by dosage (length of contact time), Outcome 4 Blood glucose mg/dL at 75‐90 minutes post birth.
4.5
4.5. Analysis
Comparison 4 Skin‐to‐skin versus standard contact by dosage (length of contact time), Outcome 5 Infant axillary temperature 90 minutes to 2.5 hours post birth.
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Update of

References

References to studies included in this review

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    1. Moore ER, Anderson GC. Randomized controlled trial or early mother‐infant skin‐to‐skin contact and breastfeeding success. Journal of Human Lactation 2005;21(4):488‐9.
Nahidi 2011 {published data only}
    1. Nahidi F, Dorri F, Ravari M, Akbarzade A. Effect of early skin‐ to‐ skin contact of mother and newborn on mother's satisfaction. Journal of Nursing & Midwifery 2011;20(4):1‐5.
Nasehi 2012 {published data only}
    1. Nasehi MM, Farhadi R, Ghaffari V, Ghaffari‐Charati M. The effect of early breastfeeding after cesarean section on the success of exclusive breastfeeding. HealthMED 2012;6(11):3597‐601.
Nimbalkar 2014 {published and unpublished data}
    1. Nimbalkar SM, Patel DV, Patel DN, Patel VK, Nimbalkar AS, Phatak AG. Infant and young child feeding practices in infants receiving skin to skin care at birth: A follow up of randomised cohort. Pediatric Academic Socieities Annual Meeting; 2015 April 25‐28; San Diego, California, USA. 2015. - PMC - PubMed
    1. Nimbalkar SM, Patel VK, Patel DV, Nimbalkar AS, Sethi A, Phatak A. Effect of early skin‐to‐skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology 2014;34(5):364‐8. - PubMed
Nolan 2009 {published data only}
    1. Nolan A, Lawrence C. A pilot study of a nursing intervention protocol to minimize maternal‐infant separation after Cesarean birth. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2009;38(4):430‐42. - PubMed
Norouzi 2013 {published data only}
    1. Norouzi F, Keshavarz M, SeyedFatemi N, Montazeri A. The impact of kangaroo care and music on maternal state anxiety. Complementary Therapies in Medicine 2013;21(5):468‐72. - PubMed
Punthmatharith 2001 {unpublished data only}
    1. Punthmatharith B. Randomized Controlled Trial of early Kangaroo Care (Skin‐to‐Skin) Care: Effects on Maternal Feelings, Maternal‐Infant Interaction and Breastfeeding Success in Thailand [dissertation]. Cleveland (OH): Case Western Reserve University, 2001.
Shiau 1997 {published and unpublished data}
    1. Shiau S‐HH. Randomized Controlled Trial of Kangaroo Care with Full‐Term Infants: Effects on Maternal Anxiety, Breast‐Milk Maturation, Breast Engorgement, and Breastfeeding Status [Dissertation]. Cleveland (OH): Case Western Reserve University, 1997.
    1. Shiau S‐HH. Randomized controlled trial of kangaroo care with full term infants: effects on breastmilk maturation, breast engorgement, and breastfeeding status. International Breastfeeding Conference, Australia's Breastfeeding Association; 1997 October; Sydney, Australia. 1997.
