25
at 1–4 months age and on exclusive breastfeeding at 4–6 months ater birth. It also noted that although there is low quality evidence, the cost of its implementation is
low and is most likely to be feasible to implement in low-resource settings.
5.3.1 Evidence and summary of findings
here was very low quality evidence from one Cochrane review published in 2007, although the studied population and intervention evaluated was generally in line
with the intervention of interest. he exception was skin-to-skin contact was started ater the irst hour of birth in some of the studies included in the recommendation.
Hence, the results should be interpreted with caution. Notably, there were important variations in the implementation of the intervention of interest. In many studies, the
intervention was not initiated immediately ater birth and its duration ranged from a few minutes to several hours in diferent trials. his is a common practice and being
implemented currently according to WHO guidelines. Since there was no notable harm in implementing this recommendation, the expected beneits outweighed the
risks.
here was very low quality evidence see GRADE table A7.3
in making this rec- ommendation. None of the studies included in the review examined the impact of
early SSC on neonatal mortality. Ten studies involving 552 participants have showed signiicant positive efects of early SSC on breastfeeding at 1–4 months post birth
OR=1.8, 95 CI 1.08 to 3.07. Only one available trial with 92 participants assessed the efect of SSC on exclusive breastfeeding at 4–6 months post birth. Results were
positive and statistically signiicant OR=5.67, 95 CI 2.27 to 14.16. he pooled ef- fect on mean duration of breastfeeding from seven trials 324 participants was not
statistically signiicant weighted mean diference [WMD] = 42.55 days, 95 CI -1.69 to 86.79.
hree studies, with 168 participants, measured the efect of SSC on body tem- perature in the second hour of life. Two of them measured the temperature ater
90 minutes of SSC and the third ater 2 hours of SSC. All three studies started the intervention immediately ater birth. he irst two studies observed a positive, statis-
tically signiicant efect while the third failed to demonstrate a signiicant diference in temperature between groups. Meta-analysis of these three studies showed a pooled
WMD of 0.25 degrees centigrade, 95 CI -0.15 to 0.65.
Although there were a few studies from developing country settings, the majority were conducted in hospitals from high-income countries. No adverse efects were
shown.
5.3.2 Benefits and risks
Benefits SSC has a positive efect on breastfeeding 1–4 months post birth and on exclusivity of
breastfeeding at 4–6 months ater birth low quality evidence for both. As exclusive breastfeeding is associated with improved survival, SSC may be expected to reduce
neonatal mortality.
