Anne Nadine Heirman, Coralie Romé Arends, Dominique Valérie Clarence de Jel, Richard Dirven, Lisette van der Molen, Gyorgy Bela Halmos, Michiel Wilhelmus Maria van den Brekel, Martijn Matthias Stuiver
Decisional Conflict and Decision Regret in Head and Neck Oncology: A Systematic Review and Meta-Analysis
JAMA otolaryngology-- head & neck surgery
motherinfant separation post birth common standard hospital care newborn infants held wrapped dressed mothers arms placed open cribs radiant warmers skintoskin contact ssc begins ideally birth last continually end first breastfeeding ssc involves placing dried naked baby prone mothers bare chest often covered warm blanket according mammalian neuroscience intimate contact inherent place habitat evokes neurobehaviors ensuring fulfillment basic biological needs time frame immediately post birth may represent sensitive period programming future physiology behaviorto assess effects immediate early ssc healthy newborn infants compared standard contact establishment maintenance breastfeeding infant physiologywe searched cochrane pregnancy childbirth groups trials register 17 december 2015 made personal contact trialists consulted bibliography kangaroo mother care kmc maintained dr susan ludington reviewed reference lists retrieved studiesrandomized controlled trials compared immediate early ssc usual hospital caretwo review authors independently assessed trials inclusion risk bias extracted data checked accuracy quality evidence assessed using grade approachwe included 46 trials 3850 women infants 38 trials 3472 women infants contributed data analyses trials took place 21 countries recruited small samples 12 trials randomized 100 women eight trials included women ssc cesarean birth infants recruited trials healthy majority full term six trials studied late preterm infants greater 35 weeks gestation included trial met criteria good quality respect methodology reporting trial successfully blinded analyses imprecise due small sample size many analyses statistical heterogeneity due considerable differences ssc standard care control groups results womenssc women likely women standard contact breastfeeding one four months post birth though uncertainty estimate due risks bias included trials average risk ratio rr 124 95 confidence interval ci 107 143 participants 887 studies 14 41 grade moderate quality ssc women also breast fed infants longer though data limited mean difference md 64 days 95 ci 3796 8950 participants 264 studies six gradelow quality result sensitivity analysis excluding one trial contributing heterogeneity primary analysis ssc women probably likely exclusively breast feed hospital discharge one month post birth six weeks six months post birth though analyses substantial heterogeneity discharge average rr 130 95 ci 112 149 participants 711 studies six 44 grade moderate quality six weeks average rr 150 95 ci 118 190 participants 640 studies seven 62 grade moderate qualitywomen scc group higher mean scores breastfeeding effectiveness moderate heterogeneity ibfat infant breastfeeding assessment tool score md 228 95 ci 141 315 participants 384 studies four 41 ssc infants likely breast feed successfully first feed high heterogeneity average rr 132 95 ci 104 167 participants 575 studies five 85 results infantsssc infants higher scrip stability cardiorespiratory system scores overall suggesting better stabilization three physiological parameters however infants clinical significance test unclear trialists reported averages multiple time points standardized mean difference smd 124 95 ci 076 172 participants 81 studies two grade low quality ssc infants higher blood glucose levels md 1049 95 ci 839 1259 participants 144 studies three grade low quality similar temperature infants standard care md 030 degree celcius c 95 ci 013 c 047 c participants 558 studies six 88 grade low quality women infants cesarean birthwomen practicing ssc cesarean birth probably likely breast feed one four months post birth breast feed successfully ibfat score analyses based two trials women evidence insufficient determine whether ssc could improve breastfeeding times cesarean single trials contributed infant respiratory rate maternal pain maternal state anxiety power detect group differences subgroupswe found differences outcome compared times initiation immediate less 10 minutes post birth versus early 10 minutes post birth lengths contact time 60 minutes less contact versus 60 minutes contactevidence supports use ssc promote breastfeeding studies larger sample sizes necessary confirm physiological benefit infants transition extrauterine life establish possible doseresponse effects optimal initiation time methodological quality trials remains problematic small trials reporting different outcomes different scales limited data limit confidence benefits ssc infants review included healthy infants limits range physiological parameters observed makes interpretation difficult