Summary: In very preterm infants, greater amounts of skin-to-skin contact during the hospital stay were associated with measurable differences in brain regions involved in stress response and emotional regulation. Diffusion MRI markers indicated that longer skin-to-skin sessions corresponded with alterations in white matter tracts that support attention, memory, and emotional processing.
These relationships persisted after accounting for socioeconomic status and other clinical factors, suggesting that early caregiving experiences in the neonatal period may influence white matter development in preterm infants.
Key Facts
- Study group: 88 infants born at about 29 weeks’ gestation, with an average birth weight of 2.65 pounds.
- Brain findings: More and longer skin-to-skin sessions were linked to differences in white matter microstructure in emotion-related brain regions.
- Caregiving implications: Results support the idea that early parent–infant contact can play a role in shaping brain development for preterm babies.
Source: AAN
Overview: A study published in the September 24, 2025 issue of Neurology examined whether skin-to-skin contact (kangaroo care) during the hospital course of very preterm infants was associated with white matter development in brain systems tied to emotional and stress regulation. The study reports associations but does not establish causation.
“Previous research has shown that skin-to-skin care benefits preterm infants’ physiological stability, bonding, sleep, and growth, and can reduce pain and stress,” said lead author Katherine E. Travis, PhD, of the Burke Neurological Institute. “Our results indicate that kangaroo care may also be associated with early brain development in frontolimbic systems important for socioemotional function.”
The observational study included 88 infants born before 32 weeks’ gestation (mean 29 weeks; about half female) with an average birth weight of 2.65 pounds. The typical hospital stay was about two months. Researchers quantified skin-to-skin care provided by family members throughout hospitalization, tracking both the length of each session and the total minutes per day.
On average, families visited once per day and the average skin-to-skin session lasted roughly 70 minutes; mothers provided about 73% of sessions. Across the full hospital stay, the mean daily exposure to skin-to-skin contact was 24 minutes per day.
Each infant underwent a diffusion MRI scan prior to discharge, approximately at the infant’s expected full-term age (around 40 weeks). Diffusion MRI assesses the movement of water molecules through brain tissue, which provides insight into white matter microstructure — the brain’s communication network. The investigators compared diffusion measures with both per-session duration and daily minutes of skin-to-skin care.
Longer duration per skin-to-skin session was associated with higher mean diffusivity (MD) in two frontolimbic tracts: the cingulum, which supports attention and emotion regulation, and the anterior thalamic radiations (ATRs), which connect regions involved in emotional processing and memory. Longer sessions were also linked to lower fractional anisotropy (FA) in the ATRs. Higher daily totals of skin-to-skin care showed a similar pattern in ATR MD and ATR FA.
These associations remained statistically significant after adjusting for potential confounders, including gestational age at birth, postmenstrual age at scan, socioeconomic status, medical acuity, MRI coil type, and visitation frequency. The relationships also held after excluding infants with observable white matter injury.
“Our findings add to evidence that white matter development in preterm infants can be influenced by early experiences in the neonatal intensive care unit,” Travis said. “Skin-to-skin care not only fosters parent–infant bonding but may also be associated with maturation of neural pathways that support emotional and cognitive outcomes.”
The study’s limitations include its retrospective, single-center design and reliance on medical record documentation of caregiving. The authors recommend prospective, multi-center research to further explore how early caregiving practices like kangaroo care might influence brain development and later behavioral outcomes in children born preterm.
Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Questions Answered
A: Longer and more frequent skin-to-skin sessions were associated with differences in white matter microstructure in brain regions tied to emotion and stress regulation.
A: Researchers used diffusion MRI to assess white matter microstructure, focusing on mean diffusivity (MD) and fractional anisotropy (FA) in several frontolimbic tracts.
A: No. The study demonstrates associations but cannot confirm causation; further prospective studies are needed.
About this neurodevelopment research news
Author: Renee Tessman
Source: AAN
Contact: Renee Tessman – AAN
Image: Credit to Neuroscience News
Original research: Closed access. “Skin-to-Skin Holding in Relation to White Matter Microstructure in Infants Born Preterm” by Katherine E. Travis et al., published in Neurology.
Abstract
Skin-to-Skin Holding in Relation to White Matter Microstructure in Infants Born Preterm
Background and objectives
Preterm birth is linked to altered white matter maturation and an increased risk of long-term neurodevelopmental challenges. While skin-to-skin care is known to support physiologic stability and parent–infant bonding, its relationship with early brain structure is not fully understood. This study aimed to describe associations between in-hospital skin-to-skin care and white matter microstructure in frontolimbic tracts involved in stress regulation and socioemotional development.
Methods
This single-center, retrospective observational analysis used electronic medical records and diffusion MRI scans from infants born before 32 weeks’ gestation who underwent routine predischarge MRI. Skin-to-skin care was measured as average duration per instance and daily exposure (minutes per day) prior to MRI. Diffusion MRI provided measures of mean diffusivity (MD) and fractional anisotropy (FA) in the cingulum, anterior thalamic radiations (ATRs), and uncinate fasciculus. Hierarchical regression models tested associations while adjusting for gestational age, medical acuity, postmenstrual age at scan, and MRI coil type.
Results
Eighty-eight preterm infants (mean GA 29 weeks; 49% female) were included. Longer skin-to-skin duration per session was positively associated with MD in the cingulum and ATRs, and both per-session duration and daily exposure were negatively associated with ATR FA. No significant relationships were observed for the uncinate fasciculus. Results remained after adjusting for socioeconomic status, visitation frequency, and excluding infants with white matter injury.
Discussion
Skin-to-skin care was associated with neonatal white matter microstructure in specific frontolimbic tracts. Limitations include the retrospective design and single-center sample. Future prospective, multi-site studies should examine how early caregiving experiences like kangaroo care may influence brain development and longer-term behavioral outcomes for infants born preterm.