Sosa 1976a {published data only}
    1. Sosa R, Kennell, JH, Klaus M, Urrutia JJ. The effect of early mother‐infant contact on breastfeeding, infection and growth. In: Elliott K, Fitzsimons DW editor(s). Breastfeeding and the Mother: Ciba Foundation Symposium. Vol. 45, New York: Elsevier Excerpta Medica, 1976:179‐93. - PubMed
Sosa 1976b {published data only}
    1. Sosa R, Kennell, JH, Klaus M, Urrutia JJ. The effect of early mother‐infant contact on breastfeeding, infection and growth. In: Elliott K, Fitzsimons DW editor(s). Breastfeeding and the Mother: Ciba Foundation Symposium. Vol. 45, New York: Elsevier Excerpta Medica, 1976:179‐93. - PubMed
Sosa 1976c {published data only}
    1. Sosa R, Kennell, JH, Klaus M, Urrutia JJ. The effect of early mother‐infant contact on breastfeeding, infection and growth. In: Elliott K, Fitzsimons DW editor(s). Breastfeeding and the Mother: Ciba Foundation Symposium. Vol. 45, New York: Elsevier Excerpta Medica, 1976:179‐93. - PubMed
Srivastava 2014 {published data only}
    1. Srivastava S, Gupta A, Bhatnagar A, Dutta S. Effect of very early skin to skin contact on success at breastfeeding and preventing early hypothermia in neonates. Indian Journal of Public Health 2014;58(1):22‐6. - PubMed
Svejda 1980 {published data only}
    1. Svejda MJ, Campos JJ, Emde RN. Mother‐infant bonding: failure to generalize. Child Development 1980;51:775‐9. - PubMed
Syfrett 1993 {published and unpublished data}
    1. Syfrett EB. Very Early and Virtually Continuous Kangaroo Care for 34‐36 week Gestation Preterm Infants: Effects on Temperature, Breastfeeding, Supplementation and Weight [thesis]. Gainesville (FL): University of Florida, 1993.
    1. Syfrett EB, Anderson GC. Very early kangaroo care beginning at birth for healthy preterm infants and mothers who choose to breastfeed: effect on outcome. A Workshop on the Kangaroo‐Mother Method for Low Birthweight Infants. World Health Organization; 1996 October; Trieste, Italy. 1996.
Thomson 1979 {published data only}
    1. Thomson ME, Hartsock TG, Larson C. The importance of immediate postnatal contact: its effect on breastfeeding. Canadian Family Physician 1979;25:1374‐8. - PMC - PubMed
Thukral 2012 {published data only}
    1. Thukral A, Sankar MJ, Agarwal R, Gupta N, Deorari AK, Paul VK. Early skin‐to‐skin contact and breast‐feeding behavior in term neonates: a randomized controlled trial. Neonatology 2012;102(2):114‐9. - PubMed
Vaidya 2005 {published data only}
    1. Vaidya K, Sharma A, Dhungel S. Effect of early mother‐baby close contact over the duration of exclusive breastfeeding. Nepal Medical College Journal: NMCJ 2005;7:138‐40. - PubMed
Villalon 1992 {published data only}
    1. Villalon HU, Alvarez PC. Short term effects of early skin‐to‐skin contact (kangaroo care) on breastfeeding in healthy full‐term newborns [Efecto a corto plazo del contacto precoz piel a piel sobre la lactancia materna en recien nacidos de termino sanos]. Revista Chilena de Pediatria 1993;64(2):124‐8.
    1. Villalon HU, Alvarez PC, Barria EH, Caneleo DH, Carrillo LM, Duran SG. Effect of early skin‐to‐skin contact on temperature regulation, heart rate, and respiratory rate in healthy, full‐term newborns [Contacto precoz piel a piel: efecto sobre los parametros fisiologicos en las cuatro horas posteriores al parto en recien nacidos de termino sanos]. Revista Chilena de Pediatria 1992;63(3):140‐4.

