2023-09-19 09:58:27
by Elisabetta Zocchi
An Italian study shows that two hours of immediate and uninterrupted “skin to skin” contact between mother and baby protects against “functional gastrointestinal disorders” in early childhood
The positive effects of mother-baby skin-to-skin contact immediately after birth have been studied for some time. Now new Italian research, in addition to confirming its effectiveness for the initiation and duration of exclusive breast feedings, turns the spotlight on the benefits for the functionality of the newborn’s intestine.
This is the study carried out by the University of Bari in collaboration with the Neonatology of the San Giovanni di Dio Hospital in Melfi directed by Doctor Saverio De Marca, which for the first time in the world highlights the protective role of this perinatal practice — two hours of immediate and uninterrupted skin-to-skin contact between mother and baby – on “functional gastrointestinal disorders” in early childhood.
These include colic which, due to its spread and impact on the quality of family life, is a “torture” for many new parents. According to the new study, which will be presented by one of the authors, Dr. Michela Casolino, at the XXX congress of the Italian Society of Pediatric Gastroenterology (SIGENP) in Matera from 28 to 30 September, simple skin-to-skin contact after childbirth seems to halve the overall incidence of these disorders and protect two-thirds of babies from the risk of colic.
«The benefits of skin-to-skin contact are evident – comments Mariella Baldassarre, associate professor of Pediatrics at the University of Bari -. The results of this first study represent the starting point for the collection of further data on larger groups of patients. And it will be necessary to investigate and clarify the mechanisms thanks to which this practice counteracts the factors causing functional gastrointestinal disorders and, in particular, colic.”
Colic: the bugbear of all new parents
The baby’s inconsolable crying fits, which constitute the most striking manifestation of this disorder, are a cause of great stress, alarm and a sense of helplessness for mothers and fathers, so much so that they represent a risk factor for post-natal depression and shaken baby syndrome, or syndrome of a child shaken by exasperated adults who, in a clumsy attempt to console him, instead cause him serious injuries. It must also be said that a significant portion of pediatric visits in the first months of life – around 10-20% – are motivated by colic. Their heavy impact on the psychological well-being of the family unit is not surprising if we consider the way in which they occur: the little one becomes red in the face, cries suddenly, uncontrollably and continuously, stiffens his arms and flexes his legs, has abdominal tension often accompanied but not necessarily by the emission of gas, which is why colic is also called “gaseous”. Furthermore, these episodes are concentrated in the evening hours, disturbing the rest of mothers and fathers. Furthermore, it is a rather common condition, which can affect 20% to 30% of infants usually aged 2 to 4 months, fortunately benign (if no other symptoms or alarm signs are associated) and temporary, which tends to that is, to self-limit, then resolve spontaneously.
A disorder that needs to be investigated to find effective answers
Thanks to new research, the protective role of early and prolonged skin-to-skin contact between mother and newborn after childbirth has emerged with respect to the onset of functional gastrointestinal disorders, primarily the well-known colic. But we need to ask ourselves how this practice actually acts on the underlying causes of the problem. «The etiopathogenetic factors of infantile colic that could be influenced are multiple – points out Professor Mariella Baldassarre – and include the microbiota-brain-intestine axis, the intestinal epithelial barrier function, intestinal inflammation and motility, visceral hyperalgesia . But epigenetics must also be considered, i.e. the action of environmental factors on individual genetic predispositions, as well as oxytocinergic mechanisms, i.e. the endogenous opioid system which favors both lactation and the creation of the mother-newborn bond of attachment and empathy. We have opened a path but there is much to explore.” In this regard it must be said that, despite the substantial amount of studies produced over time, the causes of the onset of colic are not yet completely known even if it is plausible to assume, as for other functional gastrointestinal disorders, a multifactorial nature which makes it even more the therapy chapter is a challenge. The factors hypothesized to cause colic include dysbiosis (alterations in quantity and quality of the intestinal bacterial flora), intestinal neuronal dysmotility and hyperexcitability, anomalous absorption of food antigens, intolerances (including to allergens from the maternal diet ), the abnormal production of inflammatory cytokines and neurotransmitters sensitive to receptors that induce contractions of the intestinal smooth muscles, disturbances in the parent-newborn relationship due to accumulation of anxiety and tension.
