Straight to you? Should preterm newborns be placed skin-to-skin with their mothers or under radiant heat?

To survive, newly born babies need to breathe effectively. They also need to keep warm – a strong association between hypothermia and death has been repeatedly demonstrated in term and preterm infants in developed and developing countries for more than 60 years. 1 Silverman W.A. Balnc W.A. The effect of humidity on survival of newly born premature infant. Pediatrics. 1957; 20: 477-486 Crossref PubMed Google Scholar , 2 Laptook A.R. Bell E.F. Shankaran S. et al. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr. 2018; 192: 53-59 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 3 Phoya F. Langton J. Dube Q. Iroh Tam P.Y. Association of neonatal hypothermia with morbidity and mortality in a tertiary hospital in Malawi. J Trop Pediatr. 2020; 66: 470-478 Crossref PubMed Scopus (10) Google Scholar Of the more than 130 million babies born in 2023, about 10% were born prematurely (before 37 completed weeks of gestation). 4 https://data.unicef.org/how-many/how-many-babies-are-born-each-year-in-the-us/ accessed 24.05.2023. Google Scholar Babies die more often and survivors have higher rates of long-term impairments if they are born prematurely. The majority of babies – and proportionally more premature babies – are born in low and middle-income countries (LMICs), where the resources available for medical care and for research are relatively scarce. Babies lose heat rapidly after birth, and premature babies are at particular risk. All babies need measures to reduce heat loss (e.g. drying, covering) and many appear to need an external heat source to maintain normal body temperature (36.5–37.5 °C). Warmth is commonly provided by placing babies on an open cot under a radiant heat source. This separates mother and baby and thus has the potential to interfere with bonding and establishing breastfeeding. It also potentially encourages caregivers to clamp the umbilical cord immediately after delivery, whereas waiting a while is beneficial to babies. 5 Rabe H. Gyte G.M.I. Diaz-Rossello J.L. Duley L. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2019; 9CD003248 PubMed Google Scholar As mothers are present at every birth and are an excellent source of heat up until that point, they certainly have the potential to be so afterwards. If premature babies are placed skin-to-skin with their mothers immediately after birth, can they breathe well enough? And can they keep warm?