References to studies excluded from this review

Abdel Razek 2009 {published data only}
    1. Abdel Razek A, Az El‐Dein N. Effect of breast‐feeding on pain relief during infant immunization injections. International Journal of Nursing Practice 2009;15(2):99‐104. - PubMed
Ali 1981 {published data only}
    1. Ali Z, Lowry M. Early maternal‐child contact: effects on later behavior. Developmental Medicine and Child Neurology 1981;23:337‐45. - PubMed
Anisfeld 1983 {published data only}
    1. Anisfeld E, Lipper E. Early contact, social support, and mother‐infant bonding. Pediatrics 1983;72:79‐83. - PubMed
Arnon 2014 {published data only}
    1. Arnon S, Diamant C, Bauer S, Regev R, Sirota G, Litmanovitz I. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta Paediatrica 2014;103(10):1039‐44. - PubMed
Bigelow 2012 {published data only}
    1. Bigelow A, Power M, MacLellan‐Peters J, Alex M, McDonald C. Effect of mother/infant skin‐to‐skin contact on postpartum depressive symptoms and maternal physiological stress. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN 2012;41(3):369‐82. - PubMed
    1. Bigelow AE, Power M, Gillis DE, Maclellan‐Peters J, Alex M, McDonald C. Breastfeeding, skin‐to‐skin contact, and mother‐infant interactions over infants' first three months. Infant Mental Health Journal 2014;35(1):51‐62. - PubMed
Castral 2008 {published data only}
    1. Castral TC, Warnock F, Leite AM, Haas VJ, Scochi CG. The effects of skin‐to‐skin contact during acute pain in preterm newborns. European Journal of Pain 2008;12(4):464‐71. - PubMed
Cattaneo 1998 {published data only}
    1. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A, et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatrica 1998;87(9):976‐85. - PubMed
Christensson 1998 {published data only}
    1. Christensson K, Bhat GJ, Amadi BC. Randomised study of skin‐to‐skin versus incubator care for rewarming low‐risk hypothermic neonates. Lancet 1998;352:1115. - PubMed
Darmstadt 2006 {published data only}
    1. Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, et al. Introduction of community‐based skin‐to‐skin care in rural Uttar Pradesh, India. Journal of Perinatology 2006;26(10):597‐604. - PubMed
de Ocampo 2013 {published data only}
    1. Ocampo FS, Uy HG, Uy MEV. A randomized controlled trial of kangaroo mother care versus conventional care in increasing the rate of weight gain among low birth weight neonates. Pediatric Academic Societies Annual Meeting; 2013 May 4‐7; Washington DC, USA. 2013.
Durand 1997 {published data only}
    1. Durand R, Hodges S, LaRock S, Lund L, Schmid S, Swick D, et al. The effect of skin‐to‐skin breastfeeding in the immediate recovery period on newborn thermoregulation and blood glucose values. Neonatal Intensive Care 1997;3/4:23‐9.
Erlandsson 2007 {published data only}
    1. Erlandsson K, Dsilna A, Fagerberg I, Christensson K. Skin‐to‐skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior. Birth 2007;34(2):105‐14. - PubMed
Feldman 2003 {published data only}
    1. Feldman R, Weller A, Sirota L, Eidelman AI. Testing a family intervention hypothesis: the contribution of mother‐infant skin‐to‐skin contact (kangaroo care) to family interaction, proximity, and touch. Journal of Family Psychology 2003;17(1):94‐107. - PubMed
Ferber 2008 {published data only}
    1. Ferber SG, Makhoul IR. Neurobehavioural assessment of skin‐to‐skin effects on reaction to pain in preterm infants: a randomized, controlled within‐subject trial. Acta Paediatrica 2008;97(2):171‐6. - PubMed
Filho 2015 {published data only}
    1. Filho FL, Sousa SH, Freitas IJ, Lamy ZC, Simoes VM, Silva AA, et al. Effect of maternal skin‐to‐skin contact on decolonization of Methicillin‐Oxacillin‐Resistant Staphylococcus in neonatal intensive care units: a randomized controlled trial. BMC Pregnancy and Childbirth 2015;15(1):63. - PMC - PubMed
Gardner 1979 {published data only}
    1. Gardner S. The mother as incubator‐after delivery. Journal of Obstetric, Gynecologic and Neonatal Nursing 1979;8(3):174‐6. - PubMed
Gathwala 2008 {published data only}
    1. Gathwala G, Singh B, Balhara B. KMC facilitates mother baby attachment in low birth weight infants. Indian Journal of Pediatrics 2008;75(1):43‐7. - PubMed
    1. Gathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Tropical Doctor 2010;40(4):199‐202. - PubMed
Gomes‐Pedro 1984 {published data only}
    1. Gomes‐Pedro J, Bento de Almeida J, Silveira da Costa C, Barbosa A. Influence of early mother‐infant contact on dyadic behaviour during the first month of life. Developmental Medicine and Child Neurology 1984;26:657‐64. - PubMed
Gray 2000 {published data only}
    1. Gray L, Watt L, Blass EM. Skin‐to‐skin contact is analgesic in healthy newborns. Pediatrics 2000;105(1):e14. - PubMed
Gray 2002 {published data only}
    1. Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002;109:590‐3. - PubMed
Grossman 1981 {published data only}
    1. Grossman K, Thane K, Grossman KE. Maternal tactual contact of the newborn after various postpartum conditions of mother‐infant contact. Developmental Psychobiology 1981;17:158‐69.
