Bedetti Luca, Lugli Licia, Bertoncelli Natascia, Spaggiari Eugenio, Garetti Elisabetta, Lucaccioni Laura, Cipolli Federica, Berardi Alberto
Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy.
PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy.
Children (Basel). 2023 Mar 17;10(3):570. doi: 10.3390/children10030570.
Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals.
To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals.
Prospective observational monocentric study.
Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis.
In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23-33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25-34 weeks), 10 days (range 1-20 days), and 1131 g (range 631-2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported.
These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.
皮肤接触（SSC）是袋鼠式护理（KC）的四个组成部分之一，在低收入国家也是一种有价值的替代暖箱的护理方式。由于其短期和长期益处以及对婴儿生长和神经发育结局的积极影响，SSC在高收入国家也已成为一种护理标准。然而，在新生儿重症监护病房（NICU）中，实施SSC存在障碍，尤其是对于早产儿，因为家长和医护人员可能认为这对早产儿的临床稳定性有潜在风险。以往的研究通过在短时间间隔内监测生命体征参数来评估SSC之前和期间的安全性。
证明在至少90分钟的间隔内，早期SSC对早产儿的安全性。
前瞻性观察单中心研究。
对2018年6月至2020年6月出生的胎龄≤33周、出生体重<2000g的早产儿在出生后前三周进行SSC期间进行监测。排除患有坏死性小肠结肠炎、败血症、先天性畸形且需要机械通气的婴儿，以及在SSC前一小时内有超过五次呼吸暂停的婴儿。在SSC期间及前一小时记录持续的血氧饱和度（SaO2）、心率（HR）和呼吸频率（RR）。SSC的最短持续时间为90分钟。收集有关胎龄（PMA）、体重、呼吸支持、中心静脉导管的存在情况以及在一次SSC后72小时内败血症发作的信息。两名对婴儿情况和分析时间段（SSC之前或期间）不知情的医生评估血氧饱和度降低发作（SaO2<85%，>15秒）、心动过缓（HR<100，>15秒）和呼吸暂停（呼吸暂停>20秒并伴有血氧饱和度降低和/或心动过缓）。采用Wilcoxon秩和检验进行统计分析。
共分析了38例婴儿的83次SSC情况。出生时的平均胎龄为29周（范围23 - 33周）。SSC时的PMA中位数、出生天数和体重分别为31周（范围25 - 34周）、10天（范围1 - 20天）和1131g（范围631 - 2206g）。我们发现77%的婴儿在SSC期间接受呼吸支持，其中47%的婴儿有中心静脉导管（脐静脉或外周静脉插入中心静脉导管）。在SSC期间和前一小时，血氧饱和度降低、心动过缓的总持续时间以及呼吸暂停的次数在统计学上无差异。未报告导管移位或破裂情况。
这些发现突出了早期SSC对早产儿的安全性以及在出生后第一周内在重症监护环境中进行SSC的可能性。此外，这些发现应能让提供这种护理方式作为护理标准的医护人员放心。由于其短期和长期的积极益处，SSC在早产儿护理中起着关键作用，值得越来越多地提供给婴儿及其父母。