The brain and gut are connected by the microbiota
Today the most important innovative contribution of research concerns the hypothesized immaturity of the microbiota – i.e. the compositional characteristics of the intestinal bacterial flora – which could be among the predisposing causes. In particular, in recent years there has been talk of the gut-brain axis, i.e. a complex bidirectional communication network that allows the central nervous system to regulate many functions of the gastrointestinal tract which, in turn, can modulate the brain ones. And it would be precisely the microbiota of the intestine – that is, the vast ecosystem of microbial populations that inhabit it – that constitutes the interface of this “dialogue”, orchestrating a multiplicity of functions through nervous, hormonal, metabolic and immune pathways. This is why it is believed that the intestinal microbial alterations found in infants suffering from colic can compromise the integrity of the mucosal barrier and trigger an inflammatory state. Hence the use of specific probiotic strains to attempt to restore the correct balance.
More than cures, reassurances are worth it
Despite the various treatment approaches (drugs, supplements, phytotherapeutic remedies), including the recent use of probiotics which, moreover, do not represent a validated option in terms of cost-benefit balance, to date it has not been possible to develop a standardized therapeutic protocol due to the absence of unique data. This is why, currently, the most effective strategy remains the reassurance of parents, to whom the pediatrician must provide adequate counseling by explaining that, although the child’s crying may seem inconsolable, these crises are not an expression of pathology nor do they interfere with growth. Not to mention that the disorder can be attributable to a paroxysmal expression of crying which, in the first months of life, represents the only communicative method with which the infant is able to express his discomfort and difficulty in self-consoling. Therefore, it is essential for parents to remain calm and avoid reacting in an anxious and stereotyped way, perhaps by offering milk, which ends up overfeeding the baby and worsening his discomfort. In short, the risk is that the newborn who suffers from colic is transformed from a subject experiencing a stress condition to an “object” of stress for his parents, amplifying in a vicious circle the very manifestations of the disorder, which is significantly affected by the emotional component. This is also why breast feedings, in addition to providing the baby with the ideal food from a nutritional and immunological point of view, strengthen the psycho-affective bond and the maternal feeling of self-efficacy thanks to the “skin-to-skin” contact investigated by the new study. And it is no coincidence that physical closeness, the sweet and delicate action of rocking and massage are, in the daily experience of many parents, the winning moves to mitigate the discomfort of the baby with colic.
What the new Italian study reveals
The research has two objectives: to evaluate the possible impact of mother-newborn “skin-to-skin” contact (SSC) after birth on the prevalence and duration of breastfeeding and on the prevalence of functional gastrointestinal disorders (FGID). To this end, the study involved the recruitment of 160 healthy newborns, delivered at term vaginally, and then divided into two groups between those who had benefited from skin to skin contact (79) and the others (81). The perinatal procedure was implemented immediately and continuously in the first two hours after birth. All the babies were then monitored at 1, 3 and 6 months of life through questionnaires to collect data both on breastfeeding and on FGIDs in early childhood, as defined in the most updated guidelines (Rome IV criteria). Well, as regards the first objective, i.e. the prevalence of exclusive breastfeeding at three months of age, it emerged that 70.9% of the children subjected to the procedure were fed only with breast milk, compared to 53.1% of others. «And this supports the hypothesis according to which timely skin-to-skin contact represents an optimal viaticum for the correct start of breast feeding», comments Professor Baldassarre. For the second objective, i.e. the prevalence of functional gastrointestinal disorders, it was seen that among the 160 children recruited for the study, 82 then presented at least one disorder as defined by the most updated criteria. Over half of the children (51.25% to be precise) were affected by one or more disorders, but the proportions were significantly to the detriment of the children deprived of skin contact at birth who then presented a problem in a proportion large number of cases, equal to 62.9%, compared to 39.2% of the others.
Colic and dyschezia clearly decreased thanks to skin contact
If we then move on to the specific analysis of colic, we saw that the protective effect of skin-to-skin contact is even more consistent because it reduces its incidence to 7.6% compared to 22.2% in the other group. The difference in the prevalence of dyschezia (difficulty in evacuation) was also significant: 3.8% in the group of children benefiting from the procedure, compared to 13.6% in the others. And it should be underlined that none of the children who presented with dyschezia were exclusively breastfed, therefore suggesting a decisive protective role of maternal food. In summary, from the results of the study it can be deduced first of all that skin-to-skin contact after birth is confirmed as a significant factor in supporting the initiation and maintenance of exclusive breastfeeding up to six months of life. Furthermore, it emerged that children deprived of skin-to-skin contact presented a greater susceptibility to functional gastrointestinal disorders, in particular infantile colic and dyschezia. «Skin to skin immediately after giving birth certainly leads to an increase in the prevalence and duration of exclusive breastfeeding in the first months of life and to a significantly lower incidence of colic and dyschezia in babies», concludes Baldassarre.
September 19, 2023 (changed September 19, 2023 | 07:31)
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