Hill 1979 {published data only}
    1. Hill ST, Shronk LK. The effect of early parent‐infant contact on newborn body temperature. Journal of Obstetric, Gynecologic and Neonatal Nursing 1979;8(5):287‐90. - PubMed
Holditch‐Davis 2014 {published data only}
    1. Holditch‐Davis D, White‐Traut RC, Levy JA, O'Shea TM, Geraldo V, David RJ. Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother‐infant relationship. Infant Behavior & Development 2014;37(4):695‐710. - PMC - PubMed
Horn 2014 {published data only}
    1. Horn EP, Bein B, Steinfath M, Ramaker K, Buchloh B, Hocker J. The incidence and prevention of hypothermia in newborn bonding after cesarean delivery: A randomized controlled trial. Anesthesia and Analgesia 2014;118(5):997‐1002. - PubMed
Ibe 2004 {published data only}
    1. Ibe OE, Austin T, Sullivan K, Fabanwo O, Disu E, Costello AM. A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants <2000g in Nigeria using continuous ambulatory temperature monitoring. Annals of Tropical Pediatrics 2004;24:245‐51. - PubMed
Ignacio 2013 {published data only}
    1. Ignacio RP, Uy MEV. Kangaroo care transport versus transport incubator in transporting stable preterm neonates: a randomized controlled trial. Pediatric Academic Societies Annual Meeting; 2013 May 4‐7; Washington DC, USA. 2013.
Johanson 1992 {published data only}
    1. Johanson RB, Malla DS, Rolfe P, Spencer A. The effect of postdelivery care on neonatal body temperature. Early Human Development 1990;21:132‐3.
    1. Johanson RB, Spencer SA, Rolfe P, Jones P, Malla DS. Effect of post‐delivery care on neonatal body temperature. Acta Paediatrica 1992;81:859‐63. - PubMed
Johnson 1976 {published data only}
    1. Johnson NW. Breast‐feeding at one hour of age. American Journal of Maternal‐Child Nursing 1976;1:12‐6. - PubMed
Kadam 2005 {published data only}
    1. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A. Feasibility of kangaroo mother care in Mumbai. Indian Journal of Pediatrics 2005;72(1):35‐8. - PubMed
Karlsson 1996 {published data only}
    1. Karlsson H. Skin to skin care: heat balance. Archives of Disease in Childhood 1996;75:F130‐F132. - PMC - PubMed
Keshavarz 2010a {published data only}
    1. Keshavarz M, Haghighi NB. Effects of kangaroo contact on some physiological parameters in term neonates and pain score in mothers with cesarean section. Koomesh 2010;11(2):91‐9.
Klaus 1972 {published data only}
    1. Kennell JH, Jerauld R, Wolfe H, Chesler D, Kreger NC, McAlpine W. Maternal behavior one year after early and extended post‐partum contact. Developmental Medicine and Child Neurology 1974;16:172‐9. - PubMed
    1. Kennell JH, Trause MA, Klaus MH. Evidence for a sensitive period in the human mother. Parent infant interaction. CIBA Foundation Symposium 1975; Vol. 33:87‐101. - PubMed
    1. Klaus M, Jerauld R, Kreger N, McAlpine W, Steffa M, Kennell J. Maternal attachment: importance of the first postpartum days. New England Journal of Medicine 1972;286:460‐3. - PubMed
    1. Ringler N, Kennell JH, Klaus MH, Navojosky B. Mother to child speech at two years: the effects of increased post‐natal contact. Pediatric Research 1974;8:345.
