Kangaroo Mother Care In Infants Research Articles

A Narrative Review of Kangaroo Mother Care (KMC) and Its Effects on and Benefits for Low Birth Weight (LBW) Babies.

Kangaroo mother care (KMC) is a preventative, economical method for infants with low birth weight (LBW). KMC benefits LBW infants in a number of ways. This review standpoints the effect of KMC on the weight gain of LBW neonates. KMC also improves breastfeeding rates during the hospital stay as well as at home. KMC can be provided not only by mothers but also by fathers and other adults in the family. However, it is not routinely practiced in hospitals.Short-term and long-term KMC is beneficial for survival, neurodevelopment, breastfeeding, and mother-infant bonding. Preterm infants are more likely to experience neonatal mortality and morbidity due to acute breathing problems, gastrointestinal problems, autoimmune disorders, and neurologicaldefects as compared to full-term and normal-weight infants. A thorough literature search was conducted using key databases like PubMed and Google Scholar, as well as Medical Subject Heading (MeSH) terms and related keywords. Clinical health experts also believed that implementing KMC would assist mothers in developing more solid emotional bonds with their newborns. As a result, both mothers and their newborns felt more secure, and the babies were more relaxed.KMC was also seen to support the infants' growth and development, which improved the mothers' sense of connection. It is crucial to remember that KMC works better for babies with very low birth weight (VLBW). The mother-child relationship enhances sucking-feeding, and KMC infants have higher means of growth parameters.

A Prospective Study on the Efficacy and Safety of Kangaroo Mother Care as an Alternative Means of Transport of Preterm and Term Small-for-Gestational Age Infants

Background. The unavailability of transport incubators in resource-limited areas increases the risk for hypothermia in low birthweight neonates requiring transfer to another hospital. The kangaroo mother care (KMC) position may be a better alternative than swaddling the neonates during transport.
 Objective. To determine the safety and efficacy of KMC as an alternative means of transport of preterm and term small-for-gestational age (SGA) infants who need to be transferred to a higher level of care. Specifically, it aims to establish if KMC is safe and efficacious in terms of thermoregulation during inter-facility transfers. It also aims to determine the impact of transport distance from the referring hospital, age of gestation, sex, birthweight, and Apgar score on the efficacy of KMC in preventing hypothermia.
 Methods. We did a prospective, single-blinded, parallel-randomized controlled trial from September 2016 to October 2017 from a community-based primary care facility to a tertiary government hospital. We included newborn preterm infants and term SGA infants weighing 1200–1800 grams, delivered at health centers, district and provincial hospitals who needed to be transferred for a higher level of care. Outcomes included physiologic variables such as temperature, heart rate, respiratory rate. We conducted statistical analysis using t-test, risk ratio, and multiple regression analysis.
 Results. Thirty-one neonates were randomized to KMC transport (n=15) and conventional transport (swaddled) (n=16). Fifty percent of the swaddled infants developed hypothermia against none in the KMC infants. The risk of hypothermia was reduced by 93.75% in the neonates transported in KMC. The gestational age, birthweight, sex, Apgar scores and distance travelled had no confounding effect on the neonates’ temperature during transport.
 Conclusions. Kangaroo mother care transport is a safe, effective, and low-cost alternative in inter-facility neonatal transport especially in limited-resource areas.

Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia

PurposeKangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital.MethodsData collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted.ResultsThis study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC.ConclusionEfforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.

Knowledge of Mothers and some Relative Factors about Kangaroo Method Take Care Premature Infants

Aim: The consequences of neonatal morbidity and mortality are severe, but interventions are available within maternal-children health care programs can save the lives of most babies. In particular, Kangaroo mother care for infants is a simple, easy-to-implement intervention that contributes to improving health and reducing infant mortality, especially among premature babies. Subjects and method of study: In this study, we used cross-sectional descriptive research to interview knowledge of 60 mothers with premature babies on Kangaroo mother care method and some related factors at Bach Mai Hospital from October 2019 to March 2020. Results: Research results show that 94.8% of mothers knew about Kangaroo mother care method, of which only 91.78% of mothers had knowledge about this method through their relatives and friends. friends accounted for 58.2%, via internet media 45.5% and 18.2% through health workers. The mother's education was related to the mother's knowledge about Kangaroo mother care method with p <0.05. Conclusion: Education enhancing about role and effection of skin-to-skin in premature infants.
 Keywords:
 skin-to-skin, Kangaroo mother care, KMC, preterm delivery.
  
