Early essential newborn care for late preterm and term infants delivered by cesarean section: a randomized controlled trial on neonatal hypoglycemia and breastfeeding

Abstract

Objective: To evaluate the effects of Early Essential Newborn Care (EENC) on neonatal hypoglycemia and breastfeeding in late preterm and term cesarean-born infants. Methods: In this RCT, infants were randomly assigned to the EENC group (immediate skin-to-skin contact and early breastfeeding) or the control group (standard care). Blood glucose was measured at 1, 3, and 6 h post-birth. Breastfeeding outcomes included the onset of lactogenesis II and exclusive breastfeeding at discharge. Time to first breastfeeding was recorded solely as a process fidelity check to confirm intervention adherence. We used multiple imputation as the primary analysis for missing data and conducted pre-specified sensitivity analyses, including a complete-case analysis. Results: Infants in the EENC group had significantly higher blood glucose levels at 1 h (aMD = 11.56 mg/dL [95%CI: 8.85, 14.27]), 3 h (aMD = 9.06 mg/dL [95%CI: 7.08, 11.04]), and 6 h (aMD = 6.83 mg/dL [95%CI: 5.31, 8.36]) post-birth, compared to the control group (all p < 0.001). The RR for hypoglycemia was significantly lower in the EENC group (RR = 0.88, [95%CI: 0.80, 0.96], p = 0.006). Additionally, mothers in the EENC group experienced earlier onset of lactogenesis II (aMD=-8.82 h [95%CI: −10.23, −7.41], p < 0.001), and had a higher rate of exclusive breastfeeding (RR = 1.31 [95% CI: 1.02, 1.26], p = 0.022). Sensitivity analyses yielded consistent directions for primary glycemic and breastfeeding outcomes. Conclusion: The EENC improves neonatal glucose regulation and breastfeeding in cesarean-born late preterm and term infants, potentially enhancing neonatal health, maternal-infant bonding, and postpartum transition.