Preterm birth is believed to disrupt the neonate’s smooth and integrated neurobehavioural development, resulting in disorganization of the nervous system. This may manifest as disturbances in physiological functioning, stress and behaviour. During KC, cardiorespiratory and temperature stability is achieved, as described above. Furthermore, preterm infants exhibit decreased arousal and decreased REM sleep during skin-to-skin care, suggesting more mature sleep organization (15
). KC increases sleep time, including time spent in quiet sleep (15
). At term, preterm infants who have received KC during their stay in the NICU demonstrate longer periods of quiet sleep and alert wakefulness, shorter periods of active sleep, and more organized sleep-wake cyclicity when compared with infants who did not, suggesting more rapid improvement in state organization (17
). These infants are also more alert and responsive, and less irritable and fussy (19
Similar advantages in neurobehaviour are also noted after NICU discharge and may have an effect on long-term development. Two cohort studies have shown that preterm infants ranging in gestational age from 25 to 35 weeks who received KC during their hospital stay had improved neurodevelopmental outcome, scoring higher on the Mental Development Index and Psychomotor Development Index of the Bayley Scales of Infant Development both at six months (17
) and at 12 months (19
) when compared with infants who received conventional care.
The benefits of breast milk for the preterm infant are well-known and include decreased incidence of infections and necrotizing enterocolitis, and improved growth and neurodevelopmental outcome. KC is associated with a longer duration of breastfeeding, higher volumes of milk expressed, higher exclusive breastfeeding rates and higher percentage of breastfeeding at the time that pre-term infants are discharged from hospital (20
The practice of KC decreases the incidence of nosocomial infection; this benefit is more significant in developing rather than developed countries (3
). Early KC likely increases the chance of the infant being colonized with maternal flora rather than the flora in the nursery, which may include antibiotic-resistant organisms and coagulase-negative staphylococcus. Because KC is only undertaken between individual infant-mother dyads, it should not increase the spread of infection from one infant to another during infectious outbreaks. However, decisions about KC during infectious outbreaks would need to be made on an individual basis in consultation with infectious disease personnel.
Preterm birth and admission to the NICU result in separation of mother and baby, interrupting the process of attachment. Mothers who have had the opportunity to provide KC for their infants describe feelings of being needed, increased confidence in knowing their infants and a sense of their role as a mother (22
). Near the time of discharge home, mothers were observed to look at and touch their infant more frequently, show more positive affect and be more adaptive to their infant’s signals than did mothers who had not provided KC (17
). When followed after discharge, these same mothers, as well as fathers, provided a better home environment and were more sensitive to their infant.
During KC, the infant experiences maternal heart sounds, rhythmic maternal breathing, warmth and prone positioning, all of which offer gentle stimulation across the auditory, tactile, vestibular and thermal sensory systems, which may modulate the perception of pain. KC has been shown to be efficacious in reducing the physiological and behavioural responses to pain in preterm infants 28 to 36 weeks’ gestation (23
). KC is one of the nonpharmacological measures recommended by the Canadian Paediatric Society and the American Academy of Pediatrics for reducing pain associated with bedside procedures in the NICU (25