Does skin-to-skin contact reduce the risk of neonatal hypoglycaemia?

Encourage skin-to-skin contact between mother and baby as early as possible after birth. [Conditional recommendation]

Low certainty of evidence shows skin-to-skin contact may result in a large reduction in neonatal hypoglycaemia and duration of hospital stay, a small reduction in admission to NICU, less separation from the mother for treatment of hypoglycaemia before discharge home and a large increase in breastfeeding.

Skin-to-skin is largely acceptable and feasible as it is already standard practice in Aotearoa New Zealand. Cost is negligible.

WHO also recommends that early and uninterrupted skin-to-skin contact between mothers and babies should be facilitated and encouraged as soon as possible after birth.

Place the baby directly on the mother’s chest immediately after birth and cover both with a warm blanket. UNICEF recommends that babies should have skin-to-skin contact at least until after their first feed.

Skin-to-skin contact might not be appropriate for all babies, depending on the clinical condition of the mother and baby.

All babies should be routinely monitored whilst in skin-to-skin contact. Observations should include checking of airway and breathing, colour, tone and temperature.

If there are any concerns about the baby's oxygen saturation, it should be monitored closely.

Studies are needed on:

• Effect of skin-to-skin contact with adults other than the mother on neonatal hypoglycaemia.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.