    1. Ringler N, Trause MA, Klaus MH, Kennell JH. The effects of extra postpartum contact and maternal speech patterns on children's IQs, speech and language comprehension at five. Child Development 1978;49:862‐5.
Kontos 1978 {published data only}
    1. Kontos D. A study of the effects of extended mother‐infant contact on maternal behavior at one and three months. Birth and the Family Journal 1978;5(3):133‐40.
Limrattamorn 2013 {published data only}
    1. Limrattamorn P, Kaewkiattikun K. The effect of early mother‐infant skin to skin contact and suckling on duration of exclusive breastfeeding: a randomized controlled trial. Thai Journal of Obstetrics and Gynaecology 2013;21:101‐9.
Lindenberg 1990 {published data only}
    1. Lindenberg CS, Artola RC, Jimenez V. The effect of early postpartum mother‐infant contact and breastfeeding promotion on the incidence and continuation of breastfeeding. International Journal of Nursing Studies 1990;27:179‐86. - PubMed
Ludington‐Hoe 2004 {published data only}
    1. Ludington‐Hoe SM, Anderson GC, Swinth JY, Thompson C, Hadeed AJ. Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants. Neonatal Network ‐ Journal of Neonatal Nursing 2004;23(3):39‐48. - PubMed
Ludington‐Hoe 2006 {published data only}
    1. Ludington‐Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson PD, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics 2006;117(5):e909‐23. - PubMed
Mikiel‐Kostyra 2002 {published data only}
    1. Mikiel‐Kostyra K, Boltruszko I, Mazur J. Skin‐to‐skin contact after birth as a factor determining breastfeeding duration [Kontakt skora‐do‐skory po porodzie jako czynnik warunkujacy czas trwania karmienia piersia]. Medycyna Wieku Rozwojowego 2001;5(2):179‐89. - PubMed
    1. Mikiel‐Kostyra K, Mazur J, Boltruszko I. Effect of early skin‐to‐skin contact after delivery on duration of breastfeeding: a prospective cohort study. Acta Paediatrica 2002;91(12):1301‐6. - PubMed
Miles 2006 {published data only}
    1. Miles R, Cowan F, Glover V, Stevenson J, Modi N. A controlled trial of skin‐to‐skin contact in extremely preterm infants. Early Human Development 2006;82(7):447‐55. - PubMed
Morelius 2015 {published data only}
    1. Morelius E, Ortenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin‐to‐skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Human Development 2015;91(1):63‐70. - PubMed
Nagai 2010 {published data only}
    1. Nagai S, Andrianarimanana D, Rabesandratana N, Yonemoto N, Nakayama T, Mori R. Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low‐birth‐weight infants: a randomized controlled trial. Acta Paediatrica 2010;99(6):827‐35. - PubMed
Neu 2010 {published data only}
    1. Neu M, Robinson J. Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. JOGNN ‐ Journal of Obstetric, Gynecologic & Neonatal Nursing 2010;39(4):401‐14. - PMC - PubMed
Ohgi 2002 {published data only}
    1. Ohgi S, Fukuda M, Moriuchi H, Kusumoto T, Akiyama T, Nugent JK, et al. Comparison of kangaroo care and standard care: behavioral organization, development, and temperament in healthy, low‐birth‐weight infants through 1 year. Journal of Perinatology 2002;22(5):374‐9. - PubMed
Okan 2010 {published data only}
    1. Okan F, Ozdil A, Bulbul A, Yapici Z, Nuhoglu A. Analgesic effects of skin‐to‐skin contact and breastfeeding in procedural pain in healthy term neonates. Annals of Tropical Paediatrics 2010;30(2):119‐28. - PubMed
Ottaviano 1979 {published data only}
    1. Ottaviano CM, Campbell SBG, Taylor PM. The effects of extra postpartum contact on infant‐mother attachment at one year. Pediatric Research 1979;13:336.
