“Early” or Timely Discharge in Kangaroo Mother Care: Evidence and Experience

Abstract

Caring for preterm and low birth weight (LBW) newborns in neonatal care units (NCU) can overwhelm healthcare systems in both developed and developing countries. Ensuring intact survival and adequate growth until term gestation and/or appropriate size is reached before discharging a LBW to the home environment leads to overcrowding of NCUs. This system undoubtedly contributes to increased morbidity and mortality due to the acquisition of secondary infections. Integral to the Kangaroo Mother Care (KMC) intervention is the policy of “early discharge” to the care of the mother/family, maintaining the kangaroo position in the home environment, coupled with frequent follow-ups in specialty clinics. This policy however, has been challenged due to the risks of loss to follow-up and inability to track neonatal outcomes especially in resource-limited places where provisions for ambulatory care are not in place or if available, cannot be accessed. This paper reviews the best available evidence on benefits, risks and safety of early discharge of LBW infants weighing < 2000gm from settings with and without KMC. Whereas safety and risks post-discharge are similar in both settings, the benefits on exclusive breastfeeding rates at discharge up to 3 months thereafter, maternal-infant bonding and family involvement are clearly evident in KMC settings. Unpublished experience by the authors on this policy are also discussed. A practical guide for the implementation of the early discharge policy of the KMC intervention is outlined. The early discharge policy is contingent upon a systematic, operational outpatient follow-up program, the absence of which should motivate the KMC program coordinator to devise appropriate measures to ensure survival and safety of the LBW infant in KMC. A low-care /KMC ward or a “halfway house” have been utilized as alternatives to home discharge in areas where follow-up cannot be assured.