Skin-to-skin Research Articles

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm...

Kangaroo Mother Care on Perfusion Index, Heart Rate, and Oxygen Saturation in Premature Infants Who were Discharged Early and Admitted to The Neonatal Intensive Care Unit: A Randomized Control Tria.

To determine the effect of kangaroo mother care (KMC) on perfusion index, heart rate, and oxygen saturation in premature infants who were discharged early and admitted to the neonatal intensive care unit (NICU) in the following days. This study has a randomized controlled experimental design and uses a pretest-posttest control group model. This study included infants between December 2019 and December 2020 who were discharged early and subsequently admitted to the NICU. Experimental (n=38) and control (n=38) groups were assigned using the simple randomization technique at the NICU of a private university hospital in Istanbul, Türkiye. Heart rate, perfusion index, and oxygen saturation levels of the experimental group in which KMC was applied and the control group in which KMC was not applied were compared. Measurements of these parameters were made at 15-minute intervals for 45 minutes (0-1, 15, 30, 45 minutes). Data were collected via the Mother and Infant Introductory Information Form, Kangaroo Mother Care Preparation Checklist, Kangaroo Mother Care Physiological Parameter Monitoring Form, and Noninvaziv Pulse Co-Oximetry. Statistics of these data were performed with the independent sample t-test, Pearson's Chi-square, Fisher's exact test. In the experimental and control groups, infants' gestational age (31.11 ± 3.25 and 31.61 ± 3.04, respectively; p = .491) and weight (1778.29 ± 436.93 and 1953.29 ± 345.74, respectively; p = .057) were similar, and the differences were statistically insignificant. Before KMC, there was no difference between the heart rate, oxygen saturation, and perfusion index values of the experimental and control groups (p > .05). From the first 15 minutes after the application of KMC to 45 minutes post-KMC, there was a significant decrease in (p=0.001) and stabilization of heart rate and oxygen saturation in the experimental group compared with the control group. The heart rates in the experimental group at 15th, 30th, and 45th minutes during KMC were lower than in the control group (147.63 ± 11.04; 142.47 ± 11.94; 136.82 ± 13.22 and 153.13 ± 8.73; 154.50 ± 7.27; 154.84 ± 7.05, respectively). Also, their oxygen saturation during KMC was higher than in the control group (96.68 ± 2.08; 97.24 ± 2.18; 97.87 ± 1.66 and 94.79 ± 1.27; 94.66 ± 1.45; 94.39 ± 1.38, respectively). This significant difference between KMC on heart rate and oxygen saturation in the experimental group compared to the control group continued for 45 minutes after KMC. The perfusion index was significantly higher at 30 minutes and 45 minutes during KMC. However, although it continued after KMC, this change in perfusion index was not statistically significant. Kangaroo mother care helps to regulate the heart rate, oxygen saturation, and perfusion index of premature infants who were discharged early and admitted to the NICU in the following days.

Does early skin-to-skin contact have a long-term effect on the emotional and behavioral development of very preterm infants?

IntroductionPremature birth may impair a sensitive, responsive, enjoyable, and regulating parenting style, potentially leading to behavioral, cognitive, and emotional deficits in children. Additionally, the emotional bond between the parent and infant may be disturbed due to the restrictions and difficulties at the neonatal intensive care unit (NICU), further negatively impacting child development. Skin-to-skin contact (SSC) directly after birth is strongly recommended also for preterm or low birth weight infants since there is high-certainty evidence that SSC has positive effects on neonatal and maternal health as well as on the quality of the parent–child relationship. The aim of this study was to examine the effect of skin-to-skin contact immediately after childbirth on the development of emotional and behavioral problems in children born preterm entering school.MethodsThis study is part of a randomized controlled delivery room skin-to-skin study (Deisy Study). A total of 33 children (aged 6–8 years) were assessed at school start. The German version of the CBCL/6-18R was used to evaluate the presence of behavior problems.ResultsThe perceived parental stress 6 months after discharge was the variable that most contributed to the variance explanation. SSC immediately after childbirth was not significant in the prediction of emotional and behavioral problems at school start.LimitationsThe study was conducted in a small study group. Partners' variables were not included. Information regarding sociodemographic variables and bonding quality was collected 6 months (corrected age) after birth. The measurement of children's behavioral problems is not objective and corresponds to the parents' perception.Clinical Trial Registrationhttps://clinicaltrials.gov, deisy study NCT01959737, deisy follow up NCT03366285.

