Moore Elizabeth R, Brimdyr Kajsa, Blair Anna, Jonas Wibke, Lilliesköld Siri, Svensson Kristin, Ahmed Azza H, Bastarache Louise R, Crenshaw Jeannette T, Giugliani Elsa R J, Grady Julie E, Zakarija-Grkovic Irena, Haider Rukhsana, Hill Rebecca R, Kagawa Mike Nantamu, Mbalinda Scovia N, Stevens Jeni, Takahashi Yuki, Cadwell Karin
School of Nursing, Vanderbilt University (Retired), Nashville, Tennessee, USA.
The Center for Breastfeeding, Healthy Children Project, Inc., Harwich, MA, USA.
Cochrane Database Syst Rev. 2025 Oct 22;10(10):CD003519. doi: 10.1002/14651858.CD003519.pub5.
Research supports the beneficial effects of immediate maternal-infant skin-to-skin contact (SSC) after all modes of birth on breastfeeding/lactation and neonatal physiology, but little is known about how it might influence maternal physiology, including postpartum blood loss and placental separation time. Despite the findings from the 2016 Cochrane review of skin-to-skin contact, and although the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend immediate, continuous, uninterrupted SSC after birth, newborn infants are still separated from their mothers during this period in many settings. SSC is less common in low-income and lower-middle-income countries (World Bank classification), which suggests country income level could impact breastfeeding exclusivity. This update integrates the evidence found since 2015 into the review.
To assess the effects of immediate skin-to-skin contact (< 10 minutes postbirth) or early skin-to-skin contact (10 minutes-24 hours postbirth) compared with existing hospital practices (standard contact) on the establishment and maintenance of breastfeeding and on maternal and infant physiology among healthy newborn infants and their mothers.
We searched CENTRAL, MEDLINE, Embase, and CINAHL up to 22 March 2024 and two trial registers up to 3 July 2025, along with reference checking and contact with experts.
Randomized controlled trials that compared immediate or early SSC with other hospital care after a vaginal or cesarean birth. Participants were mothers and their healthy full-term or late preterm newborns (≥ 34 weeks' gestation). Infants admitted to the neonatal intensive care unit were excluded.
Our critical outcomes included exclusive breastfeeding, infant axillary temperature, infant blood glucose levels, infant SCRIP score (cardiorespiratory stability), placental separation time/duration of the third stage of labor, and maternal blood loss.
We used Cochrane's original risk of bias 1 tool (RoB 1). We assessed the risk of performance and detection bias separately for subjective and objective outcomes.
We conducted random-effects meta-analysis where there was substantial heterogeneity and fixed-effect meta-analysis for infant blood glucose and SCRIP score. We calculated the summary risk ratio (RR) and 95% confidence interval (CI) using the Mantel-Haenszel method for dichotomous outcomes. We calculated the mean difference (MD) and 95% CI using inverse variance for continuous outcomes, except infant SCRIP score, where we used the standardized mean difference (SMD). We used the GRADE approach to summarize the certainty of evidence.
We added 26 new trials (3775 mother-infant pairs) to this update for a total of 69 trials (7290 mother-infant pairs). Most studies (43/69) compared immediate SSC with standard hospital care. Ten studies included late preterm infants, and 15 included children born by cesarean delivery. Thirty-two trials were conducted in high-income countries, 25 in upper-middle-income countries, and 12 in lower-middle-income countries. Fifty-six studies contributed data to the meta-analyses. No included trial met all the criteria for high-quality methodology and reporting. Many analyses had statistical heterogeneity due to considerable differences between SSC and control group conditions.
