Abstract

While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the “mother–newborn care unit (MNCU).” Mother–newborn care unit or mother–newborn intensive care unit (M–NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24 × 7, making the concept of zero-separation a reality.

Highlights

  • Quality Newborn Care in Low‐Resource SettingsIn developing nations, the quality-of-facility–based newborn care remains a challenge and we need to revisit our strategies for care of small and sick babies to achieve significant reduction in neonatal mortality and morbidity

  • The primary outcomes were death in the neonatal period and in the first 72 h of life. Immediate kangaroo mother care (iKMC) stands for immediate and continuous kangaroo mother care (KMC) which means KMC to be started soon after birth and to be given continuously before and after stabilization. Implementation of this trial led to development of the concept of “mother–newborn care unit (MNCU)”

  • Mother–newborn care unit (MNCU) or mother–newborn intensive care unit (M–neonatal intensive care units (NICU)) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers

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Summary

Introduction

The quality-of-facility–based newborn care remains a challenge and we need to revisit our strategies for care of small and sick babies to achieve significant reduction in neonatal mortality and morbidity. Studies from developed nations have shown that involvement of parents in care of newborns in NICUs results in better neonatal outcomes [6–8]. IKMC stands for immediate and continuous KMC which means KMC to be started soon after birth (within 2 h) and to be given continuously (aiming up to 20 h per day) before and after stabilization Implementation of this trial led to development of the concept of “mother–newborn care unit (MNCU)”. Mother–newborn care unit (MNCU) or mother–newborn intensive care unit (M–NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers This was necessary in study hospitals to implement iKMC to enrolled babies who all required NICU care because of their birth weight.

Mother in NICU
Opportunities for Improved Newborn Care in MNCU
Mother as Caregiver and Not a Mere Visitor
Outcomes in MNCU
MNCU Challenges
Respiratory Support Provision in KMC Position
Care for the Mother in MNCU
Experience from Other Countries
Sustenance of MNCU after iKMC Study
Experience During COVID Pandemic
Findings
Way Forward
Full Text
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