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Early skin-to-skin contact and risk of late-onset-sepsis in very and extremely preterm infants



To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants.


Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without exposure to SSC before day 4 of life and binomial log regression used to estimate risk ratios and CIs in the matched cohort. The primary outcome was at least one episode of LOS during hospitalization. Secondary outcomes were the occurrence of any late-onset neonatal infection (LONI), LOS with Staphylococcus or Staphylococcus aureus, incidence of LOS and LONI per 1000 central venous catheter days.


Among the 3422 included infants, 919 were exposed to early SSC. The risk ratio (RR) for LOS was 0.86 (95% CI, 0.67–1.10), for LONI was 1.00 (95% CI, 0.83–1.21), and for LOS with Coagulase-negative Staphylococcus or Staphylococcus aureus infection was 0.91 (95% CI, 0.68–1.21) and 0.77 (95% CI, 0.31–1.87). The incidence RR for LOS per-catheter day was 0.87 (95% CI, 0.64–1.18).


Early SSC exposure was not associated with LOS or LONI risk. Thus, their prevention should not be a barrier to a wider use of SSC.


  • Kangaroo Mother Care decreased neonatal infection rates in middle-income countries.

  • Skin-to-skin contact is beneficial for vulnerable preterm infants but barriers exist to its implementation.

  • In a large population-based study using a propensity score methods, we found that skin-to-skin contact before day 4 of life was not associated with a decreased risk of late-onset-sepsis in very and extremely preterm infants.

  • Early skin-to-skin contact was not associated with an increased risk of any late-onset-neonatal-infection, in particular with staphylococcus.

  • The fear of neonatal infection should not be a barrier to a wider use of early skin-to-skin contact in this population.

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Fig. 1: Study Flowchart.
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Data availability

The EPIPAGE studies are subject to a data-sharing policy that can be downloaded from, especially with the following link:


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All collaborators of the EPIPAGE-2 Neurodevelopmental care writing group and the EPIPAGE-2 Infectious diseases writing group have no conflict of interest or compensation in relation with this article to disclose. All consented to such acknowledgment. We are very grateful to the participating neonates and their parents. We also thank the members of national and regional coordination teams participating in this study for their substantial contribution to acquisition of data. We thank Laura Smales (BioMedEditing, Toronto, Canada) for English editing.


This project received funding support from the following: (1) The French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA). (2) The National Research Agency through the French EQUIPEX program of investments in the future (reference ANR-11-EQPX-0038). (3) The PREMUP Foundation. (4) The University Hospital of Strasbourg France supported ILR for research time. The funder/sponsor did not participate in the work.

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Authors and Affiliations




I.L.R. and P.K. conceptualized and designed this study, drafted the initial manuscript, and reviewed and revised the final version of the manuscript. M.K. and V.P. conceptualized and designed this study, and critically revised and reviewed the manuscript for important intellectual content. P.-Y.A. designed the EPIPAGE-2 study, coordinated and supervised data collection, supervised the analyses, and reviewed the manuscript. M.L. and L.M.-M. managed and cleaned the data, and critically reviewed the manuscript for important intellectual content. J.-M.R., A.M., I.G., L.F.-L. contributed to data collection, discussed the study design and reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Pierre Kuhn.

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Recruitment and data collection occurred only after families had received information and agreed to participate in this cohort by written informed consent.

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Le Ray, I., Kuhn, P., Letouzey, M. et al. Early skin-to-skin contact and risk of late-onset-sepsis in very and extremely preterm infants. Pediatr Res (2022).

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