Department of Neonatal Medicine, University Hospital of Strasbourg, University of Strasbourg, Strasbourg, France.
Institute of Cellular and Integrative Neurosciences (INCI), UPR 3212, National Center of Scientific Research (CNRS), University of Strasbourg, Strasbourg, France.
Pediatr Res. 2023 Jun;93(7):2091-2100. doi: 10.1038/s41390-022-02383-3. Epub 2022 Nov 14.
To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants.
Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without exposure to SSC before day 4 of life and binomial log regression used to estimate risk ratios and CIs in the matched cohort. The primary outcome was at least one episode of LOS during hospitalization. Secondary outcomes were the occurrence of any late-onset neonatal infection (LONI), LOS with Staphylococcus or Staphylococcus aureus, incidence of LOS and LONI per 1000 central venous catheter days.
Among the 3422 included infants, 919 were exposed to early SSC. The risk ratio (RR) for LOS was 0.86 (95% CI, 0.67-1.10), for LONI was 1.00 (95% CI, 0.83-1.21), and for LOS with Coagulase-negative Staphylococcus or Staphylococcus aureus infection was 0.91 (95% CI, 0.68-1.21) and 0.77 (95% CI, 0.31-1.87). The incidence RR for LOS per-catheter day was 0.87 (95% CI, 0.64-1.18).
Early SSC exposure was not associated with LOS or LONI risk. Thus, their prevention should not be a barrier to a wider use of SSC.
Kangaroo Mother Care decreased neonatal infection rates in middle-income countries. Skin-to-skin contact is beneficial for vulnerable preterm infants but barriers exist to its implementation. In a large population-based study using a propensity score methods, we found that skin-to-skin contact before day 4 of life was not associated with a decreased risk of late-onset-sepsis in very and extremely preterm infants. Early skin-to-skin contact was not associated with an increased risk of any late-onset-neonatal-infection, in particular with staphylococcus. The fear of neonatal infection should not be a barrier to a wider use of early skin-to-skin contact in this population.
评估极早产儿和超低出生体重儿生后早期皮肤接触（SSC）与晚发型败血症（LOS）发病的相关性。
利用 2011 年全国基于人群的 EPIPAGE-2 队列进行观察性研究。采用倾向性评分匹配生后 4 天内有无 SSC 暴露的婴儿，采用二项式 log 回归在匹配队列中估计风险比（RR）和 95%置信区间（CI）。主要结局为住院期间至少发生一次 LOS。次要结局为任何晚发型新生儿感染（LONI）、凝固酶阴性葡萄球菌或金黄色葡萄球菌感染所致 LOS、LOS 发生率和每 1000 个中心静脉导管日发生的 LONI 例数。
3422 例纳入婴儿中，919 例接受了早期 SSC。LOS 的 RR 为 0.86（95%CI，0.67-1.10），LONI 的 RR 为 1.00（95%CI，0.83-1.21），凝固酶阴性葡萄球菌或金黄色葡萄球菌感染所致 LOS 的 RR 为 0.91（95%CI，0.68-1.21）和 0.77（95%CI，0.31-1.87）。每根中心静脉导管日 LOS 的发生率 RR 为 0.87（95%CI，0.64-1.18）。
早期 SSC 暴露与 LOS 或 LONI 风险无关。因此，不应将其预防作为广泛使用 SSC 的障碍。
袋鼠式护理降低了中低收入国家的新生儿感染率。皮肤接触对脆弱的早产儿有益，但在实施过程中存在障碍。在一项使用倾向性评分的大型基于人群的研究中，我们发现生后 4 天内的皮肤接触与极低和超低出生体重儿晚发型败血症的风险降低无关。早期皮肤接触与任何晚发型新生儿感染的风险增加无关，特别是与葡萄球菌无关。对新生儿感染的担忧不应成为在该人群中广泛使用早期皮肤接触的障碍。