Kangaroo Mother Care: A Low-cost Intervention for Improving Cerebral Hemodynamics in Preterm Babies

Background Kangaroo mother care (KMC) has been utilized extensively for the care of infants with low birth weight and babies born prematurely. However, changes in cerebral blood flow (CBF) during KMC interventions are not known clearly. Hence, this study was done, in clinically stable premature babies, to study the changes in cerebral hemodynamics after KMC sessions. Methods It was a prospective study, done without a control group, with a pre-post test design. In our study, an assessment of 104 stable preterm newborns was done, before and after KMC. CBF parameters, which included mean velocity (MV), resistive index (RI) and pulsatility index (PI) were assessed using doppler ultrasonography in middle cerebral artery. Results Both PI and RI were found to be significantly decreased after KMC sessions. Their values, before and after KMC, were 2.06 ± 0.83 versus 1.67± 1.06 ( p value .04) and 0.88 ± 0.27 versus 0.75 ± 0.37 ( p value .04), respectively. On the other hand, MV of blood flow was found to be increased after KMC (33.47 ± 18.16 vs. 40.46 ± 19.49; p value .01). Thus, there is an increase in CBF parameters after KMC. Conclusion There is an increase in CBF after providing KMC, thereby having a positive influence on the structure and development of the premature infant’s brain.

The impact of skin-to-skin contact upon stress in preterm infants in a neonatal intensive care unit

IntroductionNeonatal stress significantly affects the early adaptation, maturation and long-term development of preterm infants.The objective of the studyTo investigate the effect of skin-to-skin contact (SSC) on stress level in preterm infants.Materials and methodsThe research was a prospective study. Stress indicators (cortisol, melatonin) were measured before the SSC began (pre-intervention level) and after this intervention (post-intervention).ResultsThe study included 150 preterm infants in the NICU with gestational age (GA) ≤36 weeks. Pre-intervention salivary cortisol level was higher in extremely and very preterm neonates compared to moderate and late preterm newborns (p = 0.028), in children with low Apgar scores (p = 0.041), in those who were on mechanical ventilation (p = 0.005), and suffered neonatal sepsis (p = 0.005). Pre-intervention melatonin level was lower in children with low Apgar scores (p = 0.032). Salivary cortisol levels were significantly decreased after SSC in preterm infants [pre-intervention: 0.294 (0.111; 0.854) μg/dL vs. post-intervention: 0.127 (0.070; 0.229) μg/dL, p < 0.001], and urinary melatonin levels were significantly increased after SSC [pre-intervention: 4.01 (2.48; 6.34) ng/mL vs. post-intervention: 5.48 (3.39; 9.17) ng/mL, p < 0.001]. A greater reduction in cortisol levels after skin-to-skin contact was revealed in infants with a lower gestational age (p = 0.022), in boys compared to girls (p = 0.012), in infants with respiratory distress syndrome (p = 0.048), in those who had mechanical ventilation compared to non-ventilated neonates (p = 0.008), and in infants with seizures (p = 0.036). The melatonin levels increased more intensively in infants with low Apgar scores (p = 0.002), and in those with late-onset sepsis (p = 0.006).ConclusionThe reduction in cortisol levels and the increase in melatonin levels provided strong evidence that SSC ameliorated the NICU-related stress in preterm infants. We found higher indicators of stress and more dramatic responses to SSC in reducing indicators of stress in infants with lower GA than in infants with higher GA, indicating that SSC may be even more important for lower GA infants. The infants who need SSC the most should not be denied the care they need to reduce the stress they experience from being born too soon and continuing their gestational development in the stressful environment of the NICU.

Kangaroo mother care and outcome of neonates with low birth weight

Kangaroo mother care and outcome of neonates with low birth weight

Effect of rooming-in kangaroo mother care on breastfeeding and behavioral status of full-term newborns.

