Table 1.

Overview of the current evidence on TS in the delivery room.

First author, reference number	Study characteristics	Patient characteristics	Results
Dekker et al.29	Retrospective study 01/2007–06/2016	Stimulation group: GA 290/7 [273/7; 302/7] weeks n = 164	Analyzed time frame: first 7 min of resuscitation Details of TS: 67% stimulation rate onset after 114 s [73 s; 182 s] episodes per infant 3 [1; 5] duration per episode 8 s [4 s; 16 s] overall duration 32 s [15 s; 64 s] Methods (%—of overall episodes): 68% foot rub 12% back rub 2% foot flick 9% combination 8% others Physiological and clinical outcomes: 18% heart rate recovery (HR, >100 bpm) and/or increased breathing efforts 7% were intubated*
Gaertner et al.28	Retrospective study 2004–2006	<30 weeks of GA GA 270/7 [250/7; 280/7] weeks n = 60 ≥30 weeks of GA GA 345/7 [310/7; 390/7] weeks n = 60	Analyzed time frame: first 5 min of resuscitation Details of TS: 63% stimulation rate 58% stimulation within the first minute Methods (%—of overall episodes): 41% drying 37% chest rub 12% back rub 10% foot flick Physiological and clinical outcomes: HR increase (before and 5 s after stimulation) 1 bpm [−2 bpm; 3 bpm] SpO2 increase (before and 5 s after stimulation) 1% [−1%; 4%] 36% crying after stimulation 71% limb movements after stimulation 37% facial grimace after stimulation
			<30 weeks of GA): Details of TS: 35% stimulation rate onset after 19 s [13 s, 32 s] episodes per infant 0 [0; 1]*	≥30 weeks of GA: Details of TS: 90% stimulation rate onset after 19 s [15 s, 24 s] episodes per infant 1 [1; 3]*
Baik-Schneditz et al.42	Secondary analysis of the prospective study and RCT 01/2012–12/2014	<37 + 0 weeks of GA: GA 34.9 ± 1.4 weeks n = 18 ≥37 + 0 weeks of GA: GA 38.9 ± 0.73 weeks n = 25	Analyzed time frame: first 15 min of resuscitation Preterm infants: Details of TS: 43% stimulation rate episodes per infant 1 [1; 7], overall duration 15 s [5 s; 63 s] Methods (%—of overall infants): 56% sternum 28% feet 6% back 11% several different Physiological and clinical outcomes: SpO2 increase of 14.2 % (30 s before and after each stimulation)* no significant change in heart rate 78% needed respiratory support	Term infants: Details of TS: 54% stimulation rate episodes per infant 1 [1; 13], overall duration 29 s [4 s; 230 s] Methods (%—of overall infants): 28% sternum 28% feet 8% back 36% several different Physiological and clinical outcomes: no significant change in SpO2 no significant change in heart rate 39% needed respiratory support
Pietravalle et al.43	Secondary analysis of the prospective study	GA 38 [37; 40] weeks n = 102	Analyzed time frame: depends on the infant’s transition Details of TS: 68% stimulation rate 28% infants were stimulated within first minute onset after 134 s [53 s; 251 s] overall duration 17 s [9 s; 33 s] episodes per infants 4 [2; 7], Methods (%—of episodes): 54% back rub 79% chest rub 39% abdomen rub 39% foot flick 96% truncal stimulation (chest ± back rub) Physiological and clinical outcomes: response to TS (defined as complete newborn recovery (i.e., spontaneous breathing without need for PPV) in 9% of infants (especially after rubbing the back)
Dekker et al.27	Single-center RCT 09/2016–04/2017	270/7–320/7 weeks of GA Repetitive stimulation group (defined as gently rubbing the back or the soles of the feet during 10 s, alternated with 10 s of rest): GA 295/7 [281/7; 306/7] weeks n = 21 Standard stimulation group: GA 290/7 [275/7; 310/7] weeks n = 23	Analyzed time frame: first 4 min of resuscitation Standard stimulation Details of TS: 96% stimulated onset after 74.5 s [±42.9 s] episodes per infant 3 [3; 6]* overall duration 59 s [24 s; 120 s] Methods (%—of episodes): 4% back rub 91% foot rub 4% both Primary outcome: minute volume after 1–4 min 51.5 ml/kg [5.3 ml|kg; 114.2 ml|kg] Physiological and clinical outcomes: average oxygen saturation 81.7 ± 8,7% * FiO2 at the start of transport to the NICU 0.34 [0.29; 0.44]* caffeine administration 39.1%* No statistical differences between both groups:	Repetitive stimulation Details of TS: 100% stimulated onset after 71.3 s [±34.1 s] episodes per infant 8 [7; 10]* overall duration 86 s [63 s; 105 s] Methods (%—of episodes): 1% back rub 95% foot rub 4% both Primary outcome: minute volume after 1–4 min 69.2 ml/kg [11.5 ml/kg; 153.9 ml/kg] Physiological and clinical outcomes: average oxygen saturation 87.6 ± 3.3%* FiO2 at the start of transport to the NICU 0.28 [0.23; 0.35]* caffeine administration 9.5%*
			MV at minutes 1–4 and 1–7; respiratory rate, tidal volume, RoR of spontaneous breaths on CPAP, percentage of tidal volumes >4 ml/kg or >8 ml/kg; pulse rate, FiO2, administration/duration of PPV
van Henten et al.44	Prospective study	GA 34 [32; 36] weeks n = 40	Analyzed time frame: first 10 min of resuscitation Details of TS: 90% stimulated 48% repetitively onset after 15 s [10 s; 40 s] episodes per infant 1.5 [1; 3] overall duration 28 s [14 s; 47 s] Methods/location: 84% drying 43% rubbing 0% flicking 2.5% combination of different types 20% sternum/chest 20% back 0% feet 85% combination of different locations Physiological and clinical outcomes: no association between TS and first spontaneous breath

Only the data of stimulated infants are depicted. Data are presented as median (IQR) or mean ± SD, asterisks (*) mark the statistically significant results.

RCT randomized controlled trial, GA gestational age, TS tactile stimulation, HR heart rate, SpO₂ peripheral oxygen saturation, FiO₂ fraction of inspired oxygen, NICU neonatal intensive care unit, MV minute volume, RoR rate of rise to maximum tidal volumes, CPAP continuous positive airway pressure, PPV positive pressure ventilation.