Raylene Phillips, MD, MA, FAAP, FABM, IBCLC

Introduction

After more than five years of work by an inter-professional group of neonatal experts, “Standards, Competencies, and Best Practices for Infant and Family-Centered Developmental Care in the Intensive Care Unit” was published in 2020 as a supplement to the Journal of Perinatology(1). In this publication (also posted online at https://nicudesign.nd.edu/nicu-care-standards/), the specific areas addressed included: 1) Systems thinking in complex adaptive systems, 2) Positioning and touch for the newborn, 3) Sleep and arousal interventions for the newborn, 4) Skin-to-skin contact with intimate family members, 5) Reducing and managing pain and stress in newborns and families, and 6) Management of feeding, eating and nutrition delivery. This article will focus on the standards, competencies, and best practices for “Skin-to-skin contact with intimate family members.”

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References:

1. Browne J, Jaeger C, Kenner C. Gravens Consensus Committee on Infant and Family Centered Developmental Care. Executive summary: standards, competencies, and recommended best practices for infant-and family-centered developmental care in the intensive care unit. J perinatol. 2020;40 (suppl 1):5-10.

2. Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J perinatol. 2015;35 Suppl 1:S5-8.

3. Meuter RF, Gallois C, Segalowitz NS, Ryder AG, Hocking J. Overcoming language barriers in healthcare: a protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC health services research. 2015;15:371.

4. Provenzi L, Santoro E. The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: a systematic review of qualitative studies. J clin nurs. 2015;24(13-14):1784-94.

5. Blomqvist YT, Rubertsson C, Kylberg E, Joreskog K, Nyqvist KH. Kangaroo mother care helps fathers of preterm infants gain confidence in paternal role. J adv nurs. 2012;68(9):1988-96.

6. Cuevas AG, O’Brien K, Saha S. What is the key to culturally competent care: reducing bias or cultural tailoring? Psychology & health. 2017;32(4):493-507.

7. Tucker CM, Herman KC, Pedersen TR, Higley B, Montrichard M, Ivery P. Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low income primary care patients. Medical care. 2003;41(7):859-70.

8. Holditch-Davis D, Santos H, Levy J, White-Traut R, O’Shea TM, Geraldo V, et al. Patterns of psychological distress in mothers of preterm infants. Infant behav dev. 2015;41:154-63.

9. Affonso DD, Wahlberg V, Persson B. Exploration of mothers’ reactions to the kangaroo method of prematurity care. Neonatal netw. 1989;7(6):43-51.

10. Badiee Z, Faramarzi S, MiriZadeh T. The effect of kangaroo mother care on mental health of mothers with low birth weight infants. Advanced biomedical research. 2014;3:214.

11. Browne JV, Talmi A. Family-based intervention to enhance infant–parent relationships in the neonatal intensive care unit. J pediatr psychol. 2005;30(8):667-77.

12. McGrath J, Samra H, Kenner C. Family-centered developmental care practices and research: what will the next century bring? J perinat neonat nur. 2011;25:165-70.

13. Johnston C, Campbell-Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, et al. Skin-to-skin care for procedural pain in neonates. Cochrane database syst rev. 2017;2:Cd008435.

14. Vittner D, McGrath J, Robinson J, Lawhon G, Cusson R, Eisenfeld L, et al. Increase in oxytocin from skin-to-skin contact enhances development of parent-infant relationship. Biol res nurs. 2018;20(1):54-62.

15. Olsson E, Ahlsen G, Eriksson M. Skin-to-skin contact reduces near-infrared spectroscopy pain responses in pre-mature infants during blood sampling. Acta paediatr. 2016;105(4):376-80.

16. Baley J, Watterberg K, Cummings J, Eichenwald E, Poindexter B, Stewart DL, et al. Skin-to-skin care for term and preterm infants in the neonatal ICU. Pediatrics. 2015;136(3):596-9.

17. Thapa K, Mohan D, Williams E, Rai C, Bista S, Mishra S, et al. Feasibility assessment of an ergonomic baby wrap for kangaroo mother care: a mixed methods study from Nepal. PLoS One. 2018;13(11):e0207206.