We aimed to assess the effects of rooming-in kangaroo mother care (KMC) on the breastfeeding and behavioral status of full-term newborns. Full-term newborns born from June to December 2021 were divided into Group A (n = 50) and Group B (n = 50) using a random number table. The rooming-in routine nursing intervention and KMC were given to Group A (n = 50) and Group B, respectively. The outcomes were compared. The scores of breastfeeding knowledge, breastfeeding skills, and sense of responsibility for breastfeeding of Group B were higher than those of Group A (p < 0.05). The breastfeeding rate and lactation yield within 3 days of Group B were higher than those of Group A (p < 0.05). Compared with Group A, Group B had higher effective sucking times of newborns and lower behavioral status scores 1, 2, and 3 days after birth, and shorter duration of crying after invasive operation (p < 0.05). The newborns in Group B had better sleep quality, longer sleep time, and lower procedural pain score than those of Group A (p < 0.05). Rooming-in KMC improves the maternal breastfeeding self-efficacy, breastfeeding rate, and lactation yield, ameliorates the behavioral status and sleep quality of newborns, shortens the crying time and relieves the procedural pain.

Comparing the effects of oral sucrose and kangaroo mother care on selected physiological variables and pain resulting from venipuncture in premature newborns admitted to neonatal intensive care units

BackgroundPremature newborns admitted to neonatal intensive care units (NICUs) undergo numerous painful interventions during care and treatment. The purpose of this study was to compare the effects of using sucrose and kangaroo mother care by on selected physiological variables and pain resulting from venipuncture in premature infants admitted to NICUs affiliated with Shiraz University of Medical Sciences.MethodsThis clinical trial included premature infants admitted to 2 NICUs. The sample size consisted of 66 neonates, with 22 newborns in each group. Randomization was performed using the block allocation method. Data collection involved a demographic questionnaire, the neonatal infant pain scale, and a pulse oximetry device. Friedman, Kruskal–Wallis, and Dunn’s post hoc tests employed for data analysis, with a significance level of P < 0.05.ResultsThe use of oral sucrose and kangaroo care demonstrated significant differences in breathing rate, heart rate, and average arterial blood oxygen saturation during and after venipuncture (P < 0.05). Oral sucrose was found to be significantly more effective than kangaroo care. Neonates under kangaroo care exhibited more regular heart rates compared to the other group (P < 0.05). The utilization of oral sucrose and kangaroo care had varying effects on the average pain score resulting from venipuncture in premature neonates (P < 0.05).ConclusionsBoth methods proved effective in reducing pain and improving physiological variables. However, due to the superior effectiveness of sucrose administration, it is recommended as a cost-effective and easily implementable method in NICUs.Trial registration: Iranian Registry of Clinical Trials IRCT20191215045749N1. (29/03/2020).

Promotion of breastfeeding in Italian Maternity Hospitals: a pre-intervention study

BackgroundIn Italy, exclusive breastfeeding (EBF) rates at hospital discharge range unsatisfactorily between 20–97%.MethodsIn 2023, the Project for Hospital Policy on Breastfeeding (HPB) has been launched to promote breastfeeding in Italian Maternity Hospitals (MHs) as a joint initiative of the Italian Scientific Societies involved in perinatal care together with the National Midwife (FNOPO) and Nurse (FNOPI) Boards and with Vivere Onlus, a family association. The HBP Project has been designed as an uncontrolled before-after study to increase EBF rate at hospital discharge in the population of healthy, term infant with a normal weight at birth following an intervention bundle comprising: 1) Establishment of a local hospital Working Group; 2) Adoption of a hospital policy; 3) Implementation of breastfeeding monitoring; 4) Training for perinatal care professionals; 5) Enhanced implementation of the practices of skin-to-skin contact (SSC) and mother-baby rooming-in; 6) Development/Improvement of perinatal care protocols.ResultsWe report the pre-intervention assessment of 89 out of the 111 enrolled MHs (80.2%) at the beginning of the Project (Time 1 or T1). Almost all MHs (96.6%) have a multi-professional Breastfeeding Working Group, while a hospital policy on breastfeeding is available only in 48.2%. Moreover, only 56.2% of the 9,777 perinatal health workers have been trained in breastfeeding. Over a 1-month period, SSC has been practiced in the delivery room by 76.9% of 6,304 term healthy newborn infants and rooming-in by 83.4% of 6,735 healthy term newborns of normal weight at birth. Over a 4-month period, 69.1% of 33,367 healthy term newborns of normal birth weight were exclusively breastfed at hospital discharge. Noticeably, EBF rate of MHs ranges from 4% up to 100%, the second quartile being 73%.ConclusionAt T1 of the HPB Project, breastfeeding rates at hospital discharge for healthy, term infants with a normal weight at birth appear to be suboptimal among Italians MHs. Particularly, the range of EBF rates among participating centers is wide, with 50% of the MHs having EBF rate lower than 73%. Therefore, the ongoing HPB Project might represent not only an opportunity to increase the initiation of breastfeeding and to improve quality of health care in the whole study group of MHs, but possibly also to level differences between centers.