  

Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth.

A 2016 Cochrane review showed that Kangaroo mother care (KMC) had a moderate impact on preterm growth, with high heterogeneity among studies. This systematic review and meta-analysis considered new evidence on KMC, particularly the duration. Databases were searched for papers published in English, French, Spanish and Portuguese up to 2017. Randomised controlled trials (RCT) of preterm or low birth weight infants were included if they compared growth between KMC and conventional care. Anthropometric measures were related to duration. We identified 1368 papers, and 13 RCTs covering 743 KMC infants and 718 controls met the selection criteria. Infants held in KMC for at least 6 h/d gained more weight than the controls, with a mean difference of 8.99 g/d (95% confidence interval 8.14-9.84, I2 =0%). This difference persisted between 2 and 6 h/d and disappeared with 2 hours or less. When we used g/kg/d, the weight gain was higher when the duration was at least 8 h/d. Only babies who received 6 h/d gained more length and head circumference. The effect of the KMC on growth was directly related to the duration.

Kangaroo Mother Care Reduces Noninvasive Ventilation and Total Oxygen Support Duration in Extremely Low Birth Weight Infants.

Evidence on the safety and influence of kangaroo mother care (KMC) in extremely low birth weight infants (ELBWIs) on ventilation is lacking. This is a retrospective cohort study performed in 145 ELBWIs on noninvasive mechanical ventilation from a tertiary center. The duration of nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (CPAP) ventilation was significantly shorter in infants with KMC compared with infants without (21 vs. 13.5 days, p = 0.001 and 29.5 days vs. 20.5 days, p = 0.001, respectively). The frequency of apnea during hospital stay was fewer in KMC infants, compared with no KMC (23 vs. 20 times, p = 0.002). Multiple linear regression analysis showed that KMC was an independent protective factor for shortening nIPPV/CPAP duration (β = -9.90, 95% confidence interval [CI] [-13.20, -6.60], p < 0.001), total supplemental oxygen support (β = -10.52, 95% CI [-16.73, -4.30], p = 0.001), and reducing times of apneas (β = -5.88, 95% CI [-8.56, -3.21], p < 0.001). KMC benefits ELBWIs by shortening nIPPV/CPAP ventilation duration and total supplemental oxygen support, and reducing the frequency of apneas.

Kangaroo Mother Care in Hospitalized Low Birth-Weight Infants on Respiratory Support: A Feasibility and Safety Study.

Low birth-weight (LBW) infants on respiratory support are often deprived of kangaroo mother care (KMC) due to fear of instability. Data on safety of KMC in these infants are lacking. To determine the feasibility of KMC in LBW infants on continuous positive airway pressure or synchronized intermittent mandatory ventilation. To compare vital signs (heart rate [HR], respiration, temperature, and SpO2) and ventilatory parameters (FIO2, peak inspiratory pressure [PIP], and positive end-expiratory pressure [PEEP]) before, during, and after KMC, and assess the mother's perception of the KMC intervention. LBW infants stable on respiratory support were given KMC for 1 hour. Vital signs and ventilator parameters were recorded before, every 15 minutes during and after KMC. Feasibility was defined as continuation of KMC for 1 hour without interruption, with stable vital signs (HR > 100/min, SpO2 > 90%, and temperature 36.5°C-37.5°C) and ventilator parameters (no change in PIP, PEEP, or increase in FIO2 not more than 0.1) without tube dislodgement. Twenty LBW infants with a mean birth weight of 1390 ± 484 g were included. All infants completed 1-hour duration of KMC without interruption. No significant changes in temperature, respiratory rates, or saturations were noted. The HR and FIO2 were marginally higher during KMC than before or after (HR before 147.3 ± 11.5, during 150.8 ± 11, and after 147.3 ± 11.1, P = .04; FIO2 before 30.6 ± 8.1, during 31.8 ± 8.1, and after 30.7 ± 8.0, P = .034). No accidental extubation or dislodgement of lines occurred. Most mothers were happy. The vital signs were stable during KMC. KMC is feasible in infants receiving respiratory support. Effectiveness of early initiation and prolonged duration of KMC.

