Early skin-to-skin contact helps calm newborns but does not lower bilirubin

A randomized trial finds that early skin-to-skin care can ease newborn stress and support breastfeeding, but its role in reducing jaundice remains unclear.

Study: Effect of early skin-to-skin contact after vaginal birth on neonatal stress and day-5 bilirubin levels: a randomized trial. Image Credit: Sbethmorris / Shutterstock

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Background

Every year, millions of newborns experience routine medical procedures immediately after birth, many of which can cause unnecessary stress during an already challenging transition from the womb to the outside world. It is known that early SSC has a positive impact on adaptation, lactation, and mother-infant bonding.

Early breastfeeding can also help pass meconium and eliminate bilirubin from a newborn's body, which can reduce the severity of physiological jaundice. Despite these recognized benefits, evidence regarding the combined effects of early SSC on neonatal stress and TSB levels remains limited. Further research is needed to clarify these outcomes under routine clinical conditions.

About the Study

Researchers conducted a prospective, longitudinal, randomized clinical trial involving mothers of healthy term newborns who delivered vaginally at a university hospital in western Türkiye between June 2020 and March 2021.

The study received ethical approval, and written informed consent was obtained from the participants. The research followed Consolidated Standards of Reporting Trials (CONSORT) guidelines.

Eligible mothers were 18-45 years of age with singleton pregnancies at least 37 weeks of gestation and without medical conditions that could interfere with breastfeeding or neonatal outcomes. Healthy newborns with a fifth-minute Apgar score of at least eight and no congenital abnormalities or need for resuscitation were included.

After simple randomization by coin toss, mother-newborn pairs were assigned to either routine care or SSC. After exclusions, 30 mother-newborn dyads remained in each group for the final analysis. In the intervention group, SSC began approximately two to three minutes after birth, after routine procedures, and continued until transfer to the maternity ward, while breastfeeding was initiated during contact.

The control group received routine hospital care without SSC, although breastfeeding began within the first hour after birth. Neonatal stress was measured using the Newborn Stress Scale (NSS) at different time points, for example, immediately after birth, in the radiant warmer, and during Intramuscular (IM) vitamin K administration. For the intervention group, stress was also assessed five minutes after SSC initiation.

Fifth-day TSB concentrations were obtained from routine hospital laboratory records, and breastfeeding status and neonatal weight loss were also documented. Data were analyzed using IBM Statistical Package for the Social Sciences (IBM SPSS) Statistics 20.0, with statistical significance defined as p<0.05.

Study Results

Maternal and neonatal characteristics in both intervention and control groups were comparable for maternal age, birth weight, maternal education status, employment status, history of previous pregnancies, breastfeeding knowledge, and fifth-minute Apgar scores. However, the control group had a slightly lower mean gestational age than the intervention group (38.53±1.10 weeks versus 39.10±1.06 weeks; p=0.040).

Infants in the intervention group underwent SSC beginning approximately two to three minutes after birth, after routine procedures, for an average of 32.27±3.80 minutes, which ranged from 25 to 38 minutes.

Immediately after birth, the intervention group had median NSS scores of 5.00, interquartile range [IQR] 2.00, and the control group had median scores of 5.50, IQR 1.00, with no statistically significant difference (p=0.237). Likewise, stress scores measured while newborns were under the radiant warmer did not differ significantly between groups (p=0.485).

Within-group analyses further showed that NSS scores differed significantly across assessment points in both groups. In the intervention group, scores were lowest five minutes after SSC initiation, whereas in the control group, scores were lowest under radiant heating and rose again during IM vitamin K administration.

The breastfeeding results showed differences between the two groups. In the first 24 hours of life, nearly every infant in both groups was exclusively breastfed. There were 29 infants in each group who received only breast milk during this time. By the fifth day postnatally, however, 86.7% (26/30) of infants in the SSC group remained exclusively breastfed, whereas 60.0% (18/30) in the control group did so, a statistically significant difference (p=0.020).

Despite higher exclusive breastfeeding rates in the intervention group, TSB levels on the fifth postnatal day did not differ significantly. The median TSB level of the intervention group was 10.90 mg/dL (IQR 4.61), while it was 11.54 mg/dL (IQR 5.28) in the control group (p=0.126). Likewise, neonatal weight loss did not differ significantly between groups. Before breastfeeding at 24 hours, the median percentage weight loss was 2.98% in the intervention group and 3.41% in the control group (p=0.149).

On the fifth day, the median percentage weight loss was 2.94% and 3.38%, respectively (p=0.574). These findings indicate that early SSC reduced NSS-assessed neonatal stress and was associated with higher exclusive breastfeeding rates, but the study did not demonstrate statistically significant differences in fifth-day bilirubin concentrations or early neonatal weight loss.

Conclusion

Early SSC after vaginal delivery was linked to lower stress levels in newborns, especially during IM vitamin K administration. Early SSC was associated with higher exclusive breastfeeding rates during the first five postnatal days. However, despite this apparent breastfeeding advantage, no significant differences in day-5 TSB levels or infant weight loss were observed between the early SSC and routine postnatal management conditions.

These findings support the incorporation of early SSC into postnatal care to improve newborn comfort and breastfeeding success while indicating that its influence on bilirubin levels remains uncertain. However, the findings should be interpreted cautiously because the trial was single-center, had a small final sample, was retrospectively registered, used coin-toss randomization without allocation concealment, relied on unblinded NSS assessment, and measured bilirubin at only one postnatal time point.

As a result, the bilirubin findings should be considered exploratory and hypothesis-generating rather than conclusive. Larger studies are needed to evaluate this relationship further.

Journal reference:

• Kanad, N., & Yavuz, B. (2026). Effect of early skin-to-skin contact after vaginal birth on neonatal stress and day-5 bilirubin levels: A randomized trial. Scientific Reports. DOI: 10.1038/s41598-026-60971-3 Accepted manuscript / Article in Press. https://www.nature.com/articles/s41598-026-60971-3