The Thermoregulatory Effect of Immediate Skin-to-Skin Contact for Preterm Infants: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.

Neonatal thermoregulation poses a considerable challenge, particularly in premature or low-birth-weight infants. Skin-to-skin contact (SSC) is now a recommended strategy to maintain thermoregulation in term infants. Current evidence shows promising results for the application of immediate SSC in preterm infants. A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Google Scholar, CENTRAL, Scopus, and Web of Science until May 2025. Using Stata MP v. 17 (StataCorp LLC, College Station, TX, US), we pooled dichotomous outcomes and continuous outcomes, using relative risk (RR) and standardized mean difference, respectively, along with a 95% confidence interval (CI). Five trials and 401 patients were included in our analysis. Temperature was significantly lower in the SSC group after 60 minutes (MD: -0.21, 95% CI (-0.30, -0.12), P < 0.001). However, there was no significant difference between the two groups regarding hypothermia (RR: 1.23, 95% CI (0.71, 2.16), P = 0.46) and hyperthermia (RR: 0.73, 95% CI (0.52, 1.03), P = 0.07). Also, there was no significant difference between both groups regarding hypoglycemia (RR: 3.15, 95% CI (0.34, 29.37), P = 0.31), stability of the cardiorespiratory system in preterm infants (SCRIP) score (MD: 0.22, 95% CI (-0.10, 0.54), P = 0.18), breathing support (RR: 0.92, 95% CI (0.71, 1.22), P = 0.55), and surfactant administration (RR: 0.77, 95% CI (0.40, 1.45), P = 0.41). Immediate SSC for preterm infants showed a slight decrease in temperature after 60 minutes, showing promising tolerability. Still, despite uncertain evidence, this effect did not impact any other clinical outcome, including hypothermia, hyperthermia, hypoglycemia, SCRIP score, breathing support, or surfactant administration.