Abstract
BackgroundSkin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. However, separation at birth is common with negative impact on breastfeeding. The aim was to determine the effect of immediate SSC compared to early SSC on the duration of exclusive breastfeeding.MethodsA randomized multicentre parallel clinical trial was conducted in two hospitals in Cundinamarca (Colombia) between November 2018 and January 2020. Low-risk full term newborns at birth were included. Neonates were assigned to immediate (in the first minute after birth) or early onset (start exactly at 60 min of life) skin to skin contact. Monthly follow-up was performed until 6 months of age. The primary outcome was the percentage of exclusively breastfed infants at 6 months (time in months with human milk as the only source of food). Secondary outcomes were the percentage of infants with exclusive breastfeeding at 3 months, duration in months of exclusive breastfeeding, neonate’s breastfeeding ability, percentage of weight change between birth and the first week of life and hospitalization in the neonatal unit in the first week. A bivariate analysis was performed to determine the variables associated with exclusive breastfeeding at 6 months. A survival analysis was performed to evaluate the effect of the onset of SSC on exclusive breastfeeding duration.ResultsA total of 297 newborns were included: 49.8% (n = 148) in the immediate SSC group, and 50.2% (n = 149) in the early SSC group. The mean duration of exclusive breastfeeding in both groups was 5 months. There were no differences between the groups in the percentage of exclusive breastfeeding at 6 months (relative risk [RR] 1.06, 95% CI 0.72, 1.58) or in the duration of exclusive breastfeeding (hazard ratio [HR] 0.98, 95% CI 0.74, 1.28).ConclusionsThe percentage of infants and the duration of exclusive breastfeeding in the first 6 months of age were the same between the two groups of SSC interventions. Given the current barriers to its implementation, the results of this study could positively impact the use of SSC at birth and standardize the intervention and improve breastfeeding indicators.Trial registrationClinicalTrials.gov NCT02687685.
Highlights
Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding
Statistical analysis The sample size was calculated considering a baseline risk of exclusive breastfeeding at 6 months for Colombia of 24% [25], and considering that we found no studies evaluating the two onset times of SSC, the data in Moore et al were used [26], who reported that SSC compared to separation at birth increases exclusive breastfeeding between three and 6 months of age, for a power of 80% and a Type I error probability of 5% with expected losses to follow-up of 30%
There was loss to follow-up for the primary outcome of exclusive breastfeeding at 6 months of nine participants, five in the immediate SSC group and four in the early SSC group, with no differences in baseline characteristics
Summary
Skin-to-skin contact (SSC) compared to separation at birth has a positive effect on breastfeeding. Skin-to-skin contact (SSC) at birth between mother and child consists of placing the naked newborn in the prone position on the naked thorax of the mother between her breasts at the time of birth [1]. It is part of the set of essential newborn care interventions that has a positive impact on the health of the mother and newborn [2, 3]. Increasing the prevalence of exclusive breastfeeding is a priority in all nations, with the goal of increasing it by at least 50% by 2025 [12]
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