Raguindin 2015 {published data only}
    1. Raguindin PF, Uy ME, Dumalag JA. Prolactin level and breast milk volume among mothers of low birth weight infants admitted to level II neonatal intensive care unit who underwent Kangaroo Mother Care. Breastfeeding Medicine 2015;10(Suppl 1):S‐4.
Ramanathan 2001 {published data only}
    1. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G. Kangaroo mother care in very low birth weight infants. Indian Journal of Pediatrics 2001;68(11):1019‐23. - PubMed
Roberts 2000 {published data only}
    1. Roberts KL, Paynter C, McEwan B. A comparison of kangaroo mother care and conventional cuddling care. Neonatal Network ‐ Journal of Neonatal Nursing 2000;19(4):31‐5. - PubMed
Rojas 2001 {published data only}
    1. Rojas MA, Kaplan M, Mayes L, Quevedo ME, Foster LB, Sherwonit E, et al. Traditional holding (TH) and skin‐to‐skin care (SSC) for newborn infants <= 1500 grams. A randomized controlled trial [abstract]. Pediatric Research 2001;49(4):360A.
Ruiz 2014 {published data only}
    1. Ruiz JG, Charpak N, Castillo M. Randomized controlled trial on kangaroo mother care in Bogata: cost‐utility analysis. Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting; 2014 May 3‐6; Vancouver, Canada. 2014:Abstract no: 3845.684.
Saatsaz 2011 {published data only}
    1. Saatsaz S, Rezaei R, Sharifnia SH, Kheirkhah F, Moulookzadeh M, Haji Hosseini F. Effect of mother and newborn skin to skin contact on postpartum blues [Persian]. Journal of Babol University of Medical Sciences 2011;13(3):60‐5.
Salariya 1978 {published data only}
    1. Salariya EM, Easton PM, Cater JI. Duration of breastfeeding after early initiation and frequent feeding. Lancet 1978;2:1141‐3. - PubMed
Seeman 2015 {published data only}
    1. Seeman J, Griifin J, Amoura J. Maternal outcomes associated with skin‐to‐skin contact after cesarean section. Breastfeeding Medicine 2015;10(Suppl 1):S‐18.
Sloan 2008 {published data only}
    1. Ahmed S, Mitra SN, Chowdhury AM, Camacho LL, Winikoff B, Sloan NL. Community Kangaroo Mother Care: implementation and potential for neonatal survival and health in very low‐income settings. Journal of Perinatology 2011;31(5):361‐7. - PubMed
    1. Sloan NL, Ahmed S, Chowdhury N, Mitra S, Chowdhury M, Rob U. Community‐based kangaroo mother care to prevent neonatal mortality [abstract]. Pediatric Academic Societies Annual Meeting; 2006 April 29‐May 2; San Francisco, CA, USA. 2006.
    1. Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, et al. Community‐based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 2008;121(5):e1047‐59. - PubMed
Suman 2008 {published data only}
    1. Suman Rao PN, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatrics 2008;45(1):17‐23. - PubMed
Svensson 2013 {published data only}
    1. Svensson KE, Velandia MI, Matthiesen AS, Welles‐Nystrom BL, Widstrom AM. Effects of mother‐infant skin‐to‐skin contact on severe latch‐on problems in older infants: a randomized trial. International Breastfeeding Journal 2013;8(1):1. - PMC - PubMed
Taylor 1979 {published data only}
    1. Taylor PM, Campbell SBG, Taylor FH, Maloni J, Dickey D, Rubenstein G. Short‐term effects of extra mother‐first born contact. Pediatric Research 1979;13:338.