Comparison between Kangaroo Mother Care with Standard Care in Preterm Neonate Management

Preterm low birth weight (LBW) babies are unable to control their body temperature and are at greater risk of illness. Kangaroo Mother Care (KMC) is special ways of caring for low birth weight babies. KMC provide thermal care through continuous skin to skin contact, support for exclusive breast feeding and early recognition and response to complication. The aim of the study is to assess thermal control, morbidities feeding pattern of baby getting KMC in comparison to conventional care. The study also give estimation about duration and cost during hospital stay and growth between the babies of two groups. This Randomized Controlled Trial was conducted in the Department of Neonatology, BSMMU, Dhaka from December 2012 to October 2013. Fifty neonate with birth weight 1250 to 1800 gm, gestational age &gt;30 weeks to &lt;37 weeks, Hemodynamically stable after birth were selected. Twenty five of them were randomly allocated to KMC(Group-I) and 25 of them to Standard Method Care (Group-II). The mother or care giver provided KMC at least 12hours/day in Group-I. Those in Group-II were managed under radiant warmer. During hospital stay both the groups were monitored and after discharge, the neonates were followed weekly till 40 weeks of corrected gestational age. There were no differences in birth weight, gestational age, number of male/female neonates, places of delivery and mode of delivery between two groups. During hospital stay hypothermia (Group-I 4% vs Group-II 24%) and hyperthermia (Group I 8% vs Group II 32%) were significantly low in KMC group. Late onset neonatal sepsis (LONS) developed significantly in Group-II. Though incidence of culture negative LONS did not differ in two groups but incidence of blood culture positive LONS was significantly high in standard care neonates (36% vs.0%; p=0.001). Neonates with KMC care required significantly shorter time to reach full feeding and to start direct breast feeding; also incidence of feeding intolerance was significantly lower in this group. After initial loss, weight gain started earlier as well as achieved the birth weight earlier in KMC group. Morbidities like hyperglycaemia and apnoea were significantly higher in standard care group. Neonates who received standard care stayed significantly longer in the hospital and total cost during hospital stay was also significantly higher in this group. At 40 weeks corrected gestational age, KMC infants showed significantly higher daily weight gain than standard care group. This study concluded that Kangaroo Mother Care provides effective thermal control, decreases the incidence of sepsis, improves feed tolerance, helps to achieving full enteral feeding and birth weight earlier in preterm LBW neonates. KMC enhances growth during postnatal period. KMC also found to reduce hospital stay and treatment cost. Proper implementation of KMC for the management of preterm  low birth weight babies is safe and effective care.&#x0D; Bangladesh Med J. 2018 Jan; 47 (3): 1-8

