Miles Rachel, Cowan Frances, Glover Vivette, Stevenson Jim, Modi Neena
Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Early Hum Dev. 2006 Jul;82(7):447-55. doi: 10.1016/j.earlhumdev.2005.11.008. Epub 2006 Feb 2.
Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects.
We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year.
No significant difference was identified in any infant or maternal measure at any time point.
Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.
极早早产，即使没有明显的神经功能障碍，也与疼痛反应改变、记忆和行为受损有关。早产会增加母亲患抑郁症的风险，并可能阻碍母婴关系的发展，而这些因素反过来也与婴儿预后不良有关。母婴皮肤接触已被推荐为改善这些影响的一种简单方法。
我们在两个新生儿重症监护病房进行了一项实用、前瞻性、对照、意向性治疗试验。招募出生孕周小于32周的婴儿，在出生后第一周内将其分为接受标准护理的对照组，或干预组，干预组中鼓励母亲每天进行一次皮肤接触，持续4周。我们评估了婴儿出院时的行为、4个月和12个月大时对免疫接种的反应，以及1岁矫正（月经后）年龄时的记忆、行为和发育情况。在婴儿出院时、4个月和1岁时评估母亲抑郁、压力、焦虑、泌乳表现和婴儿互动的指标。
在任何时间点，任何婴儿或母亲的测量指标均未发现显著差异。
极早早产后的母婴皮肤接触既没有益处也没有不良后果。虽然没有理由劝阻希望进行皮肤接触的母亲，但我们无法建议在新生儿重症监护病房环境中为极早早产儿实施皮肤接触计划分配资源。
