Skin-to-Skin Care Benefits Mothers and Infants in the Pediatric Cardiac ICU

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Two studies by researchers at Children’s Hospital of Philadelphia (CHOP) show that skin-to-skin care (SSC) -- a specific form of holding in which the mother holds her unclothed, diapered infant directly to her bare chest – benefits both mothers and infants in the pediatric cardiac intensive care unit (PCICU). Together, the findings demonstrate a role for SSC as a low-cost, low-risk intervention that supports physiologic stability in infants with critical congenital heart disease (cCHD) and reduces stress in mothers.

The studies followed 30 mother-infant pairs between January 2018 and January 2019. SSC was performed twice: once in the preoperative period and once in the postoperative period. Using a combination of questionnaires, self-report measures, and saliva samples in the mothers, as well as vital signs, pain and behavior measures, and saliva samples in the infants, the researchers studied the pairs immediately before SSC, 30 minutes after SSC began, and 30 minutes after SSC had finished at both time points.

The findings, which were published recently in Pediatric Critical Care Medicine, showed that infant pain scores decreased significantly at both time points during SSC, and infants moved into a calmer behavior state during SSC as compared to baseline. Before surgery, infants also had significantly reduced heart rate and respiratory rate and increased systolic blood pressure during SSC.

The mothers also experienced benefits. The 30 women who participated in the pilot study experienced significant reductions in self-reported scores of anxiety and stress, as well as reductions in salivary cortisol. The researchers also found an increase in self-reported attachment by the mothers. Those findings were recently published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing.

“Taken together, these studies show that SSC is a relatively simple but highly effective nurse-driven intervention that benefits both mothers and their infants with cCHD,” said Amy J. Lisanti, PhD, RN, a nurse scientist and clinical nurse specialist in the Cardiac Center and the Center for Pediatric Nursing Research and Evidence-Based Practice at CHOP and first author of both papers. “Nurses can collaborate with interdisciplinary health care providers in PCICUs to establish specific holding guidelines to standardize when and how infants can be held for SSC.”

Read more about CHOP’s holding guidelines and SSC procedures.

Contact: Natalie Solimeo, The Children’s Hospital of Philadelphia, 267-426-6246 or

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