18. Maguire CM, Bruil J, Wit JM, Walther FJ. Reading preterm infants’ behavioral cues: an intervention study with parents of premature infants born <32 weeks. Early hum dev. 2007;83(7):419-24.

19. Milgrom J, Newnham C, Martin PR, Anderson PJ, Doyle LW, Hunt RW. Early communication in preterm infants following intervention in the NICU. Early human dev. 2013;89(9):755-67.

20. Buil A, Carcheon I, Apter G, Laborne FX, Granier M, Devouche E. Kangaroo supported diagonal flexion positioning: new insights into skin-to-skin contact for communication between mothers and very preterm infants. Arch pediatr. 2016;23(9):913-20.

21. Arnon S, Diamant C, Bauer S, Regev R, Sirota G, Litmanovitz I. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta paediatr. 2014;103(10):1039-44.

22. Chorna OD, Hamm EL, Shrivastava H, Maitre NL. Feasibility of event-related potential (ERP) biomarker use to study effects of mother’s voice exposure on speech sound differentiation of preterm infants. Developmental neuropsychology. 2018;43(2):123-34.

23. Filippa M, Panza C, Ferrari F, Frassoldati R, Kuhn P, Balduzzi S, et al. Systematic review of maternal voice interventions demonstrates increased stability in preterm infants. Acta paediatr. 2017;106(8):1220-9.

25. Santos J, Pearce SE, Stroustrup A. Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants. Current opinion in pediatrics. 2015;27(2):254-60.

26. Vaglio S. Chemical communication and mother-infant recognition. Communicative & integrative biology. 2009;2(3):279-81.

27. Westrup B. Family-centered developmentally supportive care: the Swedish example. Arch pediatr. 2015;22(10):1086-91.

28. Altimier L, Phillips R. The neonatal integrative developmental care model: advanced clinical applications of the seven core measures for neuroprotective family-centered developmental care. Newborn & infant nursing reviews. 2016;16(4):230-44.

29. Al Maghaireh DF, Abdullah KL, Chong MC, Chua YP, Al Kawafha MM. Stress, anxiety, depression and sleep disturbance among Jordanian mothers and fathers of infants admitted to Neonatal Intensive Care Unit: a preliminary study. J pediatr nurs. 2017;36:132-40.

30. White RD, Smith JA, Shepley MM. Recommended standards for newborn ICU design, eighth edition. Journal of perinatology. 2013;33(S1):S2-S16.

31. Moore H. Improving kangaroo care policy and implementation in the Neonatal Intensive Care. Journal of neonatal nursing. 2015;21(4):157-60.

32. Bergman NJ. Neuroprotective core measures 1–7: neuroprotection of skin-to-skin contact (SSC). Newborn & infant nursing reviews,. 2015;15(3):142-6.

33. Head LM. The effect of kangaroo care on neurodevelopmental outcomes in preterm infants. J perinat neonatal nurs. 2014;28(4):290-9.

34. Suchecki D. Maternal regulation of the infant’s hypothalamic-pituitary-adrenal axis stress response: Seymour ‘Gig’ Levine’s legacy to neuroendocrinology. J neuroendocrinol. 2018;30(7):e12610.

35. Vetulani J. Early maternal separation: a rodent model of depression and a prevailing human condition. Pharmacol rep. 2013;65(6):1451-61.

36. Conde-Agudelo A, Diaz-Rosselio JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane database of systematic reviews. 2006. 2016(8: CD002771).

37. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137(1).

38. Chi LK, Long NT, Huynh TDH, Carrara HP, Bergman NJ. Newly born low birthweight infants stabilize better in skin-to-skin contact than when separated from their mothers: a randomized controlled trial. Academic pediatrics. 2016;105(4):381-90.

39. Bastani F, Rajai N, Farsi Z, Als H. The effects of kangaroo care on the sleep and wake states of preterm infants. J nurs res. 2017;25(3):231-9.

40. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017;139(1).

41. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol psychiatry. 2014;75(1):56-64.