Kangaroo mother care improves cardiorespiratory physiology in preterm infants: an observational study

ObjectivesTo evaluate whether kangaroo mother care (KMC) in preterm infants on non-invasive respiratory support improves indices of cardiorespiratory wellbeing.Study designProspective quasi-experimental observational study.SettingTertiary perinatal neonatal unit.Patients50 very preterm infants being...

Skin-to-skin stabilisation and uninterrupted respiratory support for preterm infants after birth: feasibility of a new and simplified rPAP system

BackgroundThe rPAP respiratory support system, used for delivery room stabilisation with nasal prongs, has been shown to reduce the need for intubation in extremely preterm infants. A simplified version of...

Improving Post-discharge Weight Gain Among Neonates received Kangaroo Mother Care: Two Years Experience of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: “Kangaroo Mother Care” is an effective alternative care strategy for preterm and low birth weight babies. It also causes substantial reduction of neonatal mortality due to hypothermia. Objective: To observe the status of ongoing kangaroo mother care service in a tertiary care hospital and its outcome. Material and method: This retrospective study was carried out over the period of 1st July 2020 to 30th June 2022. Newborns who received kangaroo mother care in neonatal intensive care unit and postnatal ward of Bangabandhu Sheikh Mujib Medical University, Dhaka during the study period, were enrolled in this study. Results: A total of 384 (97% of eligible candidates) newborn received kangaroo mother care. Kangaroo mother care was provided both in Neonatal intensive care unit (86% of total admission) and also in the postnatal ward. Mean gestational age was 32.02+2.85 weeks (28 weeks-41 weeks) and mean weight of starting KMC was 1367.48 g (730 g – 1970 g). Average age of initiating KMC was 6 days (ranging from 1 to 13 days of age). Mean duration of providing KMC was 6 hours and 50 minutes. More than two third (74.4%) patients came for follow up. During each follow up, an increasing trend was observed regarding weight gain and mean weight gain was 15.9+1.2 g/ kg/day. Conclusion: Kangaroo mother care was provided to most of the eligible patients and persistent weight gain was observed among all KMC candidates after discharge.

Maternity care practices supportive of breastfeeding in U.S. advanced neonatal care units, United States, 2022.

To describe breastfeeding-supportive practices in U.S. maternity hospitals with advanced neonatal care units (ANCU). Using 2022 mPINC data, we calculated the percent of hospitals reporting (1) breastfeeding-supportive practices for "most" (≥80%) mother-baby dyads in ANCUs, by hospital demographic characteristics and (2) infant receipt of mother's own milk or donor milk at any time while in the ANCU, by ANCU level. More than 90% of hospitals reported that "most" mothers (≥80%) were advised on some breastfeeding-supportive practices. Fewer hospitals reported that "most" mothers expressed milk within one hour of birth (37%) or that kangaroo care was practiced for "most" eligible newborns (63%). Receipt of mother's own milk varied by unit level and state. Breastfeeding-supportive practices requiring the technical competency of healthcare providers (e.g., early milk expression, kangaroo care) are less likely to be implemented in ANCU settings compared to practices centered around providing advice or education.

