Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study

Objectives: The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. Design: This was a retrospective cohort study. Setting: This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. Participants: Data were collected from the electronic medical records of all extremely preterm infants (gestational age < 27 weeks) admitted to the unit during 2010-2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n= 97). Outcome measures: Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). Analysis: Extracted data were analysed through a multistep process of logistic regressions, t-tests,chi(2) tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. Results: Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score >= 80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p> 0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30 weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. Conclusions: This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance.