***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background There are not many studies exploring parity differences in early lactation performance and the results obtained are fairly often contradictory . The present study investigated the effect of  different maternity home practice s in St. Petersburg , Russia , as well as of physiological breast engorgement and maternal mood , on milk production in primi- and multiparous women on day four . The amount of milk was studied in relation to the duration of " nearly exclusive " breastfeeding . Methods 176 mother-infant pairs were r and omised into four groups according to an experimental two-factor design taking into account infant location and apparel . Data were recorded in the delivery ward at 25–120 minutes postpartum and later in the maternity ward . Group I infants ( n = 37 ) were placed skin-to-skin in the delivery ward while Group II infants ( n = 40 ) were dressed and placed in their mother 's arms . Both groups later roomed-in in the maternity ward . These infants had the possibility of early suckling during two hours postpartum . Group III infants ( n = 38 ) were kept in a cot in the delivery and maternity ward nurseries with no rooming-in . Group IV infants ( n = 38 ) were kept in a cot in a delivery ward nursery and later roomed-in in the maternity ward . Equal numbers per group were either swaddled or clothed . Episodes of early suckling were noted . Number of breastfeeds , amount of milk ingested ( recorded on day 4 postpartum ) and duration of " nearly exclusive " breastfeeding were recorded . Intensity of breast engorgement was recorded and a Visual Analogue Scale measured daily maternal feelings of being " low/blue " . Results On day four , multiparas had lower milk production than primiparas when they were separated from their infants and breastfeeding according to the prescriptive schedule ( 7 times a day ; Group III ) . In contrast , there was no difference in milk production between multi- and primiparous mothers in the groups rooming-in and feeding on dem and ( Groups I , II and IV ) , although multiparas had higher numbers of feedings than primiparas . In addition during the first three days postpartum , multiparous mothers had higher perception of physiological breast engorgement and lower intensity of feeling " low/blue " than primiparous mothers . Early suckling was shown to positively affect milk production irrespective of parity . Thus Group I and II infants who suckled within the first two hours after birth ingested significantly more milk on day 4 than those who had not ( 284 and 184 ml respectively , SE = 14 and 27 ml , p = 0.0006).Regression analyses evaluated factors most important for milk production and found in Groups I and II for primiparous women that early suckling , intensity of breast engorgement and number of breastfeeds on day 3 were most important . Intensity of feeling " low/blue " was negatively related to amount of milk ingested . The significant factor for multiparous women was early suckling . Similar results were obtained in Groups III and IV ; however , in primiparous mothers , engorgement was the most important factor and in multiparous women it was rooming-in . Amount of milk produced on day 4 was strongly correlated to a duration of " nearly exclusive " breastfeeding ( p < 0.0001 ) . Conclusion The present data show that ward routines influence milk production . As our data suggest that milk production in primi- and multiparous women may be differently influenced or regulated by complex factors , further research is needed The provision of maternal-infant body contact during a period of maternal separation was examined for its effects on  parent-infant and triadic interactions .  Participants were 146 three-month-old preterm infants and their parents , half of whom received skin-to-skin contact , or kangaroo care ( KC ) , in the neonatal nursery . Global relational style and micro-patterns of proximity and touch were coded . Following KC , mothers and fathers were more sensitive and less intrusive , infants showed less negative affect , and family style was more cohesive . Among KC families , maternal and paternal affectionate touch of infant and spouse was more frequent , spouses remained in closer proximity , and infant proximity position was conducive to mutual gaze and touch during triadic play . The role of touch as a constituent of the co-regulatory parent-infant and triadic systems and the effects of maternal contact on mothering , co-parenting , and family processes are discussed Kangaroo care ( KC ) has been the intervention for preterm infants in numerous published studies . However , most well design ed studies to date have used a one-group repeated measure design . This methodology is not as definitive as an experimental design . Because of the absence of a comparable control group , change between pretest and posttest may be due to any other environmental variables or normal variation of subjects ( Kirk , 1995 ) . This r and omized controlled trial ( RCT ) was done to test the hypotheses that KC infants would have higher mean tympanic temperatures , less weight loss , more optimal behavioral states , and lower acuity ( length of stay ) . Thirty-four eligible mother-infant dyads were r and omly assigned to the KC or the control group by computerized minimization on the day following birth . Stratification variables included infant gender , birth weight , delivery method , and parity . KC infants compared to control infants had higher mean tympanic temperature ( 37.3 degrees C vs. 37.0 degrees C ) , more quiet sleep ( 62 % vs. 22 % ) , and less crying ( 2 % vs. 6 % ) all at p=.000 . No significant difference was found for weight loss and acuity ( length of stay ) . These findings can be used for evidence -based nursing practice in Taiwan . With the knowledge attained from this RCT , nurses can educate and motivate mothers to keep their stable preterm infants warm by skin-to- skin contact inside their clothing , thereby encouraging self-regulatory feeding OBJECTIVE To test the integrity of a protocol for a r and omised controlled trial ( RCT ) to examine the effectiveness of skin-to-skin care compared to routine care on the initiation and duration of breast feeding and to provide data to be used in the power calculation for a proposed trial . DESIGN R and omised pilot study . SETTING Warrington Hospital , Cheshire , UK . PARTICIPANTS Women at 36 weeks ' gestation with healthy singleton pregnancies , who intended to breast feed , who had ' booked ' for care at Warrington Hospital and had given informed consent to participate . Twenty-eight women were r and omised in the pilot study . METHOD Women were r and omly allocated to receive either routine or skin-to-skin care following birth . The first breast feed was assessed using the Breast-feeding Assessment Tool ( BAT ) .  