SKIN-TO-SKIN CONTACT IN NEONATAL CARE: CLINICAL SIGNIFICANCE, IMPLEMENTATION CHALLENGES, AND LONG-TERM OUTCOMES IN GEORGIA.

Abstract

Skin-to-skin contact (SSC) is a crucial component of neonatal care, playing a vital role in early physiological stabilization, neurodevelopment, and the formation of maternal-infant bonding. A growing body of evidence indicates that deprivation of SSC, particularly during the immediate postnatal period, is associated with long-term adverse outcomes, including emotional dysregulation, behavioral difficulties, and impaired cognitive development. Importantly, the absence of early SSC has also been shown to negatively affect the initiation and continuation of breastfeeding, thereby limiting its well-documented benefits for both infants and mothers. Our research focuses on the clinical condition of children in Georgia who were deprived of early skin-to-skin contact. The study was conducted by member physicians of a professional association - the Georgian Children's Health Care Association. (The study was conducted by the authors, whose professional backgrounds include pediatrics, allergy, and clinical immunology, and doctoral-level training in public health.) using a survey-based approach and obtaining informed parental consent. Over two years, 168 parents were interviewed during routine pediatric visits. The questionnaire included key variables such as: (1) mode of delivery (vaginal vs. cesarean section, elective or medically indicated), (2) whether SSC was initiated within the first hour after birth, and (3) type of feeding (breastfeeding vs. formula feeding). In cases of artificial feeding, additional data were collected regarding the use of specialized therapeutic formulas, particularly cow's milk protein allergy formulas, given their notably high usage in Georgia. For the clinical component of the study, a total of 168 children were initially assessed. From this cohort, 16 children aged 4-6 years were identified and selected for detailed evaluation, based on parental reports of limited SSC during the neonatal period, with maternal-infant separation lasting from one week to two months. These children presented with a range of developmental and behavioral challenges. From this group, 11 children aged 4-6 years were selected as a subgroup for detailed evaluation. These children presented with a range of behavioral disturbances, anxiety, difficulties in social interaction, attention deficits, and sleep disturbances, 5 children were selected as another subgroup who had developed behavioral challenges, including delayed speech development, emotional dysregulation, and were referred for psychological intervention. Additionally, from the same cohort of 168 children, 15 children aged 4-6 years were selected who did not have early skin-to-skin contact deficits but had similar behavioral difficulties. and were referred for psychological intervention. Following 6-7 months of therapy, significant improvement was observed across multiple domains. Although this issue requires further in-depth investigation and large-scale analysis, our findings, even within a limited sample, highlight the critical importance of SSC and underscore its benefits and role in the child's neurodevelopment. In the context of increasing global trends, including rising rates of surrogacy, assisted reproductive technologies, and single motherhood, observed both in Georgia and worldwide, ensuring early physical contact between newborns and caregivers is becoming increasingly relevant. We therefore emphasize the need for greater discussion, awareness, and integration of SSC into standard clinical practice.