Skincubator, a Novel Incubator for Skin to Skin Contact Feasibility Study

Study design: This is a non-randomized feasibility trial with no control group in which the investigators will offer parents the option to perform Skincubator care - being cared for in SSC inside the Skincubator, which is placed on the mother and/or another caregiver. Skincubator care will be provided from birth if the caring team and the parents feel it is appropriate. The option for Skincubator care will be provided for as long as the parents, surrogates, and staff feel comfortable with a goal of possible achievement of the WHO target of 8 hours per day. Each infant will participate in the study for one week from enrollment (If parents desire, they will be able to continue using the Skincubator beyond 1 week as long as NICU staff feel that it is helpful for the baby).

Implementation phase: Prior to beginning the study, each center will provide care in the Skincubator for five noninvasively ventilated preterm babies. After gaining experience in treating a preterm baby in the Skincubator and performing manikin simulations of Skincubator care for invasively ventilated babies, the NICU team in each center will be able to decide whether to include intubated babies in the trial.

Population: up to 25 preterm neonates in each site, born at GA of 24.0-32.6 with birth weight of <1.5 kg.

First 3 babies will be of GA of 26-32.6 and on noninvasive respiratory support. Those babies will be considered a learning phase for the team, and may be analyzed separately. After completing the learning phase the study will proceed with 4 groups:

• Up to 7 more babies of GA of 26-32.6 and on noninvasive respiratory support.
• 5 Intubated babies with GA of 26-32.6. The investigators will start enrolling babies from this group only after the team treated at least 5 babies from group 1 (including the learning phase) and feels ready to move on to intubated babies.
• 5 babies GA 24.0-25.6 on noninvasive respiratory support. The investigators will start enrolling babies from this group only after the team treated at least 5 babies from group 1 (including the learning phase) and feels ready to move on to this age group.
• 5 intubated babies with GA of 24.0-25.6. The investigators will start enrolling babies from this group only after the team treated at least 3 babies from group 2 and 3 babies from group 3, and only if the team feels ready to move on to this group also.

First five babies will be treated in the Skincubator only from NICU admission. After gaining experience with the first 5 babies the team may decide to start Skincubator care in birth suite (ideally on the mother, potentially on the father if the mother prefers or is feeling unwell) or in cesarean section theater (on the father).

Inclusion criteria

• Preterm neonates with birth weight of <1.5 kg
• Requiring respiratory support
• Cared for in an incubator with at least 60% humidity.

Exclusion criteria

• Critical congenital heart disease
• Suspected genetic syndrome
• Hemodynamic instability
• Having a chest tube,
• Significant congenital anomalies,
• Need for surgery
• If the attending neonatologist decides that the Skincubator is not safe for a specific baby.
• Neonates whose mothers have a significant mental disorder that is not adequately controlled
• Neonates of parents unable to perform extended SSC for any reason will be excluded as well.