Breastfeeding/lactation SSC compared with standard contact probably increases rates of exclusive breastfeeding at hospital discharge to one month postbirth (RR 1.36, 95% CI 1.19 to 1.56; I² = 62%; 12 studies; 1556 mother-infant pairs; moderate-certainty evidence) and at six weeks to six months postbirth (RR 1.38, 95% CI 1.09 to 1.74; I² = 87%; 11 studies; 1135 mother-infant pairs; moderate-certainty evidence), though both analyses had substantial heterogeneity. Infant physiological stability SSC compared with standard contact probably increases infant axillary temperature, but the MD of 0.28 °C is not clinically meaningful (MD 0.28, 95% CI 0.14 to 0.41; I² = 95%; 11 studies; 1349 infants; moderate-certainty evidence). SSC probably increases blood glucose levels measured in mg/dL (MD 10.49, 95% CI 8.39 to 12.59; I² = 0%; 3 studies; 114 infants; moderate-certainty evidence). Infants who have SSC may also have higher SCRIP scores overall, indicating more optimal cardiorespiratory stabilization. However, the trials reporting this outcome had small sample sizes, and the clinical significance was unclear because trialists reported averages of multiple time points (SMD 1.24, 95% CI 0.76 to 1.72; I² = 0%; 2 studies; 81 infants; low-certainty evidence). Maternal physiology SSC may result in little to no difference in placental separation time/duration of the third stage of labor in minutes (MD -2.26, 95% CI -5.04 to 0.52; I² = 88%; 4 studies; 450 mothers; low-certainty evidence) and maternal postpartum blood loss in mL (MD -145.92, 95% CI -416.96 to 125.11; I² = 97%; 2 studies; 143 mothers; very low-certainty evidence), although these results should be interpreted with caution due to high heterogeneity and the small number of studies.
AUTHORS' CONCLUSIONS: This review supports immediate SSC after birth, regardless of mode of birth, for mothers and their healthy full-term and late preterm infants in middle-income and high-income countries. No included studies were conducted in low-income countries. SSC probably promotes exclusive breastfeeding and improves infant thermoregulation and blood glucose levels. In addition, SSC may increase infant stabilization measured by the SCRIP score. The evidence about maternal physiological outcomes was inconclusive. Future research should prioritize methodological rigor. This includes providing clear descriptions of interventions and standard contact, carefully selecting relevant outcomes, and using reliable and objective measurement tools. Understudied areas include: the impact of medications and anesthetics, in terms of dose-response and other variables during SSC; biological and psychosocial mechanisms; additional physiological effects of SSC; and longer-term impacts. Instances of harm should be recorded. As WHO/UNICEF recommends immediate, uninterrupted SSC as the standard of care, randomizing to separation of mother and newborn may no longer be justifiable.
