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

Abstract Background Immediate skin-to-skin contact (SSC) is the biological norm for newborns; however, preterm infants are routinely separated from their mothers at birth because of fears of thermal and clinical instability. This practice prioritizes technical stabilization and potentially deprives vulnerable neonates of critical physiological regulation during the transition to an extrauterine life. This systematic review and meta-analysis evaluated whether delivery room-SSC(DR-SSC), is a safe and effective alternative to standard incubator care for preterm neonates. Methods We conducted a systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science until November 24, 2025. We included randomized controlled trials (RCTs) comparing DR-SSC with standard care (incubator or radiant warmer) in preterm neonates (< 37 weeks gestation). The outcomes assessed included thermoregulation, cardio-respiratory stability, breastfeeding rates, and critical neonatal morbidities. Results Eight RCTs involving 562 preterm neonates were included in this review. DR-SSC reduced the risk of hyperthermia compared to standard care (three studies, 254 participants, risk ratio/ RR 0.65; 95% CI 0.49–0.87; moderate certainty), with no significant difference in the incidence of hypothermia below 36 °C (three studies, 308 participants, RR 1.61; 95% CI 0.51–5.1; very low certainty). Neonates in the DR-SSC group demonstrated higher exclusive breastfeeding rates at discharge (three studies, 192 participants, RR 1.10; 95% CI 1.01–1.19; low certainty). Cardio-respiratory stability measured by the SCRIP (stability of the cardio-respiratory system in the preterm) scores was similar at 60 and 120 min, but DR-SSC resulted in significantly better stability scores at 360 min (three studies, 222 neonates, MD 0.39; 95% CI 0.25–0.52, moderate certainty). There was no difference in the numbers of neonates who developed cardiorespiratory instability during the intervention (three studies, 197 participants, RR 3.1, 95% CI 0.44, 22, low certainty). There were limited data on critical neonatal outcomes. None of these studies included extremely preterm neonates or those with congenital anomalies. Conclusion Initiating skin-to-skin contact in the delivery room for clinically stable preterm neonates born at 28 weeks’ gestational age or beyond probably reduces the risk of hyperthermia and promotes exclusive breastfeeding. DR-SSC may not increase the risk of hypothermia or compromise cardio-respiratory stability. These findings suggest that DR-SSC is a promising strategy for selected preterm mother-infant dyads immediately after birth.