Presented at the Neonatal Society 2005 Autumn Meeting.
Hickson A1, Rutherford M1, Glover V1, Stevenson J2, Doré C3, Cowan F1, Modi N1
1 Imperial College London, London, UK
2 University of Southampton, Southampton, UK
3 MRC Clinical Trials Unit, London, UK
Background: Preterm infants are at risk of neurodevelopmental impairment due to brain injury. The Neonatal Intensive Care Unit (NICU) environment may compound these problems. Developmental care is a broad category of interventions designed to minimise the stress of the NICU environment. One such intervention is mother-infant skin-to-skin contact (SSC). We have previously reported a controlled trial of SSC in preterm infants admitted to two NICUs and found no significant difference in maternal or infant outcomes (1). However the presence of brain injury, as indicated by abnormal brain imaging, was not taken into account in the analysis.
Objective: To investigate the neurological outcomes of preterm infants entered into a controlled trial of SSC, taking into account evidence of brain injury as shown by cranial ultrasound scan (CUS) data from the neonatal period and/or brain magnetic resonance imaging (MRI) obtained after 12 months corrected age.
Methods: Seventy-eight infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of SSC once daily for 4 weeks. Infants were assessed at 12 months postmenstrual age using the revised Griffiths’ Developmental Scale to give a developmental quotient (DQ) and the Hammersmith Infant Neurological examination to derive an optimality score (OS). The results of the CUS from the neonatal period and the MRI scans at 12 month assessment were analysed (74 CUS and 30 MRI scans) blind to group allocation. A composite imaging score (normal, mildly abnormal, severely abnormal) was calculated for each infant. Approval was obtained from the institutes’ Research Ethics Committee.
Results: The average total number of minutes of SSC in the intervention group was 507.36. Analysis of baseline characteristics confirmed no significant differences between infants in the two arms of the study. Seven children died and 13 were lost to follow up. Severely abnormal imaging was present in 5 infants (1 control, 4 SSC). Overall DQ, and personal-social, hearing-language, eye-hand co-ordination and performance, but not motor, sub-quotients were higher in the intervention group but these differences were not significant. There was evidence of a significant interaction between group and imaging abnormality (p=0.019). Multivariate analysis having allowed for imaging abnormality showed overall DQ to be significantly higher in the intervention group (mean difference 13.2, 95% CI 3.1 to 23.4; p=0.01). There was no difference in neurological status as measured using the OS.
Discussion: Skin-to-skin contact is associated with improved overall DQ in preterm infants when evidence of brain injury is taken into account. These findings support the use and continue evaluation of SSC for improving neurological outcomes in preterm infants.
References
1. Miles et al Pediatr Res 2003 54:569