Skin-to-skin contact improves breastfeeding but not cognitive outcomes in very preterm infants: Clinical trial

Researchers led by the Trondheim University Hospital in Norway report that two hours of immediate skin-to-skin contact between mothers and very preterm infants after birth does not improve cognitive, motor, or language development by age 2 to 3 years. Infants receiving the intervention did show significantly improved breastfeeding outcomes.

Very preterm infants born between 28 and 31 weeks of gestation are at increased risk for long-term impairments, including cerebral palsy, cognitive and language delays, psychiatric conditions, and visual or hearing deficits.

The World Health Organization advocates early maternal-infant skin-to-skin contact (SSC) as a potentially protective intervention based on previous evidence indicating improved thermoregulation, reduced infant mortality and improved physiological stability.

In the study, “Immediate Skin-to-Skin Contact in Very Preterm Neonates and Early Childhood Neurodevelopment,” published in JAMA Network Open, researchers conducted an open-label, randomized clinical trial to assess whether immediate SSC improves early childhood neurodevelopment in very preterm infants.

A total of 108 neonates born between 28 and 32 weeks gestation were enrolled across three Norwegian hospitals between 2014 and 2020. Eligible infants weighed over 1,000 g and required less than 40% oxygen support at birth. Newborns were randomized to receive either two hours of immediate SSC in the delivery room or standard care involving direct transfer to the neonatal intensive care unit in an incubator.

Primary outcome was cognitive development at 2 to 3 years of age, measured using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Secondary measures included language and motor development scores, as well as data on breastfeeding practices and parent-reported questionnaires.

No significant difference in cognitive development was found between groups. At 2 to 3 years of age, mean BSID-III cognitive composite scores were 99.6 in the SSC group and 99.4 in the standard care group (mean difference, 0.21; 95% CI, −5.26–5.68; P = 0.94).

Developmental delay risk was similar between groups, with 51% of children in the SSC group and 49% in the standard care group scoring below clinical thresholds on at least one assessment (odds ratio, 1.10; 95% CI, 0.47–2.56; P = 0.83).

Breastfeeding outcomes favored the SSC group. At hospital discharge, 84% of infants in the SSC group were breastfed compared with 67% in the standard care group. At 12 months, 44% of infants in the SSC group were still being breastfed, compared with 26% in the standard care group. No significant differences in adverse outcomes or complications were observed between the groups.

Cognitive scores were nearly identical between groups, with a mean difference of 0.21 points (95% CI, −5.26–5.68; P = 0.94). No differences emerged in developmental delay risk between SSC and control groups (51% vs. 49%, odds ratio 1.10 [95% CI, 0.47–2.56]; P = 0.83). Yet, significantly more infants in the SSC group were breastfed at hospital discharge (84% vs. 67%; P = 0.04), with higher rates of improved breastfeeding and a trend toward higher rates at 12 months (44% vs. 26%; P = 0.07).

Authors reported no neurodevelopmental benefit from immediate SSC by age 3, yet noted clinically meaningful gains in breastfeeding and maternal-infant bonding. These findings reflect earlier studies linking SSC with improved parental psychological health and emotional connection in neonatal settings.

Rather than pursue additional trials, the authors advocate for wider adoption of this low-cost intervention based on its safety and sustained breastfeeding benefit. Improved parent-infant closeness may hold practical significance in neonatal care, even when neurodevelopmental scores remain unaffected.

© 2025 Science X Network