Aim: To investigate the impact of immediate skin‐to‐skin contact with a parent after birth on thermal regulation in very preterm infants.Methods: This clinical trial was conducted in three neonatal intensive care units in Scandinavia from 2018 to 2021. Infants born between 28 + 0 and 32 + 6 weeks and days of gestation were randomised to immediate skin‐to‐skin contact or conventional care in an incubator during the first 6 postnatal hours. We report on a secondary outcome: serial measurements of axillary temperature.Results: Ninety‐one infants were randomised to skin‐to‐skin contact or conventional care. Mean (range) gestational ages were 31 + 2 (28 + 6, 32 + 5) and 31 + 0 (28 + 4, 32 + 6) weeks and days, mean birth weights were 1572 (702, 2352) and 1495 (555, 2440) grams, respectively. Mean (95%CI, p‐value) temperatures were within the normal range in both groups, 0.2°C (−0.29, −0.14, p < 0.001) lower in the skin‐to‐skin contact group. The skin‐to‐skin contact group had a lower relative risk (95%CI, p‐value) of developing events of hyperthermia, RR = 0.70 (0.50, 0.99, p = 0.04).Conclusions: Very preterm infants, irrespective of clinical stability, do not develop hypothermia during immediate skin‐to‐skin contact after birth. Immediate skin‐to‐skin contact did protect against events of hyperthermia. Concerns about thermal regulation should not limit implementation of immediate skin‐to‐skin contact in high‐resource settings.

Introduction In Scandinavia, 6% of infants are born preterm, before 37 gestational weeks. Instead of continuing in the in-utero environment, maturation needs to occur in a neonatal unit with support of vital functions, separated from the mother’s warmth, nutrition and other benefits. Preterm infants face health and neurodevelopment challenges that may also affect the family and society at large. There is evidence of benefit from immediate and continued skin-to-skin contact (SSC) for term and moderately preterm infants and their parents but there is a knowledge gap on its effect on unstable very preterm infants when initiated immediately after birth. Methods and analysis In this ongoing randomised controlled trial from Stavanger, Norway and Stockholm, Sweden, we are studying 150 infants born at 28+0 to 32+6 gestational weeks, randomised to receive care immediately after birth in SSC with a parent or conventionally in an incubator. The primary outcome is cardiorespiratory stability according to the stability of the cardiorespiratory system in the preterm score. Secondary outcomes are autonomic stability, thermal control, infection control, SSC time, breastfeeding and growth, epigenetic profile, microbiome profile, infant behaviour, stress resilience, sleep integrity, cortical maturation, neurodevelopment, mother-infant attachment and attunement, and parent experience and mental health. Ethics and dissemination The study has ethical approval from the Swedish Ethical Review Authority (2017/1135-31/3, 2019–03361) and the Norwegian Regional Ethical Committee (2015/889). The study is conducted according to good clinical practice and the Helsinki declaration. The results of the study will increase the knowledge about the mechanisms behind the effects of SSC for very preterm infants by dissemination to the scientific community through articles and at conferences, and to the society through parenting classes and magazines. Study status Recruiting since April 2018. Expected trial termination June 2021. Trial registration number NCT03521310 (ClinicalTrials.gov).