Vicki Hayes, you asked for references "about newborn regulating his vitals
and glucose better skin to skin than baking under a warmer."
A lot of basic work was done by Kyllike Christensen at the Karolinska
Institute in Sweden. Her studies are collected in her thesis: Care of the
Newborn Infant: satisfying the need for comfort and energy conservation.
You may be able to find one key study on line or in the library, since it
was published in Acta Paediatrica.
Christensson K, C Siles, L Moreno, A Belaustequi, P de la Fuente, H
Lagercrantz, P Puyol, J Winberg (1992) Temperature, metabolic adaptation
and crying in healthy, full-term newborns cared for skin-to-skin or in a
cot. Acta Paediatr Scand 81, 488-93.
In case you can't find the paper, here's the gist: Babies were dried after
birth, then placed either skin to skin or wrapped in a cot until 90 minutes
after birth. At 90 minutes, here were the significant differences:
The skin-to-skin babies had lower respiratory rates 44.3 vs. 49.8 sig
at 0.05 p value
The skin-to-skin babies had higher blood glucose 3.17 vs. 2.56 sig
at 0.001 p value
The skin-to-skin babies had higher change in base excess,
measured between cord blood at birth
and heel stick at 90 min 3.4 vs. 1.8
sig at 0.05 p value
The skin-to-skin babies also cried very much less, a total of 70 seconds out
of 15 minutes in three 5-minute observation periods, compared with 2839
seconds for the cot babies in the same three observation periods,
significant p < 0.001
The conclusion was "Our study shows that 'skin-to-skin' care, as compared to
care in a bed, during the unique period just following birth is associated
with higher body and skin temperatures and a more rapid metabolic
adaptation. Skin-to-skin care also seems to preserve the glycogen stores
and, possibly, increase the well-being of the baby."
"...[there was] a rapid increase in temperature between 5 and 10 min after
birth...[then] in the skin-to-skin group the phase of rapid increase was
followed by a slow and steady increase, whereas in the cot group the skin
temperatures levelled off at 30 min. The most reasonable explanation for
this is vasoconstriction in the cot group to conserve heat. Vasoconstriction
could be responsbile for a higher anaerobic metabolism, explaining the lower
glucose level and the slower normalization of base deficit in the cot
group."
The babies were not fed or moved during the study period. (This must have
been hard on the mothers of the cot babies, when the babies cried so much
but were not allowed to be picked up.)
These blood glucose levels are measured in mmol/l. Maybe Rachel Myr or other
European Lactnetters can translate this for the U.S. readers.
I'm not real sure what the "change in base excess" is either. Can somebody
enlighten me?
Note that this study compared babies in cots (not warmers) to babies
skin-to-skin.
In a later study, Christensen compared skin-to-skin with father to cot care
and to incubator care for Cesarean babies in the first 2 hours. Quoting from
the abstract: "The mean axillary temperature increase was significantly
greater in the skin-to-skin cared-for and incubator cared-for infants. Blood
glucose increase was significant in the skin-to-skin group, but not in the
other two groups....Interestingly, at 24 hours after birth the mean axillary
temperature was significantly higher in the skin-to-skin group than in the
incubator group..." The conclusion was that "fathers are as effective as
incubators for heat conservation in healthy fullterm caesarean section
delivered infants."
I hope this is what you are looking for.
Chris
Chris Mulford, RN, IBCLC
LLL Leader Reserve
Working for WIC in South Jersey (Eastern USA)
Chair, Workplace Bf Support Committee, USBC
Co-coordinator, Women & Work Task Force, WABA
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