Kangaroo Care Reduces Mortality for Low-Birthweight Infants

Sanjeet Bagcchi, MBBS

December 24, 2015

Kangaroo mother care (KMC), an intervention that facilitates skin-to-skin contact between newborn and mother, can substantially reduce mortality in low-birth-weight newborns, according to a meta-analysis published online December 23 in Pediatrics.

Ellen O. Boundy, ScD, from the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, and colleagues also found that in newborns, KMC can decrease the risk of neonatal sepsis, hypothermia, hypoglycemia, and hospital readmission and increase the likelihood of exclusive breast-feeding.

An estimated 4 million infants die each year in their first 4 weeks after birth, despite substantial progress toward Millennium Development Goal 4, which aims at reducing the mortality of children aged less than 5 years. "Infants born before term or at low birth weight (LBW) are at elevated risk of neonatal mortality and morbidity, inhibited growth and development, and chronic disease," the researchers write.

KMC was introduced in Bogotá, Colombia in 1978 as an alternative intervention to incubators for LBW newborns. As Dr Boundy and colleagues note, "The World Health Organization defines KMC with 4 components: early, continuous, and prolonged skin-to-skin contact (SSC) between the newborn and mother, exclusive breastfeeding, early discharge from the health facility, and close follow-up at home." The researchers add, "KMC is postulated to improve neonatal outcomes by maintaining the infant's temperature and other vital sign parameters through SSC and by providing the benefits of breastfeeding."

In the meta-analysis, Dr Boundy and colleagues looked at randomized trials and observational studies published through April 2014 and assessed the association between KMC and neonatal outcomes in infants with any birth weight and gestational age.

The team screened 1035 studies; however, 124 studies met the inclusion criteria and reported an association between KMC and at least one neonatal outcome. Of the 124 studies, 110 (89%) had been published during 2000 to 2014, and most of the studies (n = 113; 94%) were performed in middle- or high-income countries and conducted in health facilities (n = 118; 98%). Sixty-one (68%) studies involved preterm infants (<37 weeks' gestation), and 47 (58%) involved LBW infants (≤2500 g). In regard to KMC, as the researchers note, "[52] studies (66%) promoted <4 hours of SSC per day, 20 (25%) promoted ≥22 hours per day, and few studies (n = 7; 9%) had a duration between 4 and 21 hours per day."

Among LBW infants weighing less than 2000 g, KMC reduced mortality at latest follow-up time by 36% (95% confidence interval [CI], 0.46 - 0.89). KMC also reduced the risk for neonatal sepsis (relative risk [RR], 0.53; 95% CI, 0.34 - 0.83), hypothermia (RR, 0.22; 95% CI, 0.12 - 0.41), hypoglycemia (RR, 0.12; 95% CI, 0.05 - 0.32), and hospital readmission (RR, 0.42; 95% CI, 0.23 - 0.76) and could increase the likelihood of exclusive breast-feeding (RR, 1.50; 95% CI, 1.26 - 1.78).

"Newborns receiving KMC had lower mean respiratory rate and pain measures and higher oxygen saturation, temperature, and head circumference growth," the researchers add.

"Although the improvements in respiratory rate, oxygenation, and temperature that we found associated with KMC exposure may each be of modest clinical significance, when taken together they support the hypothesis that KMC improves overall physiologic regulation in the neonate, which could have important effects on other longer-term outcomes" the researchers write.

The authors also note several limitations, including the inability to adequately assess the dose–response relation between KMC duration and neonatal outcomes.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 23, 2015. Full text

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