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Tactile Stimulation for Newborns – Revisited

March 9, 2022

In a recently released issue of Pediatrics, Dr. Ruth Guinsburg and colleagues on behalf of the International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force present a systematic review on the evidence regarding the potential benefit of tactile stimulation at birth for infants with insufficient respiratory effort (10.1542/peds.2021-055067). Expert opinion and consensus, and historical practice, formalized in ILCOR’s treatment recommendations and considered standard care, have included tactile stimulation as an initial step in stabilization for decades. The authors used a systematic review format to ask whether this tactile stimulation increases the rate of establishment of spontaneous breathing without positive pressure ventilation (PPV), shortens time to first spontaneous breath or cry, or shortens time to a heart rate of 100 or more beats per minute.

What exactly is meant by “tactile stimulation” and how is it different from usual care? Routine handling includes usual efforts to maintain temperature, such as positioning, drying, and any additional thermal care. Tactile stimulation includes flicking the bottoms of the feet, rubbing the back gently or drying with a towel. It’s fascinating to consider whether interventions that have been practiced for decades, such as tactile stimulation, are actually effective or helpful. As many physicians may recall, the role of oxygen in causing retinopathy of prematurity was not appreciated initially, and it was difficult to think that a “good” and “benign” treatment, i.e., oxygen, could possibly cause harm. It is forward thinking of Dr. Guinsburg and colleagues to examine historical practices for their current effectiveness because time spent performing ineffective interventions (does this include tactile stimulation?) has potential to delay effective care (such as bag and mask ventilation) that may be lifesaving.

You may be surprised at how few studies could ultimately be included in their systematic review, of the 2,455 articles identified initially, just 2 met their eligibility criteria. The authors walk us through their rigorous methods in a way that all can understand and explain clearly why ultimately just one article offered useable information. Is tactile stimulation beneficial? As you can see from the “what this study adds” blurb, the authors identified possible benefit but with low certainty of evidence. What’s your take on this? Do we need good science here or should we “let sleeping dogs lie” and continue this time-worn intervention?  Would you encourage expectant parents in your practice to enroll their baby in a (hypothetical at this point) randomized clinical trial comparing tactile stimulation (+usual care) versus usual care only for respiratory insufficiency at birth? Let us know what you think about this question, and also about this thought provoking study.

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