Skin-to-Skin Contact and Hypothermia in Newborns: A Literature Review

This literature review analyzes the effects of skin-to-skin contact on hypothermia in newborns, breastfeeding, and mother-child bonding. It also examines barriers to implementation and strategies for improvement.

Running head: LITERATURE REVIEW 1
Literature Review
Student’s Name
Institution’s Affiliations
Date

LITERATURE REVIEW 2
PICOT Question: How does direct skin-to-skin contact, compared to absence of skin-to-skin
contact, affect the incidence of hypothermia in newborns, as measured by the infant’s body
temperature within the normal range of 36.5 C and 37.5 C, encourage breastfeeding and
improve mother-child bonding, when implemented within the first hour after birth, within a
10-week time period?
P: Population: Newly born infants and Mothers
I: Intervention: Skin-to-Skin Contact
C: Comparison: Avoidance of Skin-Skin Contact
O: Outcome: Alleviation of Hypothermia, improved breastfeeding and mother-child bonding
T: Time Period: 10 weeks
Introduction
Skin-to-skin contact (SSC) has been observed to cause positive results in neonatal
health conditions. These positive outcomes include improved breastfeeding of infants and a
strong bond between the infant and mother. Hypothermia is a condition that affects most of
the infants, therefore leading to an abnormal decrease in body temperatures below normal
levels. More than 20% of infants experience several problems when SSC is not introduced
immediately after birth (Chan et al, 2016). The symptoms of the recession may have negative
impacts on both the mother and the new-born. Skin-to-skin contact between the infant and the
mother is effective in the reduction of the problems related to the postnatal care. Research
outcomes from various nursing studies have shown that SCC is important in reducing infant
mortality rates (Alenchery et al, 2018). SSC also promotes mental growth and development
in infants. SSC leads to cognitive development of the infants (Feldman, Rosenthal, &
Eidelman, 2014). Poor maternal care has led to serious clinical problems that relate to lack of

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regular SSC during the early lives of the infants (Vilinsky, Sheridan & Nugent, 2016). The
period taken to accomplish the project was ten weeks because new-borns require intensive
care from their mothers at this age. This paper will succinctly analyse the positive effects of
SSC and barriers associated with the implementation of the project in nursing practice.
Discussion
Comparing of the Research Questions
The analysis and comparison of the research questions are crucial in the
implementation of this project. Research questions provide a guideline for effective
understanding of the barriers of related to SSC and interventions to eliminate these barriers,
therefore, leading to improved care (Baley, 2015). The first research question focuses on the
barriers and strategies to be used in the implementation of the SSC in postnatal care period.
This research question analyses the main enablers .the enablers in the implementation of SSC
include the availability of knowledge on the benefits of this practice in maternal care. One of
the known benefits of SSC is the development of a stronger bond between the infant and the
mother. From the research study, it is identified that the scarcity of skilled personnel is the
main barrier interfering with the implementation and adoption of SSC in infant care practices.
There was a reduced number of competent nursing personnel in the labor room as compared
to a large number of women giving birth. Another barrier in the implementation of SSC
practice was the doubts from the people on the efficacy of the practice in neonatal and
maternal care. Lastly, the lack of motivation from the experienced staff was another barrier
that influenced the adoption of SSC. Teamwork is one of the strategies to be used in avoiding
the negative effects related to the implementation barriers (Moore, Bergman, Anderson &
Medley, 2016). Teamwork and consultation improve the effective performance of SCC in
eradicating postpartum depressions and earl childhood health conditions.

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The second research question focuses on the safety of patients during caesarean
delivery. Safety of the mother and the new-born is a critical factor to be achieved through an
active participation of skilled paediatricians and nurses to improve the efficacy of SSC in
nursing practices (Armbrust, Hinkson, von Weizsäcker, & Henrich, 2016). This question
examines the negative impacts of SSC practices, therefore, SSC practice should be avoided
during these two procedures. The research question presented on the third article by Chan
summarizes the importance of Kangaroo mother care in the prevention of hypothermia and
breastfeeding. Through breastfeeding stimulation of the nervous system is achieved,
therefore, leading to relaxation and dilation of blood vessels leading to thermal regulation
(Koopman et al, 2016).
Comparing of the Sample Populations
Different designs were used in the collection of data during the research studies. The
first design was done based on a qualitative study whereby moderators were interviewed in
two Indian hospitals. In this case, 41 health workers were selected for an interview. The
health workers were those working in the labor unit section. Moderator's guide was used
during the interview to improve the relevancy of the data collected. The main ideas obtained
through this design were the barriers, enablers, and interventions that can be used to
overcome the negative implication of SSC on the health of both the mother and the infant and
improve postnatal care. The use of Likert’s scale was effective in providing choices to the
interviewers (Ludington-Hoe, 2015). The questionnaire materials contained multiple choice
questions to be answered to be selected population sample. The third design involved the
analysis of data obtained from the World Health Organization (WHO). The regional data
bases were evaluated because the implementation and efficacy of SSC vary depending on the
geographical areas. For instance, the data from India are different variations from African
data. The benefits of kangaroo mother were then analysed because it improves mother-to-

