Efeito do tempo de início e de exposição ao contato pele-a-pele sobre resultados Neonatais

Abstract

Low birth weight newborns are at great morbimortality risk in the neonatal period. Skin-to- skin contact (SSC), an important guideline of the Kangaroo Method, has shown itself

effective in promoting positive outcomes in this population, however, the exposure time necessary to achieve these results still lacks further investigation. This paper aimed to investigate SSC use in Brazilian neonatal units and which protecting effects can be seen with this practice. Methods: prospective longitudinal study, regarding SSC duration time in newborns weighing less than 1800 grams, admitted in five Brazilian health centers, from May 2018 to March 2020. Deaths in the first week of life, children with malformations, with perinatal asphyxia or any other condition that did not allow the SSC to be performed were excluded. The SSC was recorded by means of an individual form filled out by the health team and the neonate’s family during their hospital stay. Maternal and newborn data were obtained through direct questionnaires with the mothers and the charts of both. A machine learning method, the classification tree (CT), was used for data analysis. The algorithm generated by this tree identifies, through statistical tests, which set of variables best explains the proposed result, as well as selecting cutoff points on continuous variables that remain associated with the outcome. Results: a total of 405 dyads (mother/child) participated in the study. The median gestational age and birth weight of the newborns were 31.4 (33.3 – 29.1) weeks and 1369.7 (1605– 1164) grams, respectively. The median time to perform the first SSC was 5 (4- 8) days, and the duration of contact was 147(106.7-263) minutes/day and the frequency of 1.5 (2.45 – 1.2) times a day. Most women were young adults aged 20-34 years (63.5%), had a partner (82.1%) and progressed to cesarean delivery (66.7%). During the entire period of the NB hospitalization, the mothers had a longer CPP, a median of 2496 minutes (6557-1172) than the fathers. The late death rate (after 7 days of life) of the NB was 4%, with the median of the admission severity score being 5(0-15). The EBF rate at hospital discharge was 61.6% (excluding all deaths). After analysis by the CT, none of the maternal variables remained associated with the outcomes under study. Regarding the outcome of death, a significant association was identified with the performance of the first SSC after 206h (p=0.02). Although there was no association between the duration of SSC/day and death (p=0.09), this occurrence was lower in the group that performed longer than 146.9 minutes/day (3;1.5%) than in the group that performed for a shorter time (13;6.4%), that is, the number of deaths was 4 times higher in those who had a short time of SSC. Other variables identified by the CT associated with this outcome were: presence of early and late infection. The group that had been on SSC longer and had no early infection, the probability of death was zero. There was also a zero probability of death, the group that, even with a shorter duration of SSC, did not develop late infection. Regarding the EBF outcome, there was a strong association with the duration of SSC greater than 149.6 minutes/day in newborns with birth weight between 1125 grams and 1655 grams (p<0.001), especially in those with a zero SNAPPE-II score at admission (83.6% of EBF). However, regardless of the SNAPPE-II score, the SSC/day variable appears in the explanatory model of CT, together with birth weight, as the strongest association with the EBF at hospital discharge. Conclusion: In the units evaluated, the SSC is practiced as a care routine, intermittently, around one and a half times a day, predominantly by mothers. This study strengthens the role of SSC in contributing to positive neonatal outcomes, making it relevant as a good care practice in Neonatal Units. It is recommended that the first SSC be performed early, not exceeding the NB eight days of life and a daily time greater than 146.9 min/day, together with the control of early and late infections, for protection from neonatal death. It is also recommended to perform the CPP in a time greater than 149.6 min/day to promote EBF at hospital discharge.