Moore E R, Anderson G C, Bergman N
Vanderbilt University, School of Nursing, 525 Godchaux Hall,21st Avenue South, Nashville, Tennessee 37240-0008, USA.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD003519. doi: 10.1002/14651858.CD003519.pub2.
Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future behavior.
To assess the effects of early SSC on breastfeeding, behavior, and physiological adaptation in healthy mother-newborn dyads.
Cochrane Pregnancy and Childbirth Group's and Neonatal Group's Trials Registers (August 2006), Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (1976 to 2006).
Randomized and quasi-randomized clinical trials comparing early SSC with usual hospital care.
We independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Thirty studies involving 1925 participants (mother-infant dyads), were included. Data from more than two trials were available for only 8-of-64 outcome measures. We found statistically significant and positive effects of early SSC on breastfeeding at one to four months postbirth (10 trials; 552 participants) (odds ratio (OR) 1.82, 95% confidence interval (CI) 1.08 to 3.07), and breastfeeding duration (seven trials; 324 participants) (weighted mean difference (WMD) 42.55, 95% CI -1.69 to 86.79). Trends were found for improved summary scores for maternal affectionate love/touch during observed breastfeeding (four trials; 314 participants) (standardized mean difference (SMD) 0.52, 95% CI 0.07 to 0.98) and maternal attachment behavior (six trials; 396 participants) (SMD 0.52, 95% CI 0.31 to 0.72) with early SSC. SSC infants cried for a shorter length of time (one trial; 44 participants) (WMD -8.01, 95% CI -8.98 to -7.04). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 35 participants) (WMD 2.88, 95% CI 0.53 to 5.23). No adverse effects were found.
AUTHORS' CONCLUSIONS: Limitations included methodological quality, variations in intervention implementation, and outcome variability. The intervention may benefit breastfeeding outcomes, early mother-infant attachment, infant crying and cardio-respiratory stability, and has no apparent short or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC and include means, standard deviations, exact probability values, and data to measure intervention dose.
产后母婴分离在西方文化中很常见。理想情况下，早期皮肤接触（SSC）应在出生后立即开始，即将赤裸的婴儿用温暖的毯子裹住背部，俯卧在母亲裸露的胸前。根据哺乳动物神经科学，这种接触（环境）中固有的亲密接触会引发神经行为，确保基本生物需求得到满足。这段时间可能代表了一个对未来行为进行编程的心理生理“敏感期”。
评估早期皮肤接触对健康母婴二元组母乳喂养、行为和生理适应的影响。
Cochrane妊娠与分娩小组及新生儿小组试验注册库（2006年8月）、Cochrane对照试验中央注册库（《Cochrane图书馆》2006年第2期）、MEDLINE（1976年至2006年）。
比较早期皮肤接触与常规医院护理的随机和半随机临床试验。
我们独立评估试验质量并提取数据。与研究作者联系以获取更多信息。
纳入了30项研究，涉及1925名参与者（母婴二元组）。64项结局指标中只有8项有来自两项以上试验的数据。我们发现，早期皮肤接触对出生后1至4个月的母乳喂养（10项试验；552名参与者）（优势比（OR）1.82，95%置信区间（CI）1.08至3.07）以及母乳喂养持续时间（7项试验；324名参与者）（加权平均差（WMD）42.55，95%CI -1.69至86.79）有统计学上显著的积极影响。在观察到的母乳喂养期间，发现早期皮肤接触有改善母亲深情爱意/触摸总结得分的趋势（4项试验；314名参与者）（标准化平均差（SMD）0.52，95%CI 0.07至0.98）以及母亲依恋行为（6项试验；396名参与者）（SMD 0.52，95%CI 0.31至0.72）。皮肤接触组婴儿哭闹时间较短（1项试验；44名参与者）（WMD -8.01，95%CI -8.98至 -7.04）。晚期早产儿在早期皮肤接触时心肺稳定性更好（1项试验；35名参与者）（WMD 2.88，95%CI 0.53至5.23）。未发现不良影响。
局限性包括方法学质量、干预实施的差异以及结局的变异性。该干预可能有益于母乳喂养结局、早期母婴依恋、婴儿哭闹和心肺稳定性，且没有明显的短期或长期负面影响。建议进一步研究。为便于进行荟萃分析，未来研究应使用与此处纳入研究一致的结局指标。已发表的报告应明确指出干预是否为皮肤接触，并包括均值、标准差、精确概率值以及衡量干预剂量的数据。