42. Hendricks-Munoz KD, Xu J, Parikh HI, Xu P, Fettweis JM, Kim Y, et al. Skin-to-skin care and the development of the preterm infant oral microbiome. Am j perinatology. 2015;32(13):1205-16.

43. Gianni ML, Sannino P, Bezze E, Comito C, Plevani L, Roggero P, et al. Does parental involvement affect the development of feeding skills in preterm infants? a prospective study. Early hum dev. 2016;103:123-8.

45. Aldana Acosta AC. Randomised controlled trial on the impact of kinesthetic stimulation on early somatic growth of preterm infants in kangaroo position. Acta pædiatrica (Oslo). 2019;108(7):1230-6.

44. Evereklian M, Posmontier B. The impact of kangaroo care on premature infant weight gain. J pediatric nursing. 2017;34:e10-e6.

46. Casper C, Sarauk I, Paylyshyn H. Regular and prolonged skin-to-skin contact improves short-term outcomes for very preterm infants: a dose-dependent intervention. Arch pediatr. 2018;25(3):469-75.

47. Oras P, Thernstrom Blomqvist Y, Hedberg Nyqvist K, Gradin M, Rubertsson C, Hellstrom-Westas L, et al. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta paediatr. 2016;105(7):783-9.

48. Neu M, Robinson J. Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. J obstet gynecol neonatal nurs. 2010;39(4):401-14.

49. Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics. 1998;102(2):e17.

50. Bigelow AE, Power M, MacLean K, Gillis D, Ward M, Taylor C, et al. Mother-infant skin-to-skin contact and mother-child interaction 9 years later. Social development. 2018;27(4):937-51.

51. Cong X, Ludington-Hoe SM, Hussain N, Cusson RM, Walsh S, Vazquez V, et al. Parental oxytocin responses during skin-to-skin contact in preterm infants. Early hum dev. 2015;91(7):401-6.

52. Sriraman NK. The nuts and bolts of breastfeeding: anatomy and physiology of lactation. Current problems in pediatric and adolescent health care. 2017;47(12):305-10.

53. Hendricks-Munoz KD, Mayers RM. A neonatal nurse training program in kangaroo mother care (KMC) decreases barriers to KMC utilization in the NICU. Am j perinatol. 2014;31(11):987-92.

54. Ludington-Hoe SM, Ferreira C, Swinth J, Ceccardi JJ. Safe criteria and procedure for kangaroo care with intubated preterm infants. J obstet gynecol neonatal nurs. 2003;32(5):579-88.

55. Azevedo VM, Xavier CC, Gontijo Fde O. Safety of kangaroo mother care in intubated neonates under 1500 g. Journal of tropical pediatrics. 2012;58(1):38-42.

56. Catherine ZG, Beatrice P, Fabrice L, Claire H, Alain D. Skin-to-skin contact with an umbilical venous catheter: prospective evaluation in a level 3 unit. European journal of pediatrics. 2016;175(4):551-5.

57. Doupnik SK, Hill D, Palakshappa D, Worsley D, Bae H, Shaik A, et al. Parent coping support interventions during acute pediatric hospitalizations: a meta-analysis. Pediatrics. 2017;140(3).

58. Stikes R, Barbier D. Applying the plan-do-study-act model to increase the use of kangaroo care. J nurs manag. 2013;21(1):70-8.

59. Bidlow J, Elfiky N, Kass A, Oliveto M, Reed E, Neff-Bulger M. Interdisciplinary approach to increasing skin-to-skin contact across delivery methods. American journal of medical quality: the official journal of the American College of Medical Quality. 2017;32(4):458.

60. Bigelow AE, Power M. The effect of mother-infant skin-to-skin contact on infants’ response to the still face task from newborn to three months of age. Infant behav dev.

61. Bigelow AE, Power M, Gillis DE, Maclellan-Peters J, Alex M, McDonald C. Breastfeeding, skin-to-skin contact, and mother-infant interactions over infants’ first three months. Infant ment health J. 2014;35(1):51-62.

Disclosure: The author has no disclosures.