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Meta-Analysis
. 2023 Oct 21;23(1):744.
doi: 10.1186/s12884-023-06057-8.

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

Libby G Lord  1 , Jane E Harding  1 , Caroline A Crowther  1 , Luling Lin  2
Affiliations
Meta-Analysis

Skin-to-skin contact for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

Libby G Lord et al. BMC Pregnancy Childbirth. .

Abstract

Background: Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this.

Methods: Published randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case-control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12th, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322).

Results: This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case-control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I2 = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25-1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I2 = 90%, p for Egger's test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain.

Conclusion: Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.

Keywords: Hypoglycaemia; Infant; Kangaroo Mother Care; Kangaroo care; Neonatology; Newborn; Skin-to-skin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the included studies
Fig. 2
Fig. 2
Risk of bias assessment or quality assessment. a Risk of bias graph using Cochrane risk of bias tool I: review authors’ judgements about each risk of bias item presented as percentages across all included studies. b Risk of bias summary using Cochrane risk of bias tool I: review authors’ judgements about each risk of bias item for each included study. c Quality assessment using Effective Public Health Practice Project
Fig. 3
Fig. 3
Effect of skin-to-skin contact on neonatal hypoglycaemia. a Results from randomised or quasi-randomised controlled trials. b Results from non-randomised studies of interventions. c Results from cohort studies
Fig. 4
Fig. 4
Effect of skin-to-skin contact on admission rate to special care or neonatal intensive care nursery. a Results from randomised or quasi-randomised controlled trials. b Results from cohort studies
Fig. 5
Fig. 5
Effect of skin-to-skin contact on admission to neonatal special or intensive care nursery for hypoglycaemia
Fig. 6
Fig. 6
Effect of skin-to-skin contact on hypothermia. a Results from randomised or quasi-randomised controlled trials b Results from non-randomised studies of intervention c Results from cohort studies. d Results from case–control studies
Fig. 7
Fig. 7
Effect of skin-to-skin contact on hyperthermia
Fig. 8
Fig. 8
Effect of skin-to-skin contact on duration of hospital stay (days)
Fig. 9
Fig. 9
Effect of skin-to-skin contact on exclusive breastmilk feeding from birth to discharge
Fig. 10
Fig. 10
Effect of skin-to-skin contact on exclusive breastmilk feeding at discharge. a Results from randomised or quasi-randomised controlled trials. b Results from non-randomised studies of intervention c Results from cohort studies
Fig. 11
Fig. 11
Effect of skin-to-skin contact on exclusive breastmilk feeding at term equivalent age
Fig. 12
Fig. 12
Effect of skin-to-skin contact on exclusive breastmilk feeding within period from discharge to 3 months. a Results from randomised or quasi-randomised controlled trials. b Results from cohort studies. The results from some studies are reported at corrected age and some are at postnatal age
Fig. 13
Fig. 13
Effect of skin-to-skin contact on exclusive breastmilk feeding within the period from 3 to 6 months. a Results from randomised or quasi-randomised controlled trials. b Results from cohort studies. The results from some studies are reported at corrected age and some are at postnatal age
Fig. 14
Fig. 14
Effect of skin-to-skin contact on any breastmilk feeding. a Results from randomised or quasi-randomised controlled trials. b Results from cohort studies
Fig. 15
Fig. 15
Effect of skin-to-skin contact on blood glucose concentration (mmol/l)
See this image and copyright information in PMC

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