(66) Skin-to-skin Care in Preterm Infants Is Associated with Improved Cognitive Development: A Propensity Score Analysis

Background: Skin-to-skin care (SSC) can support infant neurodevelopment by lowering stress and offering beneficial sensory input amid the bright, noisy NICU setting. Yet its longer-term effects on preterm infants’ cognitive outcomes are sparsely studied from developed nations.

Objectives: To determine the effects of SSC in preterm infants during initial NICU hospitalization on cognitive development at 2 years corrected age (CA).

Design/Methods: We conducted a multicenter retrospective cohort sub-study within the prospective CINEPS cohort, enrolling infants born ≤32 weeks gestation at 5 level III/IV NICUs (09/2016–11/2019). We excluded one site for inconsistent SSC documentation and infants with chromosomal or CNS anomalies, cyanotic heart disease, or prolonged ventilation on >50% oxygen at 44 6/7 weeks CA. We identified SSC episodes from NICU documentation and adjusted for length of stay. At 22–26 months CA, we administered the Bayley-III Cognitive, Language, and Motor Scales, with cognitive scores as the primary outcome. We grouped infants by SSC exposure (high: ≥1 episode/week; low: < 1/week) and compared maternal and infant characteristics. To control for confounding, we used a propensity score model based on maternal marital status, insurance, employment, income, early SSC, study site, antenatal steroids, antenatal magnesium, and prophylactic indomethacin. We applied inverse probability weighting (IPW) in linear regression to evaluate the association between SSC and neurodevelopmental outcomes.

Results: Of 246 infants who met the inclusion criteria, 60% (N=148) received ≥1 episode/week of SSC. These infants were more likely to have mothers who were privately insured, partnered, employed, and with higher income (Table 1). Follow-up at age 2 was completed for 87% (N=214) of the cohort. After IPW, the sample size decreased to 179, but baseline differences between the groups were substantially reduced (Figure 1). In unadjusted analyses, high SSC exposure was associated with higher cognitive (94 vs. 85, p < 0.0001) and language scores (97 vs. 89, p = 0.002, Table 2). Adjusted IPW models confirmed that increasing SSC exposure (continuous) was significantly associated with improved Bayley-III cognitive (β = 1.25, p = 0.02) and language scores (β = 1.64, p = 0.04) at 2 years CA (Table 3).

Conclusions: Higher frequency of SSC in the NICU was independently associated with improved cognitive and language outcomes at 2 years CA in preterm children, supporting SSC as a simple, low-cost neuroprotective intervention.