Taylor 1985 {published data only}
    1. Taylor PM, Maloni JA, Taylor FH, Campbell SB. Extra early mother‐infant contact and duration of breastfeeding. Acta Paediatrica Scandinavica Supplement 1985;316:15‐22. - PubMed
    1. Taylor PM, Taylor FH, Campbell SB, Maloni JA, Cannon M. Extra early physical contact and aspects of the early mother‐infant relationship. Acta Paediatrica Scandinavica Supplement 1985;316:3‐14. - PubMed
Taylor 1986 {published data only}
    1. Taylor PM, Maloni JA, Brown DR. Early sucking and prolonged breastfeeding. American Journal of Diseases of Children 1986;140:151‐4. - PubMed
Tessier 2009 {published data only}
    1. Tessier R, Charpak N, Giron M, Cristo M, Calume ZF, Ruiz‐Pelaez JG. Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatrica 2009;98(9):1444‐50. - PubMed
Thukral 2010 {published data only}
    1. Thukral A, Sankar J, Agarwal R, Deorari A, Paul V. Effect of early skin to skin (STS) contact on breastfeeding behavior in term neonates: a randomized trial. Pediatric Academic Societies 2010 Annual Meeting; 2010 May 1‐4; Vancouver, Canada. 2010.
Velandia 2010 {published data only}
    1. Velandia M, Matthisen AS, Uvnas‐Moberg K, Nissen E. Onset of vocal interaction between parents and newborns in skin‐to‐skin contact immediately after elective caesarean section. Birth 2010;37(3):192‐201. - PubMed
    1. Velandia M, Uvnas‐Moberg K, Nissen E. Sex differences in newborn interaction with mother or father during skin‐to‐skin contact after Caesarean section. Acta Paediatrica 2012;101(4):360‐7. - PubMed
Vendivel 2011 {published data only}
    1. Vendivel EF, Gatcheco F. A randomized controlled trial on the effect of maternal skin‐to‐skin contact versus paternal skin‐to‐skin contact on the prefeeding behaviors, crying, and temperature of newborns delivered via cesarean section. Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting; 2011 April 30‐May 3; Denver, Colorado, USA. 2011:1453.598.
Vesel 2013 {published data only}
    1. Vesel L, Asbroek AH, Manu A, Soremekun S, Tawiah Agyemang C, Okyere E, et al. Promoting skin‐to‐skin care for low birthweight babies: findings from the Ghana Newhints cluster‐randomised trial. Tropical Medicine & International Health 2013;18(8):952‐61. - PubMed
Wimmer‐Puchinger 1982 {published data only}
    1. Wimmer‐Puchinger B, Nagel M. The importance of attitudes during pregnancy and early mother‐child contact for breastfeeding behavior: an empirical study. In: Prill HJ, Stauber M editor(s). Advances in Psychosomatic Obstetrics and Gynecology. Springer‐Verlag, 1982:482‐4.
Worku 2005 {published data only}
    1. Worku B, Kassie A. Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia. Journal of Tropical Pediatrics 2005;51(2):93‐7. - PubMed

References to studies awaiting assessment

Ramani 2015 {published data only}
    1. Ramani M, Choe EA, Major M, Newton R, Carlo W. Randomized trial of skin‐to‐skin contact to prevent hypothermia in term neonates. Journal of Investigative Medicine 2015;63(2):418.
Rosas 2015 {published data only}
    1. Rosas BS, Rodriguez J, Vargas G, Lozano F, Canfield H. Effect of skin to skin care on the success of breastfeeding exclusivity: A randomized controlled trial. Pediatric Academic Socieities Annual Meeting; 2015 April 25‐28; San Diego, California, USA. 2015.
Tateoka 2014 {published data only}
    1. Tateoka Y, Katori Y, Takahashi M. Effect of early mother‐child contact immediately after birth on delivery stress state. International Confederation of Midwives 30th Triennial Congress. Midwives: Improving Women’s Health; 2014 June 1‐4; Prague, Czech Republic. 2014:P188.

References to ongoing studies

Keshavarz 2010b {published data only}
    1. Keshavarz M. Comparison the effect of skin to skin contact and music during skin to skin contact on maternal state anxiety in cesarean section unit. IRCT Iranian Registry of Clinical Trials (www.irct.ir) (accessed 6 December 2010) 2010.

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