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial

BackgroundKangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent.MethodsA single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis.ResultsForty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group.ConclusionsKangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants.Trial registrationChinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Effects of skin-to-skin contact on mental health outcomes in the parents of full-term newborns: A systematic review and meta-analysis of randomized clinical trials

BackgroundThe postpartum period can be emotionally challenging for parents, with documented levels of anxiety, stress, and depression. While the benefits of skin-to-skin contact (SSC) are well-known, its impact on the mental health of parents of full-term newborns has been less studied. Objective: We aimed to assess the effects of SSC in mental health outcomes in the parents of full-term newborns. MethodsIn this systematic review, a comprehensive search was conducted to identify randomized clinical trials (RCTs) comparing SSC versus no SSC and assessing mental health outcomes. Meta-analyses were performed whenever possible, and the GRADE approach was used to rate the certainty of evidence. ResultsWe included 9 RCTs with 1201 participants. Regarding the risk of bias, the most affected domains were selective reporting, blinding, and allocation concealment. Regarding parental anxiety, SSC may reduce it at short-term, while it is unsure its effect at mid-term and it may not have any effect at long-term. Regarding Psychological stress, SSC may not have an impact at mid- and long-term. Regarding delivery-related post-traumatic stress symptoms, SSC may not have an impact at short-, mid-, and long-term. Regarding depressive symptoms, the evidence is uncertain at short- and mid-term. LimitationsFor the assessed outcomes, certainty of the evidence was low or very low. ConclusionSSC may reduce parental anxiety at short-term, while it may not have an impact in psychological stress and delivery-related post-traumatic stress symptoms. Moreover, the evidence is uncertain regarding its effect in long-term anxiety and depressive symptoms.

A critical review of neonatal parent support programme in United Kingdom: the effect of kangaroo mother care in NHS.

It has become critically important to provide a thorough understanding of the effects of the Kangaroo mother care (KMC) phenomenon on infants in the neonatal stage within the United Kingdom (UK). The current body of knowledge suggests numerous research publications globally, but the UK has yet to scale up its KMC practice. This study provides a critical review of the subject for a more nuanced understanding of the subject effect and to identify the current stage of KMC research in the UK. The findings were consistent with the body of knowledge on KMC with slight variations. Specifically, the UK has limited primary study in KMC. Randomized clinical trials (RCT) in KMC are minimal hence the UK is dependent on MedTech like an infant incubator which is a potential threat to KMC scale-up. Breastfeeding figures in the UK suggest depleting practice of KMC. The National and local policies captured KMC components but have impacted morbidity and mortality indices. It also showed three areas of divergence in practice and standardization. To enhance UK national and local policies uniformized guidelines and standardization of postnatal follow-up and community-based supervision are necessary.

Factors Associated with Newborn’s Survival: A Cross-Sectional Study at two Districts of Bihar

Family Participatory Care (FPC) is a relatively new concept adopted in SNCUs in India. Its effect on survival outcomes of sick newborns has not been studied much. As such newborn mortality studies are rare due to their large sample scale requirement. This is one of the few studies which have been conducted using primary data on this subject in India. In our study, we have found similar causes of death among newborns as published by renowned studies. Study findings highlighted that FPC may reduce newborn mortality by reducing the length of stay at the facility, newborn growth, and survival outcome of sick neonates, especially Kangaroo mother care and exclusive breastfeeding are key components of FPC, and help in reducing newborn deaths. Objectives: Family Participatory Care (FPC), a cost-effective innovation implemented in Special Newborn Care Units (SNCUs) where vulnerable newborns are treated, is a well-established concept akin to Family Centered Care (FCC) in developed nations. The study aims to assess the impact of FPC on the survival rates of sick neonates in SNCUs. The study explored the factors associated with the care of sick neonates after discharge from SNCU that adapted FPC and that did not adapt FPC. Methods: A multistage random sampling method was used to examine sick neonates and newborns discharged from Special Newborn Care Units (SNCUs) in selected districts of Bihar namely Nalanda SNCU with Family Participatory Care (FPC) and Vaishali SNCU without FPC. Findings: The study found a notable variance in the rate of newborn mortality between the district implementing Family Participatory Care and the district that did not implement FPC, with the former experiencing nearly double the rate of newborn deaths. 11 key factors (maternal, household, family support, newborn health-related) attributing towards newborn survival status were identified in this study. Novelty: Family Participatory Care (FPC) is a relatively new concept in India, and this is one of the few studies that have been conducted on this subject. Keywords: Neonatal death, Family Participatory Care, Newborn Survival, Newborn Care, Family participation in Newborn care

A Staff Educational Intervention to Increase the Time of Skin-to-Skin Care in a Swedish NICU: A Quality Improvement Project.

