Premature infants who received more skin-to-skin contact while in NICU showed significantly greater brain growth on discharge than preemies who received little or no skin-to-skin contact, based on data from 88 babies born at less than 32 weeks’ gestation.

Children born at less than 32 weeks’ gestational age are at increased risk for adverse developmental outcomes compared with older premature infants and full-term infants, said lead author Katherine Travis, PhD, of Stanford University, Stanford, California, and the Burke-Cornell Medical Research Institute, White Plains, New York, and colleagues in an interview.

Despite decades of neonatal care advances, these risks remain high, in part because effective clinical strategies that directly support very early brain development are lacking, Travis said.

In a study published in Neurology, the researchers sought to describe the association between in-hospital skin-to-skin care and brain microstructure in very premature infants. Supporting early brain development may be a key strategy for improving long-term outcomes for these vulnerable children, said Travis.

The researchers reviewed data from 88 infants with a mean gestational age of 29 weeks who were born at a single center. Infants underwent routine predischarge MRI, and skin-to-skin care was logged as duration per instance and as minutes of daily exposure prior to the MRI.

The study focused on three frontal and limbic pathways associated with stress regulation and emotional development: the cingulum, anterior thalamic radiations (ATRs), and uncinate fasciculus. Specifically, changes in mean diffusivity and fractional anisotropy of the three pathways were examined using MRI data.

Families in the study visited the NICU approximately once each day, but some visited more than twice a day. Periods of skin-to-skin care ranged from approximately 0.5 hour to 2 hours on a given visit, but the timing varied among the families; 10 infants received more than 50 minutes of daily skin-to-skin care, but six infants received no skin-to-skin care from families during their NICU stays.

Overall, the amount of skin-to-skin care in the NICU was significantly associated with greater development in the cingulum and ATR but not the uncinate fasciculus.

Skin-to-skin care duration per instance was associated with changes in the mean diffusivity of the cingulum and in both the mean diffusivity and fractional anisotropy of the ATR (P = .041, P = .047, and P = .082, respectively).

Signals Support Skin Contact

Detecting signals in neuroimaging metrics can be challenging is heterogenous populations such as premature infants, Travis said. “The fact that we were able to detect significant associations, despite this variability, speaks to the overall impact of skin-to-skin experiences on brain development,” she said.

The findings are consistent with recent studies in Journal of Pediatrics and Infancy showing that higher rates of skin-to-skin care are associated with improved cognitive outcomes at 12 and 18 months, Travis added.

The current study findings were limited by several factors including the retrospective design and use of data from a single center, the researchers noted. However, the main takeaway remains that skin-to-skin care likely has a direct effect on brain development and families should be doing much more of it, Travis said.

“On average, families in our studies were found to perform skin-to-skin care every 2-3 days for about an hour each time,” Travis told Medscape Medical News. “When I reflect on how much I held my own children as newborns, these amounts seem shockingly low. There are many barriers that make it difficult for families to engage in skin-to-skin care consistently, and my hope is that our findings are used to advocate for changes at the hospital, policy, and caregiver support levels that make it easier for families to be involved in caring for their preterm infants,” she said.

Findings Support More Skin-to-Skin Care

The benefits of skin-to-skin care for premature infants are well studied, and the practice is widely endorsed in NICUs in North America, wrote Emma G. Duerden, MD, of Western University, London, Ontario, Canada, and Marie Brossard-Racine, MD, of McGill University, Montreal, Quebec, Canada, in an accompanying editorial. Previous studies also have shown links between skin-to-skin care for newborns and enhanced neurodevelopmental outcomes later in life, they wrote.

“Even ex-preterm adults who received skin-to-skin care displayed increases in brain volume compared with those who experienced standard care, suggesting that skin-to-skin care fosters neural connectivity and brain structural development,” they noted.

Although the current study suggests that more skin-to-skin care is better, the study found that even a small amount of skin-to-skin care, such as a session around 60 minutes, has neurodevelopmental benefits. “Therefore, time constraints should not be a limiting factor for its implementation,” the editorialists wrote. The study findings may foster additional research, guide clinical decision-making, and embed skin-to-skin care into neonatal care, they concluded.

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The researchers disclosed having no financial conflicts of interest. Duerden and Brossard-Racine disclosed receiving funding through the Canada Research Chairs program but had no financial conflicts of interest.