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether evidence is available to support the use of KMC in LBW infants as an alternative to conventional neonatal care before or after the initial period of stabilization with conventional care, and to assess beneficial and adverse effects. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches in CENTRAL (Cochrane Central Register of Controlled Trials; 2016, Issue 6), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Science Information database), and POPLINE (Population Information Online) databases (all from inception to June 30, 2016), as well as the WHO (World Health Organization) Trial Registration Data Set (up to June 30, 2016). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google Scholar. Randomized controlled trials comparing KMC versus conventional neonatal care, or early-onset KMC versus late-onset KMC, in LBW infants. Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. Twenty-one studies, including 3042 infants, fulfilled inclusion criteria. Nineteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early-onset KMC with late-onset KMC in relatively stable LBW infants. Sixteen studies evaluated intermittent KMC, and five evaluated continuous KMC. KMC versus conventional neonatal care: At discharge or 40 to 41 weeks' postmenstrual age, KMC was associated with a statistically significant reduction in the risk of mortality (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (RR 0.35, 95% CI 0.22 to 0.54; five trials, 1239 infants), and hypothermia (RR 0.28, 95% CI 0.16 to 0.49; nine trials, 989 infants; moderate-quality evidence). At latest follow-up, KMC was associated with a significantly decreased risk of mortality (RR 0.67, 95% CI 0.48 to 0.95; 12 trials, 2293 infants; moderate-quality evidence) and severe infection/sepsis (RR 0.50, 95% CI 0.36 to 0.69; eight trials, 1463 infants; moderate-quality evidence). Moreover, KMC was found to increase weight gain (mean difference [MD] 4.1 g/d, 95% CI 2.3 to 5.9; 11 trials, 1198 infants; moderate-quality evidence), length gain (MD 0.21 cm/week, 95% CI 0.03 to 0.38; three trials, 377 infants) and head circumference gain (MD 0.14 cm/week, 95% CI 0.06 to 0.22; four trials, 495 infants) at latest follow-up, exclusive breastfeeding at discharge or 40 to 41 weeks' postmenstrual age (RR 1.16, 95% CI 1.07 to 1.25; six studies, 1453 mothers) and at one to three months' follow-up (RR 1.20, 95% CI 1.01 to 1.43; five studies, 600 mothers), any (exclusive or partial) breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age (RR 1.20, 95% CI 1.07 to 1.34; 10 studies, 1696 mothers; moderate-quality evidence) and at one to three months' follow-up (RR 1.17, 95% CI 1.05 to 1.31; nine studies, 1394 mothers; low-quality evidence), and some measures of mother-infant attachment and home environment. No statistically significant differences were found between KMC infants and controls in Griffith quotients for psychomotor development at 12 months' corrected age (low-quality evidence). Sensitivity analysis suggested that inclusion of studies with high risk of bias did not affect the general direction of findings nor the size of the treatment effect for main outcomes. Early-onset KMC versus late-onset KMC in relatively stable infants: One trial compared early-onset continuous KMC (within 24 hours post birth) versus late-onset continuous KMC (after 24 hours post birth) in 73 relatively stable LBW infants. Investigators reported no significant differences between the two study groups in mortality, morbidity, severe infection, hypothermia, breastfeeding, and nutritional indicators. Early-onset KMC was associated with a statistically significant reduction in length of hospital stay (MD 0.9 days, 95% CI 0.6 to 1.2). Evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care, mainly in resource-limited settings. Further information is required concerning the effectiveness and safety of early-onset continuous KMC in unstabilized or relatively stabilized LBW infants, as well as long-term neurodevelopmental outcomes and costs of care.

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional neonatal care. The standard search strategy of the Cochrane Neonatal Group was used. This included searches in MEDLINE, EMBASE, LILACS, POPLINE, CINAHL databases (all from inception to March 31, 2014) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2014) In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google scholar. Randomized controlled trials comparing KMC versus conventional neonatal care, or early onset KMC (starting within 24 hours after birth) versus late onset KMC (starting after 24 hours after birth) in LBW infants. Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. Eighteen studies, including 2751 infants, fulfilled inclusion criteria. Sixteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early onset KMC with late onset KMC in relatively stable LBW infants. Thirteen studies evaluated intermittent KMC and five evaluated continuous KMC. At discharge or 40-41 weeks' postmenstrual age, KMC was associated with a reduction in the risk of mortality (typical risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (typical RR 0.45, 95% CI 0.27 to 0.76), hypothermia (typical RR 0.34, 95% CI 0.17 to 0.67), and length of hospital stay (typical mean difference 2.2 days, 95% CI 0.6 to 3.7). At latest follow up, KMC was associated with a decreased risk of mortality (typical RR 0.67, 95% CI 0.48 to 0.95; 11 trials, 2167 infants) and severe infection/sepsis (typical RR 0.56, 95% CI 0.40 to 0.78). Moreover, KMC was found to increase some measures of infant growth, breastfeeding, and mother-infant attachment. There were no significant differences between KMC infants and controls in neurodevelopmental and neurosensory impairment at one year of corrected age. Sensitivity analysis suggested that the inclusion of studies with high risk of bias did not affect the general direction of findings or the size of the treatment effect for the main outcomes. The evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care mainly in resource-limited settings. Further information is required concerning effectiveness and safety of early onset continuous KMC in unstabilized or relatively stabilized LBW infants, long term neurodevelopmental outcomes, and costs of care.

Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low‐birth‐weight infants: a randomized controlled trial

The aim of this study was to examine the effectiveness of earlier continuous Kangaroo Mother Care (KMC) for relatively stable low-birth-weight (LBW) infants in a resource-limited country. A randomized controlled trial was performed in LBW infants at a referral hospital in Madagascar. Earlier continuous KMC (intervention) was begun as soon as possible, within 24 h postbirth, and later continuous KMC (control: conventional care) was begun after complete stabilization (generally after 24 h postbirth). Main outcome measure was mortality during the first 28 days postbirth. This trial was registered with ClinicalTrials.gov, NCT00531492. A total of 73 infants (intervention 37, control 36) were included. Earlier continuous KMC had higher but no statistically different mortality in the first 28 days postbirth (1 vs. 2; risk ratio, 1.95; 95% CIs, 0.18-20.53; p = 1.00). There were no differences in incidence of morbidities. Body weight loss from birth to 24 h postbirth was significantly less in earlier KMC infants compared with later KMC infants. (-34.81 g vs. -73.97 g; mean difference, 39.16 g; 95% CIs, 10.30-68.03; p = 0.01; adjusted p = 0.02). Adverse events and duration of hospitalization were not different between the two groups. Further evaluations of earlier continuous KMC including measurement of KMC dose, are needed in resource-limited countries.

Good short-term outcomes of kangaroo mother care in infants with a low birth weight in a rural South African hospital

Objective The aim of the study was to determine the outcome of kangaroo mother care (KMC) in low birth weight infants at a community hospital. Methods This descriptive study included 87 mothers and their low birth weight infants who were in a stable condition and eligible for KMC at Dr JS Moroka Hospital, Thaba Nchu. The infants were assessed four times: at birth, twice during hospitalisation, and a week after discharge. Infants received breast milk exclusively. Results Regarding the mothers’ obstetric history (n=87), gravidity ranged from 1 to 7 (median 3), with a 43% incidence of miscarriage. The median birth weight of the infants (n=87) was 1.5 kg (first assessment), the discharge weight (third assessment) was 1.8 kg, and a week after discharge (fourth assessment) it was 2.2 kg. Initially the infants lost weight significantly from birth to the second assessment (95% CI for median decrease [0.02; -0.01]), but significantly gained weight from the second to the third (95% CI for median increase [0.27; 0.33]) and from the third to the fourth assessment (95% CI for median increase [0.32; 0.45]). Approximately half (49%) of the infants had developed jaundice by the time of second assessment. These babies had a significantly lower birth weight [0.12;0.30]. Conclusion Our findings confirm that infants with a low birth weight treated with KMC can have a good growth pattern, and exclusive breast milk is sufficient to guarantee such growth. Kangaroo mother care is a safe method for stable infants with a low birth weight in a community hospital.

Kangaroo Mother Care: A method for protecting high-risk low-birth-weight and premature infants against developmental delay

Aim: The purpose of this study was to examine the relationship between intervention with Kangaroo Mother Care (KMC) and the subsequent mental development of the infants. In this prospective study, 431 low-birth-weight and premature infants (≤1801 g) were assigned randomly to KMC or Traditional Care. Of these, 336 (78%) received the Griffiths test at 12 months of corrected age. Results: After control for the infant’s health at birth, family socioeconomic status and mother labor and delivery characteristics, the KMC infants had a higher IQ than those given traditional care (TC). The difference was most highly significant for infants who were more premature (30–32 weeks of gestational age), had required intensive care, and had a diagnosis of doubtful or abnormal neurological development at 6 months. The main impact of KMC was on the development of personal relations and on planning functions related to brain developmental stage at birth. Discussion: The KMC intervention can be viewed as a developmentally supportive care, in which parents are guided in managing their biological parenting abilities and which provides “brain care” during a highly sensitive period of a preterm infant’s neurological development.

