Author Identifier (ORCID)
Evalotte Morelius: https://orcid.org/0000-0002-3256-5407
Abstract
Objective To explore the effects of immediate parent–infant skin-to-skin contact (iSSC) at very preterm birth on maternal–infant behavioural responses and hypothalamic–pituitary–adrenal (HPA) axis reactivity to age-appropriate socio-emotional stress at 4months corrected age. Design Two secondary outcomes from a multicentre randomised controlled trial with two non-blinded parallel groups. Setting Three Scandinavian neonatal intensive care units, level 2 and level 3. Participants 91 infants born at gestational age 28+0to 32+6 from April 2018 to June 2021. Singletons and twins with a second caregiver present were included, regardless of mode of birth. Higher-order births, infants with congenital infections and major malformations were excluded. Intervention Infants were randomised before birth to iSSC (n=46) or conventional care (n=45) during the first 6hours of life. At 4months corrected age, the infants were exposed to socio-emotional stress using the Face-to-Face Still-Face procedure (FFSF). Salivary cortisol was collected before and after FFSF. Main outcome measures Behavioural and hormonal stress responses at 4 months of age. Results 65 of 91 infants were assessed by FFSF, of which 37 infants had cortisol sampling. The iSSC group demonstrated heightened positive emotionality during FFSF compared with controls (beta 0.74, 95%CI 0.40 to 1.07; p<0.001). Also, the iSSC group showed an association between mother−infant cortisol levels at baseline (r 0.55, 95%CI 0.13 to 0.80; p=0.014) and 30min post-FFSF (r 0.55, 95%CI 0.05 to 0.83; p=0.035). Conclusion Infants who experienced iSSC during the first 6hours after very preterm birth showed improved infant socio-emotional stress coping and suggested enhanced mother–infant HPA axis synchrony at 4months.
Keywords
Endocrinology, intensive care units, neonatal, neonatology, psychology
Document Type
Journal Article
Date of Publication
2-11-2026
Volume
10
Issue
1
PubMed ID
41672603
Publication Title
BMJ Paediatrics Open
Publisher
BMJ Publishing Group
School
School of Nursing and Midwifery
Funders
Laerdal Foundation (5007, 40202) / Norwegian Health Region West (F- 12504- D11698) / BabyBjörn / Swedish Research Council (2017- 01497, 2021- 03169) / Region Stockholm (ALF, 2019- 0374) / Karolinska Institutet / Italian Ministry of Health Ricerca Corrente and Ricerca Finalizzata (SG- 2018- 12368279) / Little Child’s Foundation / Kempe Carlgrenska Fonden / Swedish Order of Freemasons Foundation / Sällskapet Barnavård
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Lode-Kolz, K., Lillieskold, S., Hetland, H. B., Mascheroni, E., Klemming, S., Pike, H., Linner, A., Bergman, N. J., Westrup, B., Ådén, U., Morelius, E., Montirosso, R., Jonas, W., & Rettedal, S. (2026). Immediate skin-to-skin contact at very preterm birth and effect on infant socio-emotional stress response and mother–infant cortisol co-regulation: secondary outcomes from the randomised clinical Immediate Parent-Infant Skin-To-Skin Study (IPISTOSS). BMJ Paediatrics Open, 10(1), e003778. https://doi.org/10.1136/bmjpo-2025-003778