Mothers were followed up at discharge from hospital and again at four months to provide details of duration of breast feeding . FINDINGS 66 women were approached to participate in the trial and 44 consented ( 67 % consent rate ) . Twenty-eight women were r and omised in the study and 26 breast feeds were observed ( 93 % ) . The pilot study identified procedural changes that were required in the design of the main study , provided an estimate of recruitment rates and confirmed the previously calculated sample size . CONCLUSION The pilot study demonstrated that a large RCT of skin-to-skin versus routine care was feasible . This is an example of how a pilot study has the ability to identify unforeseen challenges in the conduct of the trial as well as allowing necessary changes to be made to the design that will increase the quality of the subsequent research Purpose : To compare kangaroo mother care ( KMC ) and conventional cuddling care ( CCC ) in premature and smallfor-gestational-age infants . Design and Sample : Thirty mother-infant dyads in two Australian neonatal nurseries were r and omly assigned to the KMC group or the CCC group . Both groups of mothers cuddled their babies for a minimum of two hours a day , five days a week while in the study , with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing . Main Outcome Variable : The main outcome variables were infant weight gain , temperature maintenance during KMC and CCC , and length of hospital stay . Results : The results showed no difference between groups on the Parental Stress Scale ( NICU ) or the Parental Expectations Survey . Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators , equal weight gain , equal length of stay in the hospital , and equal duration of breastfeeding This prospect i ve study compared st and ard newborn care under radiant heat with two methods of warming babies that provided immediate parent-infant contact . Fifty-one mother-infant dyads were r and omly assigned to three treatment groups . Control group babies had no skin-to-skin contact with their mothers during the study period . One group of experimental infants began skin-to-skin contact after completion of initial nursing care in a radiant heater . The second group of experimental babies had the earliest , most continuous skin-to-skin contact with their mothers and were never under radiant heat . Skin temperatures of all 51 newborns were noted every 3 minutes for 45 minutes using an electronic thermometer . Rectal temperatures were also taken at 21 and 45 minutes after birth . Results supported the hypothesis that body temperatures would be warmest in experimental babies given the earliest skin-to-skin contact , less warm in experimental infants beginning skin-to-skin contact after initial nursing care , and coolest in control babies given no skin-to-skin contact with their mothers ( p < 0.001 ) . Significantly more control than experimental newborns had skin and rectal temperatures below the neutral thermal range at 21 and 45 minutes of life . High delivery room temperature and drying babies well immediately after birth did not differ significantly among the three groups , but were found to be positively correlated with neonatal body temperature for the sample as a whole BACKGROUND Extremely preterm birth , even in the absence of significant neurological impairment , is associated with altered pain responses and impaired memory and behaviour . Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship , factors that in turn are also associated with impaired infant outcome . Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects . METHODS We conducted a pragmatic , prospect i ve , controlled , intention-to-treat trial in two neonatal intensive care units . Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving st and ard care , or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks . We assessed  infant behaviour at time of discharge from hospital  , responses to immunisation at 4 and 12 months of age , and memory , behaviour and development at 1 year corrected ( postmenstrual ) age . Indices of maternal depression , stress , anxiety , lactation performance and infant interaction were assessed at time of infant discharge , 4 months and 1 year . RESULTS No significant difference was identified in any infant or maternal measure at any time point . CONCLUSIONS Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences . Although there is no reason to dissuade mothers who wish to provide STS contact , we are unable to recommend re source allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting Background . Based on the general bonding hypothesis , it is suggested that kangaroo mother care ( KMC ) creates a climate in the family whereby parents become prone to sensitive caregiving . The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant 's cues . Method . The r and omized controlled trial was conducted on a set of 488 infants weighing < 2001 g , with 246 in the KMC group and 242 in the traditional care ( TC ) group . The design allows precise observation of the timing and duration of mother – infant contact , and takes into account the infant 's health status at birth and the socioeconomic status of the parents . Bonding Assessment . Two series of outcomes are assessed as manifestations of a mother 's attachment behavior . The first is the mother 's feelings and perceptions of her premature birth experience , including her sense of competence , feelings of worry and stress , and perception of social support . The second outcome is derived from observations of the mother and child 's responsivity to each other during breastfeeding at 41 weeks of gestational age . Interventions . KMC has three components . The first is the kangaroo position . Once the premature infant has adapted to extrauterine life and is able to breastfeed , he is positioned on the mother 's chest , in a upright position , with direct skin-to-skin contact . The second component is kangaroo nutrition . Although breastfeeding is the prime source of nutrition , infants also may receive preterm formula whenever necessary and vitamin supplements . The third component is the clinical control ; infants are monitored on a regular basis , daily until they are gaining at least 20 g per day . Afterward , weekly clinic visits are scheduled until term , which constitutes the ambulatory minimal neonatal care . In the TC group , infants are kept in incubators until they are able to self-regulate their temperature and are thriving ( ie , have an appropriate weight gain ) . Infants are discharged according to current hospital practice , usually not before their weight is ∼1700 g. Afterward , as with the KMC group , weekly clinic visits are scheduled until term . Results . We observed a change in the mothers ' perception of her child , attributable to the skin-to-skin contact in the kangaroo-carrying position . This effect is related to a subjective “ bonding effect ” that may be understood readily by the empowering nature of the KMC intervention . Moreover , in stressful situations when the infant has to remain in the hospital longer , mothers practicing KMC feel more competent than do mothers in the TC group . This is what we call a resilience effect . In these stress 
    Output:
    
The intervention may benefit breastfeeding outcomes , early mother-infant attachment , infant crying and cardio-respiratory stability , and has no apparent short or long-term negative effects .