{
  "abstract": "Objective To explore the effects of immediate parent–infant skin-to-skin contact (iSSC) at very preterm birth on maternal–infant behavioural responses and hypothalamic–pituitary–adrenal (HPA) axis reactivity to age-appropriate socio-emotional stress at 4 months corrected age.Design Two secondary outcomes from a multicentre randomised controlled trial with two non-blinded parallel groups.Setting Three Scandinavian neonatal intensive care units, level 2 and level 3.Participants 91 infants born at gestational age 28+0 to 32+6 from April 2018 to June 2021. Singletons and twins with a second caregiver present were included, regardless of mode of birth. Higher-order births, infants with congenital infections and major malformations were excluded.Intervention Infants were randomised before birth to iSSC (n=46) or conventional care (n=45) during the first 6 hours of life. At 4 months corrected age, the infants were exposed to socio-emotional stress using the Face-to-Face Still-Face procedure (FFSF). Salivary cortisol was collected before and after FFSF.Main outcome measures Behavioural and hormonal stress responses at 4 months of age.Results 65 of 91 infants were assessed by FFSF, of which 37 infants had cortisol sampling. The iSSC group demonstrated heightened positive emotionality during FFSF compared with controls (beta 0.74, 95% CI 0.40 to 1.07; p<0.001). Also, the iSSC group showed an association between mother−infant cortisol levels at baseline (r 0.55, 95% CI 0.13 to 0.80; p=0.014) and 30 min post-FFSF (r 0.55, 95% CI 0.05 to 0.83; p=0.035).Conclusion Infants who experienced iSSC during the first 6 hours after very preterm birth showed improved infant socio-emotional stress coping and suggested enhanced mother–infant HPA axis synchrony at 4 months.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Neurophysiology and Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway",
        "Faculty of Health Sciences, University of Stavanger, Stavanger, Norway"
      ],
      "name": "Karoline Lode-Kolz"
    },
    {
      "affiliations": [
        "Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden",
        "Department of Neonatology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden"
      ],
      "name": "Siri Lillieskold"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Hanne Brit Hetland"
    },
    {
      "affiliations": [
        "0–3 Center for the at-Risk Infant, IRCCS Eugenio Medea, Bosisio Parini, Italy"
      ],
      "name": "Eleonora Mascheroni"
    },
    {
      "affiliations": [
        "Lund-Malmö NIDCAP Training and Research Center, Department of Neonatology, Skanes universitetssjukhus Lund, Lund, Sweden"
      ],
      "name": "Stina Klemming"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, University of Stavanger, Stavanger, Norway",
        "Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Hanne Pike"
    },
    {
      "affiliations": [
        "Department of Neonatology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden",
        "Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden"
      ],
      "name": "Agnes Linner"
    },
    {
      "affiliations": [
        "Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Nils J Bergman"
    },
    {
      "affiliations": [
        "Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Bjorn Westrup"
    },
    {
      "affiliations": [
        "Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden",
        "Department of Neonatology, Astrid Lindgren Children’s Hospital, Stockholm, Sweden"
      ],
      "name": "Ulrika Ådén"
    },
    {
      "affiliations": [
        "Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden",
        "School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia"
      ],
      "name": "Evalotte Morelius"
    },
    {
      "affiliations": [
        "0–3 Center for the at-Risk Infant, IRCCS Eugenio Medea, Bosisio Parini, Italy"
      ],
      "name": "Rosario Montirosso"
    },
    {
      "affiliations": [
        "Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Wibke Jonas"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, University of Stavanger, Stavanger, Norway",
        "Department of Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Siren Rettedal"
    }
  ],
  "title": "Immediate skin-to-skin contact at very preterm birth and effect on infant socio-emotional stress response and mother–infant cortisol co-regulation: secondary outcomes from the randomised clinical Immediate Parent-Infant Skin-To-Skin Study (IPISTOSS)",
  "uid": "d7ff413b-d82f-5035-80e6-c737ccad0ee2"
}