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infant bond. In the last research study, 73 premature infants during a consecutive period of
two weeks were compared with a case in which 73 participants were receiving standard care.
A follow up was done to record and analyze cognitive and psychological changes in these
infants in one year.
Comparing the Limitation of the Study
The available models used in the analysis of the collected research data were tiresome
and consumed a lot of time because it involved sorting of quotes and data, identification of
thematic issues and familiarizing with the data. In the first research, the interpretation of the
data was difficult because different health workers had different views on the barriers of SSC
and the appropriate measures to improve its efficacy and reduce infant mortality rates.
Another limitation of the research was the lack if relevant models used in the analysis of the
collected data. The analysis of randomized data is not appropriate; therefore, does not support
the implementation of the SSC practice in mothers and infants (Sharma, 2016). The main
problem identified from the research involving the analysis of the articles from WHO was the
lack of enough regional databases in articles. The limitations vary depending on the research
design used in the data collection and analysis (Safari et al, 2018).
Conclusion
In conclusion, some interventions should be applied to improve neonatal care and
reduce psychological stress on both the mother and the infant. An immediate intervention that
should be applied in the implementation of SSC practice is improving antenatal awareness
among mothers and nurses to reduce neonatal mortality rates in the country. The best
recommendation for avoiding negative effects of barriers of SSC and limitations of the
research is training more health workers on the antenatal care practices. The first touch
should be introduced to boost the psychological development of the child in a later lifetime.

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References
Alenchery, A. J., Thoppil, J., Britto, C. D., de Onis, J. V., Fernandez, L., & Rao, P. S. (2018).
Barriers and enablers to skin-to-skin contact at birth in good neonates-a qualitative
study. BMC Pediatrics, 18(1), 48. https://doi.org/10.1186/s12887-018-1033-
Armbrust, R., Hinkson, L., von Weizsäcker, K., & Henrich, W. (2016). The Charité
caesarean birth: a family orientated approach of caesarean section. The Journal of
Maternal-Foetal & Neonatal Medicine, 29(1), 163-168.
https://www.ncbi.nlm.nih.gov/pubmed/25572878
Baley, J. (2015). Skin-to-skin care for a term and preterm infants in the neonatal ICU.
Pediatrics, 136(3), 596-599. doi: 10.1542/peds.2015-2335.
Chan, G. J., Valsangkar, B., Kajeepeta, S., Boundy, E. O., & Wall, S. (2016). What is
kangaroo mother care? A systematic review of the literature. Journal of global
health, 6(1). https://dx.doi.org/10.7189%2Fjogh.06.010701
Feldman, R., Rosenthal, Z., & Eidelman, A. I. (2014). Maternal-preterm skin-to-skin contact
enhances child physiologic organization and cognitive control across the first 10 years
of life. Biological psychiatry, 75(1), 56-64.
https://doi.org/10.1016/j.biopsych.2013.08.012
Koopman, I., Callaghan‐Koru, J. A., Alaofin, O., Argani, C. H., & Farzin, A. (2016). Early
skin‐to‐skin contact for healthy full‐term infants after vaginal and caesarean delivery:
a qualitative study on clinician perspectives. Journal of clinical nursing, 25(9-10),
1367-1376. http://doi.org/10.1111/jocn.13227

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Ludington-Hoe, S. M. (2015). Skin-to-skin contact: a comforting place with comfort
food. MCN: The American Journal of Maternal/Child Nursing, 40(6), 359-366. doi:
10.1097/NMC.0000000000000178
Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin‐to‐skin
contact for mothers and their healthy new-born infants. Cochrane database of
Systematic Reviews, (11). doi: 10.1002/14651858.CD003519.pub4.
Sharma, A. (2016). Efficacy of early skin-to-skin contact on the rate of exclusive
breastfeeding in term neonates: a randomized controlled trial. African health
sciences, 16(3), 790-797. doi: http://dx.doi.org/10.4314/ahs.v16i3.20.
Vilinsky, A., Sheridan, A., & Nugent, L. E. (2016). Preventing peri-operative maternal and
neonatal hypothermia after skin-to-skin contact. Journal of Neonatal Nursing, 22(4),
163-170. doi: https://doi.org/10.1016/j.jnn.2016.02.002