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Traditional care immediately after very preterm birth separates the mother and child by the transfer of the infant to the neonatal intensive care unit. A nonseparation approach is currently being considered, allowing early skin-to-skin contact in the delivery room/postoperative care unit. This study aimed to explore mothers’ experiences of early skin-to-skin contact and traditional care. A qualitative study using individual semi-structured interviews with five mothers from each of the two groups was conducted. Content analysis revealed that both groups’ experiences were characterized by (i) mothers’ need to be affirmed of their infants’ vitality, (ii) bonding challenges, and (iii) benefits of skin-to-skin contact. We suggest that early skin-to-skin contact after very preterm births is crucial for the bonding process and mothers’ feelings of safety and well-being. When early skin-to-skin contact is infeasible, our findings reveal the significance of photos, information, and the father’s presence at the time of postpartum separation.

Aim We compared the effect of two different doses of sucrose on neonatal pain scores during venepuncture. Methods This randomised crossover study focused on neonates born weighing more than 1000 g from December 2014 to June 2016, who received neonatal intensive care at two hospitals: one in Empangeni, South Africa, and one in Trondheim, Norway. During two consecutive venepuncture procedures, 27 neonates from South Africa and 26 neonates from Norway were randomised to receive 0.2 mL or 0.5 mL sucrose. Half was administered two minutes before venepuncture and the rest immediately before the procedure. South Africa used 25% sucrose and Norway 24%. Pain scores were measured twice using the Premature Infant Pain Profile-Revised: during skin puncture and after the needle was removed. Results The mean pain scores during skin puncture were significantly lower with 0.5 mL sucrose than with 0.2 mL (5.3 versus 6.8, p=0.008), but the mean pain scores after the needle was removed were similar with both doses (4.7 versus 5.4, p=0.29). We found no significant association between weight and pain scores. Conclusion We showed that neonates received better pain relief from 0.5 mL than 0.2 mL sucrose during venepuncture but not after the needle was removed.

Aim We compared the pain relieving effect of skin-to-skin contact versus standard care in the incubator during screening for retinopathy of prematurity. Methods This randomised crossover study included 35 preterm infants of less than 32 weeks of gestational age admitted to St Olavs University Hospital, Trondheim, Norway, between January 2014 and June 2016. Randomisation was for skin-to-skin with one of the parents or standard care with supportive positioning by parents for the first of two consecutive eye examinations. The pain score was measured twice using the Premature Infant Pain Profile (PIPP) during and after the eye examination. The infants' movement activity was video recorded after the examination. Results There was no difference in mean pain scores with skin-to-skin contact versus standard care during (10.2 vs. 10.3, p = 0.91) or after (7.0 vs. 6.8, p = 0.76) the procedure. Independent of the randomisation group, PIPP scores were lower than previous comparable studies have found. Bouts of movement activity were also the same whether the examination was conducted in skin-to-skin position or in the incubator (p = 0.91). Conclusion Skin-to-skin contact during the eye examination did not provide additional pain relief compared to standard care where the parents were already a part of the multidimensional approach.

Objective: The aim of the present study was to investigate mothers’ own experiences of skin-to-skin contact (SSC) with their newborns immediately following moderately premature birth. Design: Mixed method, survey and focus groups interviews. Participants: Thirty-nine mothers giving birth at gestational age 320 - 346 weeks responded to a quantitative questionnaire. Nine of these mothers participated in focus group interviews. Method: In order to obtain information about mothers’ own experiences of immediate SSC with their moderately preterm newborns after birth, quantitative and qualitative data were collected. Using a mixed method approach, descriptive quantitative data were combined with rich qualitative data from focus group interviews to offer a more comprehensive picture of the mother’s own experiences. Key concepts were information about SSC, feeling of safety and mother-infant bonding. Results: The results from both the quantitative and qualitative part of the study were highly congruent: the mothers perceived that they had been given sufficient information by midwives and nurses about SSC following premature birth. According to questionnaire responses and interviews, the mothers’ perception of safety during SSC was enhanced by the continuous presence of a nurse from the Neonatal Intensive Care Unit (NICU). Moreover, the mothers felt that SSC was important during the first hours after birth, both for mother-child bonding and for normalization of the birth experience. Conclusion: The results of our study demonstrate that SSC is a useful method to normalize the birth experience and enhance mother-child bonding following a moderately premature birth. We argue that midwives, nurses from NICU and physicians should support and promote SSC immediately following premature birth. © 2018 Dahlø. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background Skin-to-skin care immediately following delivery is a common practice for term infants and has been shown to improve cardiorespiratory stability, facilitate early bonding, and promote breastfeeding. Since 2007, the use of skin-to-skin care has been practiced for preterm infants from 32 weeks of gestation in the delivery room at St. Olav’s University Hospital. In the present study we aim to investigate whether skin-to-skin care following delivery is safe, and how it affects early and late outcomes compared to standard care for very preterm infants. Methods/Design A randomized controlled trial (RCT) of skin-to-skin care in the delivery room for very preterm infants born at gestational age 280–316 weeks with birth weight >1000 grams. Infants with severe congenital malformations or need of intubation in the delivery room are excluded. A detailed checklist and a flowchart were prepared for the study, and all involved professionals (neonatologists, neonatal nurses, obstetricians, anesthesiologists, midwives) participated in medical simulation training prior to study start on February 1, 2014. A consultant in neonatology and a neonatal nurse are present at all deliveries. Infants with birth weight

Objective To investigate the feasibility and safety of skin-to-skin care after birth for moderately preterm infants. Design Prospective cohort study. Setting The study was conducted at the maternity wards and NICUs of three study sites in Norway. Participants Ninety preterm infants born vaginally with gestational ages of 32 weeks/0 days to 34 weeks/6 days. Methods Comparison of groups of preterm infants who received skin-to-skin care or conventional treatment in incubators after birth. Results Median gestational age and birth weight were similar in the two groups: 33 weeks/5 days versus 34 weeks/3 days ( p = .464) and 2,100 versus 2,010 g ( p = .519). There were no differences in the first body temperature ( p = .841) and blood glucose level ( p = .539) between the groups. Conclusion Early skin-to-skin contact in the delivery room for moderately preterm infants may be feasible and safe.

BACKGROUND: Gavage feeding is required in preterm infants who cannot feed by themselves. Insertion of the feeding tube is painful, and reducing the discomfort in these patients is desirable. OBJECTIVE: The aim of this study was to assess pain and discomfort during nasal insertion of a feeding tube, and to evaluate different measures for pain relief. METHODS: We included 24 preterm infants with postmenstrual age 28 to 32 weeks' who were in stable condition. Each infant acted as his or her own control over a 3-week period during which the tube was changed 6 times. On these occasions, 6 different treatment combinations were given in randomized order: pacifier or no pacifier, combined with no fluid, sterile water, or 30% sucrose. Pain and discomfort were assessed by at least 2 independent and experienced observers using a pain assessment tool, the Premature Infant Pain Profile; score range: 0 to 21. In general, scores of 4 to 6 are interpreted as normal or no discomfort; ≥12 usually signals significant pain and distress. RESULTS: The median Premature Infant Pain Profile score during the procedure was 9 and decreased gradually toward 4 after 5 minutes. The lowest pain score was achieved by combining a pacifier with oral sucrose. Sterile water without a pacifier gave the highest score. CONCLUSIONS: Insertion of a feeding tube in preterm infants leads to a measurable degree of pain and discomfort, according to the Premature Infant Pain Profile assessment tool. Pain relief was best achieved by combining a pacifier with 30% sucrose.