Skin-to-skin contact (SSC) is crucial in neonatal intensive care unit (NICU) care; yet, challenges exist in its implementation. This study addresses a knowledge gap by examining the most effective ways to introduce SSC in the NICU, emphasizing the need to seamlessly integrate this practice for optimal infant and parent care. One way, among many, to implement SSC is to increase staff's knowledge and awareness about SSC. To describe the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. A pre- and postinterventional study design was used to determine the effect of an educational intervention on SSC time, the number of SSC sessions per day, and the number of infants cared for with SSC within their first day of life. The prevalence of infants receiving SSC during their first 24 hours of life, the number of SSC sessions per day, and the duration of each SSC session increased after the intervention, and these effects persisted over 2 years. Our study highlights the impact of staff education and reflective discussions on SSC in the NICU. Integrating these with practical training, parental education, and NICU environment modifications is pivotal for enhancing and sustaining optimal SSC practices, benefiting both infants and parents.

Maternal Care of Preterm Infants after Discharge from the Neonatal Intensive Care Unit: A Rapid Review

Abstract The maternal care of infants poses a unique challenge for mothers, especially after discharge from the hospital. This review focused on the literature on maternal care of preterm infants at home after discharge from the hospital’s Neonatal Intensive Care Unit (NICU). A comprehensive literature search was conducted using keywords relevant to the topic. PubMed and EBSCO essential databases were searched for studies published between 2017 and 2023 (six years). Out of the 2903 retrieved studies, 7 were eligible and included in the review. The quality of available evidence was assessed using the Johns Hopkins Nursing Evidence Appraisal Tool (JHNEAT) and the Critical Appraisal Skills Programme (CASP) checklist. This review found that exclusive breastfeeding rates for preterm infants at home varied from 27% to 76% (Pooled prevalence of 48%) in data extracted from the studies conducted in Ethiopia (Africa), Brazil (South America), USA (North America), Denmark, and Italy (Europe). The practice of kangaroo mother care (KMC) for temperature regulation ranged from 41% to 83% (Pooled prevalence of 63%) in data extracted from studies conducted in Ethiopia (Africa) and Denmark (Europe). The review concluded that the care provided by mothers at home after discharge from the NICU was inadequate. Maternal and child health services providers should develop social media platforms to educate and encourage mothers to sustain exclusive breastfeeding and KMC practices after leaving the NICU.

Predictors of effective kangaroo mother care, exclusive breastfeeding, and skin-to-skin contact among low birthweight newborns in Amhara, Ethiopia.

Globally, 20% of all newborns are born with low birth weight (LBW). There is, therefore, an urgent need to expedite the delivery of high-impact, evidenced-based, and low-cost interventions such as kangaroo mother care (KMC (defined as continuous skin-to-skin care) and exclusive breastfeeding for this vulnerable group. A multinational World Health Organization (WHO)-supported consortium created and tested the impact of locally-specific and globally-informed phases of KMC care on KMC uptake/scale-up across multiple sites. Here we report on the study of KMC predictors that is nested within Amhara's KMC implementation trial in Amhara, Ethiopia. We used multivariate logistic regression phases to identify diverse predictors of KMC, skin-to-skin contact, and exclusive breastfeeding at hospital discharge and day 28 of life. We analysed data from 860 LBW newborns. At day 28, implementation period (adjusted odds ratio (aOR) = 3.2-5.0), hospital facility (aOR = 3.0-4.6), and having multiple births (aOR = 0.31) were the strongest predictors of effective KMC. Meanwhile, previous death of a newborn, type of health facility where delivery occurred, and previous LBW delivery were predictors of effective KMC at both time points. No single factor predicted KMC, skin-to-skin contact, and exclusive breastfeeding at all time points and across all implementation periods. Having multiple births was a negative predictor for skin-to-skin contact, while the implementation period and having older fathers (>29 years) were strong positive predictors for exclusive breastfeeding at both discharge and day 28. Mothers with a previous history of neonatal death and current skin-to-skin-care uptake strongly predicted exclusive breastfeeding uptake at both time points. At discharge, however, having a history of preterm birth and neonatal death strongly predicted exclusive breastfeeding uptake, while multiple current births, current very LBW newborns, and the use of standard binders decreased the likelihood of exclusive breastfeeding. To achieve the effective KMC coverage target of ≥80% in Ethiopia, KMC scale-up phases may have to consider the key predictors of KMC, EBF, and SSC to effectively target beneficiaries.