Skin-to-skin contact in the neonatal intensive care unit


Skin-to-skin contact, sometimes called "kangaroo care," is a cheap, effective intervention to improve outcomes in preterm and low-birthweight infants.

According to the World Health Organization (WHO), over 15 million babies are born preterm—before 37 weeks’ gestation—every year worldwide. Preterm birth complications are the leading causes of death for children aged younger than 5 years. In 2019, 47% of all deaths under the age of 5 occurred in the newborn time period of the first 28 days of life. One-third of those deaths occurred on the day of birth, and three-fourths were the first week of life.1

One of the WHO’s many recommendations to improve survival and health outcomes in small and preterm infants is initiating skin-to-skin contact, or "kangaroo care."2 Starting kangaroo care early and performing it often has proven to be a safe, low-cost, and effective intervention for preterm and low-birth-weight infants.3 Also called kangaroo mother care, this is when the mother and baby have continuous skin-to-skin contact. These infants need interventions for hypothermia, better glucose levels, better regulation of blood pressure, and reducing stress hormone levels.4

During kangaroo care, a mother or father holds their baby’s chest to their chest, skin to skin, for a minimum of 1 hour per day. For a healthy term infant, this begins immediately after birth. For an infant who is preterm or low birth weight or had complications at birth, kangaroo care begins once the infant is stable.

Although the minimum time frame is 1 hour per day, the recommended time for kangaroo care is 2 to 4 hours per day.5 For an infant in the neonatal intensive care unit (NICU), health care workers including respiratory therapists and nurses can help with the placement of the infant on the mother’s chest. Infants who are intubated and have intravenous catheters can still be eligible for kangaroo care.4

Kangaroo care initiated early and done often provides many benefits to mothers and infants. Mothers who practice kangaroo care report enhanced attachment and bonding, more confidence in caring for their infant, increased milk production, and more success at breastfeeding.

Research from Vittner et al shows that kangaroo care is associated with an increase in oxytocin levels, which leads to decreased stress.6 Mothers who practice kangaroo care report breastfeeding their infants for a longer period of time each day at 1 month and at 6 months after discharge from the hospital.4

Additionally, fathers who participate in kangaroo care report enhanced bonding to their infant and more confidence in providing care and in providing for their infant.4 Importantly, both fathers and mothers experience decreased levels of anxiety during kangaroo care, and infants have decreased stress response regardless of which parent is holding them.

Infants in the NICU need kangaroo care as much as healthy newborns. Research shows that infants in the NICU who participate in kangaroo care have a reduced mortality rate, a better sleep-wake cycle, fewer incidents of infections, and increase in weight gain.4

Infants who are in the NICU and are stable tolerate kangaroo care well by keeping vital signs the same or having improved vital signs.4 Mothers, fathers, and caregivers of both term and preterm infants are encouraged to participate in kangaroo care to provide infants with the benefits of skin-to-skin contact.4


1. World Health Organization. Preterm birth: key facts. Accessed August 3, 2021.

2. WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. Accessed August 3, 2021.

3. Chan G, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bull World Health Organ. 2016;94(2):130–141J. doi:10.2471/BLT.15.157818

4. Gardner SL, Carter BS, Enzman-Hines M, Niermeyer S. Merenstein & Gardner's Handbook of Neonatal Intensive Care, 9th Edition. Elsevier; 2021.

5. Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016;11(11):CD003519. doi:10.1002/14651858.CD003519.pub4

6. Vittner D, McGrath J, Robinson J et al. Increase in oxytocin from skin-to-skin contact enhances development of parent-infant relationship. Biol Res Nurs. 2018;20(1):54-62. doi:10.1177/1099800417735633

7. Preterm and low brith weight. World Health Organization. Accessed August 4, 2021.

This article was originally published on Contemporary Pediatrics®.

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