IN BRIEF

Skin-to-Skin Care Safe for Infants After Surgery

September 30, 2019
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A quality improvement project shows that skin-to-skin care can be safely integrated into the treatment of infants who require surgery.

Multiple barriers prevent routine skin-to-skin care for infants in the neonatal intensive care unit (NICU), particularly for infants requiring surgical consultation.

A recent quality improvement project, published in the Journal of Pediatric Surgery, shows that routine skin-to-skin care is possible for infants in the NICU who have had surgery.

“Skin-to-skin care improves brain development, stabilizes infant vital signs, decreases risk of infection and improves parent-infant bonding,” says Lorraine Kelley-Quon, MD, MSHS, FAAP, an assistant professor in the Division of Pediatric Surgery at Children’s Hospital Los Angeles and lead author of the new study. “We did not want surgical infants to miss out on those benefits.”

Dr. Kelley-Quon, who is also an assistant professor in the Department of Surgery and Preventive Medicine at Keck School of Medicine of the University of Southern California, led a team that used quality improvement methodology to address the issue while she was a Pediatric Surgery fellow at Nationwide Children’s Hospital.

“Instead of simply issuing a policy from on high and then assuming things will get better, quality improvement methodology involves identifying a problem, pinpointing barriers, developing interventions and measuring those interventions in a systematic way,” says Thomas Bartman, MD, PhD, associate chief medical officer at Nationwide Children’s and a co-author of the study.

The team identified several key areas as targets for improvement, including NICU culture, nursing engagement, surgeon endorsement and parental empowerment. Interventions included education of physicians, nurses, and families; adding orders for skin-to-skin care to electronic health records; and partnering with the communication department to promote skin-to-skin care throughout the hospital.

As a result, overall rates of skin-to-skin care in the NICU showed a sustained increase for 12 months.

“The most effective intervention was talking about skin-to-skin care on daily rounds,” says Dr. Kelley-Quon. “This helped remind the family and everyone on the care team that it was just as important to discuss as the dosing of antibiotics or the ventilator settings.”

Although “every institution is different,” according to Dr. Bartman, “this sends the message that if you take a systematic approach to the problem, any institution should be able to find solutions that can work for them to increase skin-to-skin care in surgical infants.”

Dr. Bartman, who is also a practicing neonatologist, notes that there is still room to improve and expand the scope of the project. “We’ll be continuing the interventions that worked and possibly coming up with more ideas to push our performance even higher,” he says.

“The next question to answer would be, how does skin-to-skin care improve recovery for infants after surgery?” says Dr. Kelley-Quon. “We may see different benefits for infants who receive surgery and skin-to-skin care that have not been observed before.”

 

Reference: 

Kelley-Quon LI, Kenney BD, Bartman T, Thomas R, Robinson V, Nwomeh BC, Bapat R. Safety and feasibility of skin-to-skin care for surgical infants: A quality improvement project. Journal of Pediatric Surgery. 2019 Feb 28. [Epub ahead of print]

Image credit: Nationwide Children’s