Multiple Perspectives Essay

Aim: Conventional care of prematurely born infants involves extended maternal”“infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal”“ infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn lowbirthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth. Methods: This was a prospective, unblinded, randomized controlled clinical trial; potential subjects were identified before delivery and randomized by computerized minimization technique at 5 min if eligible. Standardized care and observations were maintained for 6 h. Stability was measured in terms of a set of pre-determined physiological parameters, and a composite cardio-respiratory stabilization score (SCRIP). Results: 34 infants were analyzed in comparable groups: 3/18 SSC compared to 12/13 incubator babies exceeded the pre-determined parameters (p _ 0.001). Stabilization scores were 77.11 for SSC versus 74.23 for incubator (maximum 78), mean difference 2.88 (95% CI: 0.3”“5.46, p = 0.031). All 18 SSC subjects were stable in the sixth hour, compared to 6/13 incubator infants. Eight out of 13 incubator subjects experienced hypothermia.

Conclusion: Newborn care provided by skin-to-skin contact on the mother’s chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian “protest-despair” biology, and with “hyper-arousal and dissociation” response patterns described in human infants: newborns should not be separated from their mothers.


Dear Mrs/Mss Bergman, Linley, and Fawcus,

On reading your article “Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns”, published in Acta Pædiatr in 2004, issue 93, I have noticed some inconsistency in your method used in the research, which can affect the outcomes of the research and conclusions you make. As the matter of fact your research is dedicated to the problem of the kangaroo effect on newborns, which apparently affects not only physiological but also and, probably, primarily the psychological state of the newborns. Your research was based on the comparison of a conventional treatment of newborns, based on the use of convention incubator for newborns, with skin-to-skin contact from birth, i.e. kangaroo effect. In your research you studied both groups of newborns and their mothers that actually created conditions for the seeming objectivity of outcomes of the research because you used both a subject group which you compared to the control group, which was placed in incubator. In the result of your research, you arrived to the conclusion that newborns should not be separated from their mothers, especially in cases of premature birth, because kangaroo effect has a positive impact on physiological as well as psychological state of newborns.

In fact, I highly appreciate your research and your efforts to improve the quality of health care services newborns and their mothers receive or should receive, but, I have noticed than, while selecting subjects of the research you mainly focused on the choice of a specific category of newborns, which should had a definite weight from 1200 to 1199 grams, while you conducted your research involving the indigent population of South Africa. At this point, I believe that such a selection of subjects of your research narrows the scope of your research and makes its outcomes arguable. To put it more precisely, you did not take into consideration ethnic and cultural background as well as social traditions of representatives of different ethnic groups.

What is meant here is the fact that indigent population of South Africa may be more accustomed to the practice when newborn children stay with their mothers and, probably at the instinctive, subconscious level, newborns and mothers feel more secure when they stay together when a child is born. However, I am a representative of Hispanic community living in the US and such a practice of leaving a newborn child, who is only 1200-2199 of weight, is quite unusual. Moreover, I believe that the application of kangaroo effect in my community could evoke anxiety of mothers because they may be unprepared for this. Traditionally, they get used to health care professionals taking care of children, especially if they may have health problems. But you ignore the factor of traditional practices and cultural difference of various ethnic groups.

This is why I admit that your conclusions are not absolutely reliable and the further research is needed, in order to reveal the impact of kangaroo effect on representatives of different ethnic groups.

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