ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2020
Skin-to-Skin Care Is a Safe and Effective Comfort Measure for Infants Before and After Neonatal Cardiac Surgery.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Breastfeeding infants with CHD: an evidence summary and recommendations from the Cardiac Newborn Neuroprotective Network, a special interest group of the Cardiac Neurodevelopmental Outcome Collaborative.Cardiology in the young · 2025Guideline
- Parent-Infant Skin-to-Skin Contact and Stress Regulation: A Systematic Review of the Literature.International journal of environmental research and public health · 2021Pooled it
- Human milk and breastfeeding at the first oral feed for infants with critical congenital heart disease: a multi-institutional study.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Neurodevelopmental care across pediatric critical care settings: toward brain-focused critical care.European journal of pediatrics · 2026Review
- Skin-to-skin contact significantly impacts maternal anxiety, mother-infant bonding, and autonomic function in infants with congenital heart disease and their mothers.Scientific reports · 2026Article
- Implementation mapping to develop strategies for skin-to-skin care in the pediatric cardiac intensive care unit: planning for a hybrid trial.Frontiers in pediatrics · 2026Article
- Physiological Stability During Kangaroo Mother Care Among Very-Low-Birthweight Premature Infants, Supported by Non-Invasive Respiratory Support.Journal of paediatrics and child health · 2025Observational
- Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative.Cardiology in the young · 2023Article
- Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates.Pediatric cardiology · 2023Article
- Developmental Care for Hospitalized Infants With Complex Congenital Heart Disease: A Science Advisory From the American Heart Association.Journal of the American Heart Association · 2023Article
- Comfort-holding in critically ill children: a scoping review.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2021Article
- Role alteration predicts anxiety and depressive symptoms in parents of infants with congenital heart disease: a pilot study.Cardiology in the young · 2021Article
- Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative.Cardiology in the young · 2021Article
- Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2021Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesTo determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery.
designA baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2).
settingCardiac ICU and step-down unit in a large metropolitan freestanding children's hospital. SUBJECTS: Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease.
interventionsEligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. MEASUREMENTS AND MAIN
resultsMeasurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended.At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group.
conclusionsSkin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
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