Background: 

Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood.

Objective: 

Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress.

Methods: 

A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria.

Results: 

Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC.

Implications for Practice and Research: 

While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.

Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48

中文翻译：

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皮肤接触对早产儿和父母压力生物标志物影响的系统评价

背景： 

早产儿及其父母经历与分离和救生程序相关的巨大压力。虽然有证据表明，皮肤接触 (SSC) 对新生儿和父母都是一种减轻压力的干预措施，但其功效背后的机制尚不清楚。

客观的： 

本系统评价的目的是总结与早产儿和父母的 SSC 相关的生物标志物（即催产素 [OT]、皮质醇、次黄嘌呤、黄嘌呤、尿酸和尿囊素）变化的当前知识状态，这可能反映对压力的生理反应。

方法： 

从 1990 年到 2020 年进行了全面的文献检索。使用预先指定的纳入和排除标准选择研究。

结果： 

在确定的 175 项研究中，只有 19 项被纳入本综述。10 项研究仅评估了婴儿，2 项研究仅评估了父母，7 项研究评估了婴儿和父母双方生物标志物的变化。皮质醇是评估的最常见的生物标志物。虽然婴儿皮质醇水平的变化差异很大，但在 55% 的父母研究中，父母皮质醇水平在 SSC 后下降。在父母和婴儿中，SSC 后 OT 水平下降。只有一项研究发现接受 SSC 的婴儿的尿囊素水平显着降低。

对实践和研究的启示： 

虽然有证据表明 SSC 的诸多好处，但仍需要进一步的研究来确定最佳生物标志物，以确定这些影响背后的机制。使用新的生物标志物（例如，基因表达改变微生物组）可能会为 SSC 功效的机制提供新的见解。

视频摘要见：https ://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48