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Kangaroo mother care (KMC), defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. We used the standard search strategy of the Neonatal Review Group of the Cochrane Collaboration. MEDLINE, EMBASE, LILACS, POPLINE and CINAHL databases, and the Cochrane Controlled Trials Register (Cochrane Library) up to Issue 2, 2000, were searched using the key words terms "kangaroo mother care" or "kangaroo mother method" or "skin-to-skin contact" and "infants" or "low birthweight infants". Randomised trials comparing KMC and conventional neonatal care in LBW infants. Trial quality was assessed and data were extracted independently by two reviewers. Statistical analysis was conducted using the standard Cochrane Collaboration methods. Three studies, involving 1362 infants, were included. All the trials were conducted in developing countries. The studies were of moderate to poor methodological quality. The most common shortcomings were in the areas of blinding procedures for those who collected the outcomes measures, handling of drop outs, and completeness of follow-up. The great majority of results consist of results of a single trial. KMC was associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months follow-up (relative risk 0.37, 95% confidence interval 0.15 to 0.89), not exclusively breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68), and maternal dissatisfaction with method of care (relative risk 0.41, 95% confidence interval 0.22 to 0.75). KMC infants had gained more weight per day by discharge (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Scores on mother's sense of competence according to infant stay in hospital and admission to NICU were better in KMC than in control group (weighted mean differences 0.31 [95% confidence interval 0.13 to 0.50] and 0.28 [95% confidence interval 0.11 to 0.46], respectively). Scores on mother's perception of social support according to infant stay in NICU were worse in KMC group than in control group (weighted mean difference -0.18 (95% confidence interval -0.35 to -0.01). There was no evidence of a difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. Although KMC appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use in LBW infants. Well designed randomized controlled trials of this intervention are needed.

Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000‐1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin‐to‐skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11 788 vs US$ 29 888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000‐1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low‐income countries KMC may represent an appropriate use of scarce resources.

Kangaroo mother care

This article presents the findings of a case-control study of Kangaroo-mother care (KMC) among mothers in Bogota, Colombia. The study group included mothers from one hospital in Bogota who were encouraged to maintain skin-to-skin contact with their infants, with frequent breast feeding and early discharge from the maternity unit. The other hospital relied on traditional care. Findings indicate that infant mortality rates were similar with both types of care. The KMC infants were at higher risk of an adverse outcome. More detailed analysis was made of infants weighing under 2000 g. 1084 KMC infants with low birth weights were considered for inclusion in the study. These infants were required to be free of infections, adjusted to extrauterine life, and free of malformations or diseases. This reduced the random sample to 382 infants allocated to KMC and 364 allocated to traditional care. KMC required the following: strapping the baby upright to the mother's chest in skin-to-skin contact, frequent breast feeding, formula supplements if weight gain did not exceed 20 g/day, and early discharge. Traditional care included incubation until the temperature stabilized, discharge after reaching 1700 g, and severely restricted parents' access. A comparison between the two infant groups showed similar mortality rates: 1.6% for KMC infants and 2.9% for traditional care infants. The KMC group had a 1.1-day shorter hospital stay, infections were less severe, and breast feeding rates were higher. Breast feeding was engaged in by 98.0% of KMC infants and 92.5% of traditional infants. This study was flawed in that low-birth-weight infants may not be strong enough to suck and swallow at birth. Traditional care can include close parent contact and early introduction of breast feeding in the hospital. Before KMC can be applied to all infants, research needs to identify those most likely to benefit, to determine that benefits outweigh risks, and to perform long-term follow-up.