benefits of skin to skin for prema

55,000. This is the number of children who are born prematurely, that is to say before 36 weeks of amenorrhea, each year in France. The immaturity of their organs, particularly their brain, makes them vulnerable. As a result, some of them will develop neurodevelopmental disorders including cerebral palsy, the leading cause of motor disability in children. Half of children with cerebral palsy are born prematurely. To limit the impact on their development, “skin to skin”, initiated in neonatology departments, is one of the recommended methods, particularly for these newborns, who are subject to significant stress.

Olivier Baud, vice-president of the Cerebral Palsy Foundation and neonatologist (doctor specializing in the care of newborns at risk or whose condition has deteriorated after birth), reveals the advantages of the “kangaroo method”.

H.fr: What exactly does “skin to skin” consist of?
Olivier Baud : This method consists of placing the child naked, or with a diaper, on the chest or stomach of one of his parents, in order to allow him to enter into sensory contact with the parent (smell, heat, touch, vibration of the voice, etc.).

This close contact brings comfort, reassurance and allows the diffusion of certain hormones, such as oxytocin. Called “love hormone” or ” happiness “, it plays a crucial role in moments of human connection, particularly between a mother and her baby. The fact of inducing this hormonal modification, linked to the emotion that skin to skin can arouse, is very important because premature newborns are hospitalized in a context which can be very anxiety-provoking. This stress will then generate numerous physiological changes and promote inflammation, a biological defense process, which can interfere with the maturation of certain organs, and in particular the brain.

H.fr: What are the other benefits?
OB : For all babies, this method helps to provide well-being but also to regulate respiratory and heart rates as well as temperature and sleep. Physiological constants will then normalize in the face of a stressful situation. All these benefits are multiplied in premature newborns, who are particularly exposed to stress. This special moment also promotes parent-baby interactions.

H.fr: When to practice it?
OB : From birth. The idea is to immediately place the child on one of its parents, if its respiratory state and vital functions allow, before installing it in its incubator. (editor’s note: or incubator). Studies, particularly Scandinavian, demonstrate that the concept of “zero separation” allows for greater and earlier parental attachment. However, the current system involves separating these babies from their parents when they are taken into care in the delivery room, which causes interference in terms of physiological attachment. Some parents feel this way “dispossessed” of their role, for the benefit of caregivers.

H.fr: How long should the child stay in contact with their parents’ skin?
OB : Its duration is not limited, the more the better! But we must obviously take into account the problem of organizing care; not all children can benefit from skin-to-skin care 24 hours a day, because their clinical condition is too unstable. To feel all the benefits, it must be practiced for at least 1 to 2 hours per day, but it can be continued for 4, 6 or 8 hours. But the idea is not to impose it on parents, it must be a wish and a moment of pleasure.

H.fr: How does this method help limit the consequences of brain damage?
OB : For the moment, what we can say is that the child’s physiological state stabilizes better when skin-to-skin contact is carried out and parental attachment is encouraged. We know that this attachment and the family environment, after discharge from hospital, play a major role in the development of brain plasticity and in reducing the risk of subsequent disability. Concretely, skin to skin does not have a direct effect on reducing the rate of severe brain damage, however it can positively modify subsequent neurodevelopment by promoting brain maturation and plasticity (at the age of 2, from 5 years).

H.fr: And this is “simply” explained by this bond of attachment that is created with the parent?
OB : Among others. But, ultimately, the effects of skin to skin are relatively poorly understood. We know what it induces in terms of heart or respiratory rate, oxygen saturation, and the child’s behavior with their parent, since these are clinical data. What we know much less, however, are the biological or neurobiological bases which are at the origin of these behavioral or clinical modifications. Even if we are starting to understand them better, in particular the role of certain hormones, such as oxytocin, which have an anti-inflammatory action and reduce stress.

H.fr: What is the origin of brain damage in premature newborns?
OB : There are different types. During the first days of life, hemorrhagic lesions may appear, particularly linked to respiratory or cardiac instability, which I mentioned previously. White matter lesions (editor’s note: which ensures the conduction of nerve impulses) can occur later, in the first three weeks. The latter are caused more by persistent, systemic inflammation, detectable in the blood, or even neuroinflammation (inflammation in the brain). I repeat, skin to skin will not so much prevent the most serious lesions in an extremely ill child but rather contribute to the reduction of the later consequences of these lesions.

H.fr: What consequences can these injuries cause?
OB : They can cause cerebral palsy, cognitive delays, behavioral or psychopathological disorders, among others.

H.fr: When were the benefits of skin-to-skin care for premature newborns democratized?
OB : The « kangaroo care » (or kangaroo method) was launched more than 25 years ago in Bogota, Colombia, as part of a parallel approach to usual care in the Neonatal Intensive Care Unit (NICU) for low birth weight infants. birth, in response to overcrowded nurseries, scarce and expensive resources, such as incubators, and high rates of neonatal infection and mortality. The first studies on the subject, in particular those of the Franco-Colombian pediatrician, Nathalie Charpak date from 1997 so it is not that recent!

H.fr: Are there other methods that can limit the risk of cerebral palsy?
OB : Yes, in particular magnesium sulfate, administered to the future mother just before the birth of the child. This medication has partial effectiveness but has been shown to prevent cerebral palsy. We can also prevent brain lesions through the least invasive management possible, respiratory problems, prevention of secondary, nosocomial infections (editor’s note: contracted during a stay in a health establishment), optimization of nutrition. , etc…

H.fr: Who can parents of premature children turn to for support?
OB : They can first of all rely on the care team of the neonatology department where they were admitted, then, subsequently, on various specialized associations, such as SOS préma or the Cerebral Palsy Foundation, in the event of appearance of motor disorders.

© Cerebral Palsy Foundation