Inpatient Skin-to-Skin Care in Infants with Congenital Kidney Failure

Background: Infants with congenital kidney failure [CKF, kidney replacement therapy (KRT) initiated in the neonatal period] are at high risk for neurodevelopmental delay. Despite evidence supporting the neuroprotective benefits of skin-to-skin care in preterm infants, its use in infants with CKF is not well described. Methods: Single-center retrospective cohort study of 22 infants with CKF admitted to a tertiary neonatal intensive care unit (NICU) after May 2018, when skin-to-skin care criteria were standardized. Primary outcome was skin-to-skin care rate [total minutes of family-provided skin-to-skin care divided by the infant’s total NICU length of stay (LOS); minutes/total days in NICU]. Secondary outcomes were total number of sessions during NICU stay, duration (minutes/session) and proportion of days with family visitation (number of days with a family visit divided by total days in NICU). Group differences were assessed using Wilcoxon rank-sum and Fisher’s exact tests. Results: Nine infants (41%) received no skin-to-skin care. Infants born to white or non-Hispanic/Latino mothers were more likely to receive skin-to-skin care (Table 1). No other differences in demographics, contraindications to skin-to-skin care, dialysis characteristics, NICU LOS, proportion of days with family visitation or mortality were found. In the 13 infants who received any skin-to-skin care, median skin-to-skin care rate was 3.3 minutes/total days in NICU (IQR 1.5-7.2) [median 4 sessions (IQR 4-8) during NICU stay, 80 minutes/session (IQR 59-103)]. Conclusion: Skin-to-skin care was limited in this CKF cohort, with nearly half receiving none, despite frequent family visitation. This contrasts with published data from preterm infants without CKF at the same center, where infants' average skin-to-skin care rate was 18 minutes/total days in NICU. Further research is needed to identify modifiable barriers to skin-to-skin care in this high-risk population.