“Kangaroo care,” or skin-to-skin contact, may be neuroprotective and is associated with neonatal development in areas of the brain involved in emotional regulation in preterm infants, according to a new preliminary study from Weill Cornell Medicine, Burke Neurological Institute and Stanford Medicine investigators. Even short sessions correlated with noticeable effects on brain imaging scans, which is important because more than half of preterm infants have risk for neurodevelopmental impairment.
The findings of the retrospective study, published Sept. 24 in Neurology, the medical journal of the American Academy of Neurology, could ultimately lead to better neurological outcomes for preterm infants and a wider adoption of kangaroo care in neonatal intensive care units (NICUs).
Dr. Katie Travis
“We’re just starting to understand why a very natural thing—skin-to-skin contact—is so powerful,” said lead author Dr. Katie Travis, assistant professor of neuroscience in pediatrics at Weill Cornell Medicine and director of the Laboratory for Language Development and Recovery at Burke Neurological Institute, a Weill Cornell Medicine affiliate. “It’s not just about medicine and an incubator in the NICU; mom and dad are a powerful medicine for brain development, and that needs to be leveraged more often.”
One benefit of the finding is that it can be immediately applied to help newborns and families in neonatal intensive care units, according to study author Dr. Melissa Scala, clinical professor of pediatrics at Stanford Medicine. Dr. Scala is a neonatologist at Lucile Packard Children’s Hospital Stanford, where the data was collected.
“Parents often ask how they can take care of their babies in the NICU,” Dr. Scala said. “When I tell them about how skin-to-skin care can impact brain development, they ask me when they can get started. This simple but powerful activity is an important part of optimizing neurodevelopment for our high-risk babies.”
Dr. Melissa Scala. Credit: Stanford Medicine
Kangaroo care as a clinical practice began in the 1970s as a way to reduce mortality rates among preterm babies and to help caregivers bond with their babies. With this approach, infants wearing only a diaper rest on their stomachs against the bare chests of their caregivers. A blanket is sometimes placed on the babies’ backs to keep them warm. Because the bundled-up baby and caregiver resemble a kangaroo baby snuggled in their mother’s pouch, the practice is sometimes called “kangaroo care.”
Studies have shown that babies who experience skin-to-skin contact sleep and breathe more regularly, cry less often and are more successful at breastfeeding. They also suggest it may have neurological benefits, but the studies didn’t directly examine brain changes. Dr. Travis and her team set out to evaluate the practice in more depth with a pilot study.
The Smallest Patients
The study reported data from 88 preterm infants born at about 29 weeks gestational age at Packard Children’s NICU. Trained nurses noted in the patients’ records whether caregivers practiced skin-to-skin contact and for how long. Families varied in their practice of kangaroo care, with some babies having no skin-to-skin contact, and others having as much as 2 hours in a visit. Mothers were the main family members that practiced kangaroo care, which was done for an average of 2-3 days a week.
The NICU routinely scanned the infants with magnetic resonance imaging at near-term age and before being released from the hospital. These scans revealed that the cingulate and anterior thalamic tracts, which are involved in socio-emotional development and stress regulation, showed changes that could be beneficial to brain development in the discharge scan that correlated with skin-to-skin contact.
“We see this association even when we account for the gestational age or how many health complications the babies had,” said Dr. Travis. “It suggests that there is an effect of these early experiences over and above these other factors that we know can affect brain development.”
Larger trials will attempt to validate the findings and determine optimal dosing and timing, and the team will expand their scope to include patients at Weill Cornell Medicine. In the meantime, Dr. Travis said that this approach should be encouraged. “Parents should be involved as a partner in their baby’s care, and they have the power to shape their baby’s brain development,” she said.
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development through grant number 5R00-HD847904 and 2R01-HD069150.