The research team, led by Purbasha Mishra of Smt. NHL Municipal Medical College in Ahmedabad, India, together with Shrutiprajna Kar and Rajendra Prasad Anne, conducted a systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science through November 24, 2025. They included only randomized controlled trials comparing delivery room skin-to-skin contact with standard care in neonates born before 37 weeks of gestation, and they assessed outcomes spanning thermoregulation, cardio-respiratory stability, breastfeeding rates, and critical neonatal morbidities. The question they set out to answer is deceptively simple but clinically profound: when a preterm infant is clinically stable at birth, does the biological norm of immediate maternal contact do harm, or does it help?

The physiology behind the debate is worth unpacking. A newborn preterm infant loses heat rapidly because of a high surface-area-to-mass ratio, thin skin, and limited subcutaneous fat, and cold stress in the first minutes of life is linked to serious consequences including hypoglycemia, respiratory distress, and increased mortality. Incubators and radiant warmers were engineered precisely to solve this problem. Yet the mother’s chest offers something no machine can replicate: a dynamic thermal field that adjusts to the infant’s needs, warming a cold baby and cooling an overheated one, a phenomenon often described as maternal thermal synchrony. Skin-to-skin contact also stabilizes heart rate and breathing, reduces crying and stress hormone levels, and promotes early colonization with maternal skin flora and the release of hormones that support breastfeeding. The concern, however, has always been that preterm infants, unlike full-term babies, might be too unstable to tolerate this arrangement safely in the first minutes and hours of life.

One of the most striking findings of the new analysis concerns overheating, a complication that receives far less attention than hypothermia but carries real risks for newborns, including apnea and metabolic stress. Across three studies encompassing 254 participants, neonates who experienced delivery room skin-to-skin contact had a significantly lower risk of hyperthermia compared with those receiving standard care, with a risk ratio of 0.65 and a 95 percent confidence interval of 0.49 to 0.87, a result the authors graded as being of moderate certainty. This finding aligns with the thermal synchrony hypothesis: the maternal chest appears to be remarkably good at not just warming babies but preventing them from becoming too warm, something radiant warmers in particular can struggle to achieve with precision.

What about the cold, the fear that has driven routine separation for generations? On this question the evidence is more equivocal. Across three studies with 308 participants, there was no statistically significant difference in the incidence of hypothermia, defined as a temperature below 36 degrees Celsius, between the skin-to-skin group and standard care, with a risk ratio of 1.61 and a wide confidence interval of 0.51 to 5.1. The authors graded the certainty of this evidence as very low, meaning the true effect could range from a substantial increase in risk to a meaningful reduction. The wide interval reflects small sample sizes and few events, a persistent challenge in neonatal research where recruiting large numbers of extremely vulnerable infants is ethically and practically difficult. Still, the point estimate and the lack of statistical significance suggest that fears of dramatic cooling during skin-to-skin contact may be overblown, at least for the stable preterm infants studied here.

Perhaps the most clinically consequential finding involves cardio-respiratory stability. The review used the SCRIP score, a validated tool measuring the stability of the cardio-respiratory system in preterm infants, which tracks heart rate, respiratory rate, temperature, and oxygen saturation over time. At 60 and 120 minutes of age, stability scores were similar between the two care approaches. But by 360 minutes, six hours after birth, infants who had received delivery room skin-to-skin contact showed significantly better stability scores, with a mean difference of 0.39 and a confidence interval of 0.25 to 0.52 across three studies involving 222 neonates, graded as moderate certainty. This delayed divergence is intriguing: rather than destabilizing fragile infants, sustained maternal contact appears to confer a physiological advantage that becomes apparent as the newborn continues the transition to extrauterine life.

Critically, the review also looked for evidence of harm and found little. There was no significant difference in the number of neonates who developed cardiorespiratory instability during the intervention itself, with three studies and 197 participants yielding a risk ratio of 3.1 but a very wide confidence interval of 0.44 to 22, graded as low certainty. The wide interval again reflects sparse data, but it does not signal a consistent danger. And in one of the most practical outcomes for families and health systems alike, skin-to-skin contact was associated with higher rates of exclusive breastfeeding at discharge: across three studies with 192 participants, the risk ratio was 1.10 with a confidence interval of 1.01 to 1.19, graded as low certainty. Early maternal contact is thought to prime the breastfeeding relationship by stimulating oxytocin release, encouraging the first latch, and keeping mother and baby together during the sensitive window when feeding behavior is established.

The authors are careful about the limits of their evidence, and those limits matter for how the findings should be applied. None of the included studies enrolled extremely preterm neonates, typically defined as those born before 28 weeks of gestation, nor infants with congenital anomalies, the very patients for whom the risks of separation and of contact are both most contested. Data on critical neonatal outcomes such as mortality, intraventricular hemorrhage, necrotizing enterocolitis, and chronic lung disease were limited, meaning the review cannot speak to whether DR-SSC influences these rare but devastating events. The certainty ratings ranged from moderate to very low across outcomes, a reminder that 562 infants spread across eight trials is a thin evidentiary base for a practice that would touch millions of births worldwide. The meta-analysis followed PRISMA reporting standards and was prospectively registered, lending methodological credibility, but the underlying trials themselves were small.

Even with those caveats, the implications for neonatal practice are substantial. The authors conclude that initiating skin-to-skin contact in the delivery room for clinically stable preterm neonates born at 28 weeks of gestation or beyond probably reduces the risk of hyperthermia and promotes exclusive breastfeeding, while likely not increasing the risk of hypothermia or compromising cardio-respiratory stability. In other words, the traditional justification for routine separation, that the incubator is demonstrably safer, is not supported by the best available evidence for a large group of preterm infants. What emerges instead is a picture of DR-SSC as a promising strategy for selected mother-infant dyads, contingent on clinical stability at birth and the availability of appropriate monitoring. Many neonatal guidelines, including those shaped by the World Health Organization’s embrace of kangaroo mother care, have been gradually moving toward earlier and earlier maternal contact, and this review adds rigorous, if still imperfect, evidence to that trajectory.

The human stakes are hard to overstate. Every year an estimated 13 million babies are born preterm, and the first hour of life, sometimes called the golden hour, shapes trajectories of survival, feeding, and bonding. If the simplest intervention imaginable, a mother holding her baby against her bare chest in the delivery room, can outperform a high-technology incubator on key measures of temperature regulation, six-hour physiological stability, and breastfeeding success, then delivery rooms everywhere may need to rethink their choreography. The next generation of trials will need to test the approach in extremely preterm infants, track long-term neurodevelopmental outcomes, and establish clear protocols for identifying which stable preterm babies can safely go to their mother’s chest instead of a plastic bassinet. For now, the message of this review is quietly revolutionary: for many preterm newborns, the safest place after birth may not be a machine at all, but the mother they were separated from in the first place.

Subject of Research: Delivery room skin-to-skin contact as an alternative to incubator care for clinically stable preterm neonates

Article Title: Delivery room skin-to-skin contact for preterm neonates: a systematic review and meta-analysis

Article References: Mishra, P., Kar, S., & Anne, R. P. (2026). Delivery room skin-to-skin contact for preterm neonates: a systematic review and meta-analysis. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07759-6

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07759-6

Keywords: preterm birth, skin-to-skin contact, delivery room, neonatology, hypothermia, hyperthermia, cardiorespiratory stability, breastfeeding, kangaroo mother care, systematic review, meta-analysis, incubator care