Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease.

Amy Jo Lisanti, Department of Cardiac Nursing and Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA
Abigail C. Demianczyk
Andrew Costarino
Maria G Vogiatzi
Rebecca Hoffman
Ryan Quinn
Jesse L Chittams
Barbara Medoff-Cooper


OBJECTIVE: To estimate the effect of skin-to-skin care (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery.

DESIGN: A prospective interventional, baseline response-paired pilot study.

SETTING: Cardiac center of a large, metropolitan, freestanding children's hospital.

PARTICIPANTS: Thirty women whose infants were hospitalized for neonatal cardiac surgery.

METHODS: Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin.

RESULTS: Significant reductions in self-reported scores of anxiety and salivary cortisol were found as a result of SSC at each time point, as well as increased self-reported attachment. No significant differences were found in oxytocin.

CONCLUSION: Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.