Abstract
INTRODUCTION: Despite improved survival of preterm infants, neonatal complications and long-term morbidity remain high, highlighting the need for optimized care in neonatal intensive care units. Developmental care aims to reduce stress and better align the extrauterine environment with intrauterine conditions, and has been associated with improved short- and long-term outcomes in preterm infants. In Ukraine, its implementation is limited, and evidence on its association with clinical outcomes in routine neonatal practice is lacking. The aim of this study was to evaluate the association between the implementation of developmental care elements, including skin-to-skin contact, and early clinical outcomes in preterm infants. MATERIALS AND METHODS: This was a single-center, non-randomized observational before-after cohort study. The study compared outcomes of preterm infants before and after the implementation of developmental care as part of routine clinical practice, using a retrospective control group. Two groups were included: 91 infants receiving developmental care (19 extremely and 72 very preterm infants) and 119 infants receiving standard care (21 extremely and 98 very preterm infants). RESULTS: Developmental care was associated with lower rates of late-onset sepsis in extremely (42.1% vs. 76.2%, p = 0.049; OR = 0.23) and very preterm infants (11.1% vs. 22.4%, p = 0.041; OR = 0.37), lower rates of intraventricular hemorrhage in very preterm infants (13.9% vs. 30.6%, p = 0.008; OR = 0.37), and lower stage III retinopathy of prematurity (ROP) in extremely preterm infants (26.3% vs. 61.9%, p = 0.025; OR = 0.22), compared with standard care. Infants receiving developmental care had shorter length of hospital stay (p = 0.037 and p < 0.001 for extremely and very preterm infants, respectively), shorter duration of mechanical ventilation in very preterm infants (p = 0.045), lower risk of postnatal growth failure (26.3% vs. 57.1%, p = 0.048; OR = 0.20 in extremely preterm; 9.7% vs. 37.8%, p < 0.001; OR = 0.18 in very preterm). Developmental care with skin-to-skin contact was associated with twice the rate of prolonged breastfeeding in very preterm infants (p = 0.028; OR = 2.03), with higher breastfeeding at discharge (47.2% vs. 30.6%, p = 0.020). CONCLUSION: Implementation of developmental care, including skin-to-skin contact, in preterm infants was associated with lower rates of late-onset sepsis, intraventricular hemorrhage, ROP, and postnatal growth failure, shorter hospital stays and mechanical ventilation, and higher rates of breastfeeding at discharge.