Premature babies benefit socially from early body contact

Early skin-to-skin contact impacts mother-infant interaction quality at four months for very preterm infants.


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Holding a very premature baby close to their parent’s skin right after birth helps the baby learn social skills, says a new study in JAMA Network Open. Researchers from Karolinska Institutet found that dads might be even more important than we thought in this process.

Very premature babies are usually placed in an incubator after birth for warmth and stability. However, an “Immediate parent-infant skin-to-skin study” (IPISTOSS) involved 91 premature babies born at 28 to 33 weeks. They were randomly assigned to either traditional incubator care or immediate skin-to-skin contact with one parent. The study found that quick skin-to-skin contact is safe, helps babies’ breathing and heart stability, maintains their temperature, and is valued by parents.

As part of the study, researchers looked at the social development of 71 premature babies at four months old. These babies were randomly assigned to either standard incubator care or to rest on one of their parents’ chests (either the mother’s or the father’s) for the first six hours after birth.

Wibke Jonas, midwife, senior lecturer, and associate professor at Karolinska Institutet’s Department of Women’s and Children’s Health, as well as a research leader and last author of the study, said, “What is new about our study is that we also allowed the fathers to have skin-to-skin contact immediately after the birth. In most previous studies, it is the mother who is the primary caregiver. However, in our study, it was the fathers who had the most skin-to-skin contact.”

“The study found that fathers play a crucial role in immediate skin-to-skin contact if the mother isn’t available,” said Siri Lilliesköld, a PhD student and neonatal care specialist who led the study.

After four months, psychologists, unaware of the early contact details, assessed filmed social interactions between mother and child. They used the Parent-Child Early Relational Assessment (PCERA) scale, rating various elements from one to five, where one is a concern, and five indicates excellent quality.

Children with immediate skin-to-skin contact showed significantly better results on a scale measuring their communication and social skills. Their average score was close to four on a five-point scale, while those cared for conventionally scored just above three.

Wibke Jonas explains, “Kids in the skin-to-skin group had slightly better communication skills, were a bit more social and happier.” Premature babies face developmental challenges and require extensive support. Despite medical advancements, the care for these babies still needs improvement.

Jonas Wibke emphasizes, “Combining immediate medical care with a simple intervention like skin-to-skin contact has positive effects on a child’s social skills.” Previous studies indicate that premature babies may struggle with social interaction. However, close contact with parents at birth can stimulate later interaction and overall child development.

The benefits of immediate skin-to-skin contact are so clear that Wibke Jonas and Siri Lilliesköld believe it should be immediately introduced in Swedish neonatal care. They’re already working on it.

“We’ve actively worked to reduce separation between parents and children, and now we have the evidence to do the same for very premature babies,” said Siri Lilliesköld.

The research team will keep updating the children’s development at 12 and 24 months. The study is a collaboration between researchers from Karolinska Institutet, the University Hospital of Stavanger (Norway), and the University of Turku (Finland). It was funded by the Swedish Research Council, Region Stockholm, and Stiftelsen Barnavård, with no conflicts of interest declared by the researchers.

Early body contact, mainly through immediate skin-to-skin contact, emerges as a promising intervention for fostering the social skills development of premature babies. The study underscores the importance of incorporating such practices into neonatal care to support the overall well-being of these vulnerable infants.

Journal reference:

  1. Siri Lilliesköld, Karoline Lode-Kolz, et al., Skin-to-Skin Contact at Birth for Very Preterm Infants and Mother-Infant Interaction Quality at 4 Months. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2023.44469.


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