Anderson G C, Moore E, Hepworth J, Bergman N
Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-4904, USA.
Cochrane Database Syst Rev. 2003(2):CD003519. doi: 10.1002/14651858.CD003519.
Early skin-to-skin contact involves placing the naked baby prone on the mother's bare chest at birth or soon afterwards (< 24 hour). This could represent a 'sensitive period' for priming mothers and infants to develop a synchronous, reciprocal, interaction pattern, provided they are together and in intimate contact. Routine separation shortly after hospital birth is a uniquely Western cultural phenomenon that may be associated with harmful effects including discouragement of successful breastfeeding.
To assess the effects of early skin-to-skin contact on breastfeeding, behavior, and physiology in mothers and their healthy newborn infants.
The Cochrane Pregnancy and Childbirth Group and Neonatal Group trials registers (December 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002), MEDLINE (1976 to 2002).
Randomized and quasi-randomized clinical trials comparing early skin-to-skin contact with usual hospital care.
Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials.
Seventeen studies, involving 806 participants, were included. We found statistically significant and positive effects of early skin-to-skin contact on breastfeeding at one to three months postbirth (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.10 to 4.22), breastfeeding duration (weighted mean difference (WMD) 41.99, 95% CI 13.97 to 70.00), maintenance of infant temperature in the neutral thermal range (OR 12.18, 95% CI 2.04 to 72.91), infant blood glucose (WMD 11.07, 95% CI 3.97 to 18.17), infant crying (OR 21.89, 95% CI 5.19 to 92.30) and summary scores of maternal affectionate love/touch (SMD 0.73, 95% CI 0.36 to 1.11) during an observed breastfeeding within the first few days postbirth. We found no statistically significant benefit of early skin-to-skin contact for other major clinical variables: breastmilk maturation, maternal chest circumference, infant heart rate.
REVIEWER'S CONCLUSIONS: Limitations included the methodological quality of the studies, variations in the implementation of the intervention and outcome variability. Early skin-to-skin contact appears to have some clinical benefit especially regarding breastfeeding outcomes and infant crying and has no apparent short or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis of the data, future research in this area should involve outcome measures consistent with those used in the studies included here. Published reports should also clearly indicate if the intervention was skin-to-skin contact and include means, standard deviations and exact probability values.
早期肌肤接触是指在婴儿出生时或出生后不久（<24小时），让裸体的婴儿俯卧在母亲裸露的胸部。倘若母婴在一起且有亲密接触，这可能代表着一个“敏感期”，有助于促使母亲和婴儿形成一种同步、相互的互动模式。出生后不久在医院进行常规分离是西方独有的文化现象，可能会带来包括阻碍成功母乳喂养在内的有害影响。
评估早期肌肤接触对母亲及其健康新生儿的母乳喂养、行为和生理的影响。
Cochrane妊娠与分娩组及新生儿组试验注册库（2002年12月）、Cochrane对照试验中心注册库（《Cochrane图书馆》，2002年第4期）、MEDLINE（1976年至2002年）。
比较早期肌肤接触与常规医院护理的随机和半随机临床试验。
两名评价员独立评估试验质量并提取数据。我们联系研究作者获取更多信息。我们从试验中收集不良反应信息。
纳入了17项研究，涉及806名参与者。我们发现，早期肌肤接触对出生后1至3个月的母乳喂养（优势比（OR）2.15，95%置信区间（CI）1.10至4.22）、母乳喂养持续时间（加权均数差（WMD）41.99，95%CI 13.97至70.00）、将婴儿体温维持在中性温度范围（OR 12.18，95%CI 2.04至72.91）、婴儿血糖（WMD 11.07，95%CI 3.97至18.17）、婴儿啼哭（OR 21.89，95%CI 5.19至92.30）以及产后头几天观察到的母乳喂养期间母亲的深情关爱/抚摸综合评分（标准化均数差（SMD）0.73，95%CI 0.36至1.11）有统计学上的显著积极影响。我们发现早期肌肤接触对其他主要临床变量无统计学上的显著益处：母乳成熟度、母亲胸围、婴儿心率。
局限性包括研究的方法学质量、干预实施的差异以及结果的变异性。早期肌肤接触似乎有一些临床益处，尤其是在母乳喂养结果和婴儿啼哭方面，且没有明显的短期或长期负面影响。建议进一步研究。为便于对数据进行荟萃分析，该领域未来的研究应采用与此处纳入研究一致的结局指标。已发表的报告还应明确指出干预是否为肌肤接触，并包括均值、标准差和确切概率值。
