Early SSC Improves Breastfeeding, Not Neurodevelopment

TOPLINE:

Neonates born very preterm receiving 2 hours of immediate skin-to-skin contact (SSC) with their mothers showed no improvement in neurodevelopmental outcomes at 2-3 years of age, according to a Norwegian trial; however, SSC resulted in increased breastfeeding rates at hospital discharge (84% vs 67%; P = .04) and up to the age of 12 months.

METHODOLOGY:

• Researchers conducted a prospective, open-label randomised clinical trial across three Norwegian neonatal units between 2014 and 2020 and included neonates born very preterm who were randomly assigned to receive either 2 hours of immediate SSC with their mothers (n = 39) or standard care in an incubator (n = 42).
• Participants (37% girls) included neonates born preterm at a gestational age of 28 weeks 0 days to 31 weeks 6 days with a birth weight > 1000 g, excluding those requiring more than 40% oxygen supplementation or intubation or having major congenital malformations.
• The primary outcome was neurocognitive development at 2-3 years of age, measured using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III); secondary outcomes were language and motor composite scores and breastfeeding outcomes up to 12 months.
• After discharge, infants were assessed at corrected ages of 3 and 12 months and 2-3 years using standard questionnaires filled by parents: The Ages and Stages Questionnaire (ASQ) and the ASQ–Social-Emotional questionnaire.

TAKEAWAY:

• The analysis revealed no significant difference in BSID-III cognitive composite scores between the groups (mean difference, 0.21; P = .94).
• The risk for developmental delay at 2-3 years of age was not significantly different between the SSC and standard care groups (51% vs 49%; P = .83).
• Breastfeeding rates were significantly higher in the SSC group than in the standard care group at hospital discharge (84% vs 67%; P = .04) and up to the age of 12 months (17% vs 10%; P = .03). The duration of exclusive breastfeeding was longer in the SSC group than in the standard care group (50% vs 21%; P = .03).

IN PRACTICE:

“Although immediate SSC did not translate into improved neurodevelopment, a nonseparation approach might still have an impact on breastfeeding outcomes. Instead of doing more studies on immediate SSC, resources should be focused on implementing this important, feasible, and low-cost intervention,” the authors wrote.

SOURCE:

This study was led by Laila Kristoffersen, PhD, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway. It was published online on April 16, 2025, in JAMA Network Open.

LIMITATIONS:

This study excluded the sickest neonates due to safety concerns. Data on the total duration of SSC during the hospital stay were not recorded, and the planned sample size was not achieved. The follow-up process was challenging, complicated by the COVID-19 pandemic and the inclusion of multiple study sites. Socioeconomic status was assessed on the basis of the maternal education level alone, and limited data were available regarding markers of neonatal illness. Additionally, the study lacked a control group with healthy, full-term–born infants.

DISCLOSURES:

This study was supported by a grant from the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.