Travis Katherine E, Lazarus Molly F, Scala Melissa, Marchman Virginia A, Bruckert Lisa, Poblaciones Rocio Velasco, Dubner Sarah, Feldman Heidi M
Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, US.
Burke-Cornell Medical Research Institute, Department of Pediatrics, Weill Medical College, Cornell University, New York, NY.
medRxiv. 2025 Mar 23:2025.03.21.25324424. doi: 10.1101/2025.03.21.25324424.
Preterm birth is associated with altered white matter development and long-term neurodevelopmental impairments. Skin-to-skin care (kangaroo care) has well-documented benefits for physiological stability and bonding, but its association with neonatal brain structure remains unclear. This study explored the association between in-hospital skin-to-skin care and neonatal white matter microstructure in frontal and limbic pathways that are linked to stress regulation and socio-emotional development, processes potentially influenced by affective touch during skin-to-skin care.
This retrospective study analyzed electronic medical records and diffusion MRI data collected from 86 preterm infants (<32 weeks gestational age) in a single NICU. Skin-to-skin care exposure was quantified as total duration (minutes/instance) and rate (minutes/day) of sessions. Diffusion MRI scans obtained before hospital discharge assessed mean diffusivity (MD) and fractional anisotropy (FA) in the cingulate, anterior thalamic radiations (ATR), and uncinate fasciculus. Hierarchical regression models examined associations between skin-to-skin care and white matter microstructure, adjusting for gestational age, health acuity, postmenstrual age at scan, and MRI coil type. Sensitivity analyses controlled for socioeconomic status and NICU visitation frequency.
Skin-to-skin care duration was positively associated with MD in the cingulate (B = 0.002, p = 0.016) and ATR (B = 0.002, p = 0.020). Skin-to-skin care rate was also positively linked to MD in the ATR (B = 0.040, p = 0.041). Skin-to-skin care duration and rate were not associated with FA in the cingulate but skin-to-skin duration and rate were negatively associated with FA in the ATR (duration: B = -0.001, = 0.020; rate: B = -0.017, p = 0.008). No significant associations were found for the uncinate fasciculus. Findings remained robust after adjusting for socioeconomic status and visitation frequency.
This study provides novel evidence linking in-hospital experiences of skin-to-skin care to neonatal white matter development. These findings have important implications for understanding how family-centered neuroprotective practices, such as skin-to-skin care, may affect brain development to improve long-term developmental outcomes.
早产与白质发育改变及长期神经发育障碍有关。肌肤接触护理（袋鼠式护理）对生理稳定性和母婴联结有诸多已被充分证实的益处，但其与新生儿脑结构的关联仍不明确。本研究探讨了住院期间的肌肤接触护理与新生儿额叶和边缘系统通路白质微观结构之间的关联，这些通路与应激调节及社会情感发育相关，而肌肤接触护理过程中的情感触摸可能会影响这些过程。
这项回顾性研究分析了从一家新生儿重症监护病房（NICU）的86名早产儿（胎龄<32周）收集的电子病历和扩散磁共振成像（MRI）数据。肌肤接触护理的暴露程度通过护理时长（分钟/次）和护理频率（分钟/天）来量化。在出院前进行的扩散MRI扫描评估了扣带回、丘脑前辐射（ATR）和钩束的平均扩散率（MD）和各向异性分数（FA）。分层回归模型检验了肌肤接触护理与白质微观结构之间的关联，并对胎龄、健康状况、扫描时的孕龄和MRI线圈类型进行了校正。敏感性分析对社会经济地位和NICU探视频率进行了控制。
肌肤接触护理时长与扣带回（B = 0.002，p = 0.016）和ATR（B = 0.002，p = 0.020）的MD呈正相关。肌肤接触护理频率也与ATR的MD呈正相关（B = 0.040，p = 0.041）。肌肤接触护理时长和频率与扣带回的FA无关联，但与ATR的FA呈负相关（时长：B = -0.001，p = 0.020；频率：B = -0.017，p = 0.008）。钩束未发现显著关联。在对社会经济地位和探视频率进行校正后，研究结果依然稳健。
本研究提供了新的证据，将住院期间的肌肤接触护理经历与新生儿白质发育联系起来。这些发现对于理解以家庭为中心的神经保护措施（如肌肤接触护理）如何影响大脑发育以改善长期发育结局具有重要意义。