This Cochrane review had no dedicated funding.
Review Update (2016) https://doi.org/10.1002/14651858.CD003519.pub4 Review Update (2012) https://doi.org/10.1002/14651858.CD003519.pub3 Review Update (2007) https://doi.org/10.1002/14651858.CD003519.pub2 Original review (2003) https://doi.org/10.1002/14651858.CD003519 Protocol (2002) DOI unavailable.
研究证实，各种分娩方式后立即进行母婴皮肤接触（SSC）对母乳喂养/泌乳及新生儿生理机能具有有益影响，但对于其如何影响产妇生理机能，包括产后失血和胎盘娩出时间，人们了解甚少。尽管有2016年Cochrane关于皮肤接触的综述结果，并且世界卫生组织（WHO）和联合国儿童基金会（UNICEF）建议出生后立即、持续、不间断地进行SSC，但在许多情况下，新生儿在此期间仍与母亲分离。在低收入和中低收入国家（世界银行分类），SSC不太常见，这表明国家收入水平可能会影响纯母乳喂养情况。本次更新将2015年以来发现的证据纳入综述。
评估与现有医院常规做法（标准接触）相比，出生后立即进行皮肤接触（出生后<10分钟）或早期皮肤接触（出生后10分钟至24小时）对健康新生儿及其母亲建立和维持母乳喂养以及母婴生理机能的影响。
我们检索了截至2024年3月22日的CENTRAL、MEDLINE、Embase和CINAHL以及截至2025年7月3日的两个试验注册库，并进行参考文献核对和与专家联系。
将阴道分娩或剖宫产术后立即或早期SSC与其他医院护理进行比较的随机对照试验。参与者为母亲及其健康的足月儿或晚期早产儿（≥34周妊娠）。入住新生儿重症监护病房的婴儿被排除。
我们的关键结局指标包括纯母乳喂养、婴儿腋下温度、婴儿血糖水平、婴儿SCRIP评分（心肺稳定性）、胎盘娩出时间/第三产程持续时间以及产妇失血。
我们使用Cochrane最初的偏倚风险1工具（RoB 1）。我们分别针对主观和客观结局评估实施偏倚和检测偏倚风险。
对于存在实质性异质性的情况，我们进行随机效应荟萃分析；对于婴儿血糖和SCRIP评分，我们进行固定效应荟萃分析。对于二分结局，我们使用Mantel-Haenszel方法计算汇总风险比（RR）和95%置信区间（CI）。对于连续结局，除婴儿SCRIP评分使用标准化均差（SMD）外，我们使用逆方差法计算平均差（MD）和95%CI。我们使用GRADE方法总结证据的确定性。
本次更新新增了26项新试验（3775对母婴），总计69项试验（7290对母婴）。大多数研究（43/69）将立即SSC与标准医院护理进行了比较。10项研究纳入了晚期早产儿，15项研究纳入了剖宫产出生的儿童。32项试验在高收入国家进行，25项在中高收入国家进行，12项在中低收入国家进行。56项研究为荟萃分析提供了数据。没有纳入的试验完全符合高质量方法和报告的所有标准。由于SSC组和对照组条件存在相当大的差异，许多分析存在统计学异质性。
与标准接触相比，SSC可能会使出生后住院至出生后1个月的纯母乳喂养率增加（RR 1.36，95%CI 1.19至1.56；I² = 62%；12项研究；1556对母婴；中等确定性证据）以及出生后6周至6个月的纯母乳喂养率增加（RR 1.38，95%CI 1.09至1.74；I² = 87%；11项研究；1135对母婴；中等确定性证据），尽管这两项分析均存在实质性异质性。与标准接触相比，SSC可能会提高婴儿腋下温度，但0.28°C的MD在临床上无意义（MD 0.28，95%CI 0.14至0.41；I² = 95%；11项研究；1349名婴儿；中等确定性证据）。SSC可能会使以mg/dL为单位测量的血糖水平升高（MD 10.49，95%CI 8.39至12.59；I² = 0%；3项研究；114名婴儿；中等确定性证据）。接受SSC的婴儿总体上可能也有更高的SCRIP评分，表明心肺稳定情况更佳。然而，报告该结局的试验样本量较小，且由于试验者报告的是多个时间点的平均值，临床意义尚不清楚（SMD 1.24，95%CI 0.76至1.72；I² = 0%；2项研究；81名婴儿；低确定性证据）。SSC对产妇生理机能的影响可能在胎盘娩出时间/第三产程持续时间（以分钟计）方面几乎没有差异（MD -2.26，95%CI -5.04至0.52；I² = 88%；4项研究；450名母亲；低确定性证据）以及产妇产后失血量（以mL计）方面几乎没有差异（MD -145.92，95%CI -416.96至125.11；I² = 97%；2项研究；143名母亲；极低确定性证据），尽管由于异质性高且研究数量少，这些结果应谨慎解读。
本综述支持在出生后立即进行SSC，无论分娩方式如何，适用于中高收入国家的母亲及其健康的足月儿和晚期早产儿。没有纳入的研究在低收入国家进行。SSC可能促进纯母乳喂养并改善婴儿体温调节和血糖水平。此外，SSC可能会提高以SCRIP评分衡量的婴儿稳定性。关于产妇生理结局的证据尚无定论。未来的研究应优先考虑方法的严谨性。这包括清晰描述干预措施和标准接触、仔细选择相关结局指标以及使用可靠和客观的测量工具。研究不足的领域包括：药物和麻醉剂在SSC期间的剂量反应及其他变量的影响；生物学和心理社会机制；SSC的其他生理效应；以及长期影响。应记录不良事件实例。由于WHO/UNICEF建议立即、不间断的SSC作为护理标准，将母亲和新生儿随机分组至分离状态可能不再合理。
本Cochrane综述没有专门的资金。
综述更新（2016）https://doi.org/10.1002/14651858.CD003519.pub4 综述更新（2012）https://doi.org/10.1002/14651858.CD003519.pub3 综述更新（2007）https://doi.org/10.1002/14651858.CD003519.pub2 原始综述（2003）https://doi.org/10.1002/14651858.CD003519 方案（2002）DOI不可用。
