"Kangaroo mother care" (KMC),a neonatal intervention that involves prolonged skin-to-skin contact,exclusive breastfeeding,and early discharge from a health facility,cut infant mortality rates among lower birth weight newborns,a meta-analysis found.

Of the 124 studies included,15 that examined lower birth weight newborns (<2,000 g or <4.4 lbs),found that Kangaroo mother care was associated with a 36% lower mortality rate compared with conventional care (relative risk 0.64,95% CI 0.46-0.89),reported Ellen O.Boundy,ScD,of the Harvard T.H.Chan School of Public Health in Boston,and colleagues.

Mortality was also 41% lower in the seven studies that reported mortality at 3,6,and 12 months with KMC groups versus controls (95% CI,0.43-0.82,I²=0),they wrote in Pediatrics.

Co-author Grace J.Chan,MD,PhD,of Boston Children's Hospital,told MedPage Today that the group decided to conduct this meta-analysis to provide an evidence base for users,including providers and policy-makers,to enhance implementation of KMC in various settings to improve neonatal survival and health.

"This is a low-cost intervention that can have a large impact on neonatal health,but part of the challenge in incorporating KMC into routine neonatal care is making healthcare providers and parents aware of its benefits,as well as training them in proper implementation since many are not familiar with this practice,or may be hesitant to implement it in high-risk infants," she wrote in an email.



In addition to lower mortality rates,KMC also decreased the frequency of infant morbidities.KMC was associated with a 47% reduced risk of sepsis among lower birth weight infants (<2,250 g) in 12 studies (95% CI 0.34-0.83,I²=25%).The nine studies examining incidence of hypothermia found the KMC group of infants had a 78% lower risk of developing the condition (95% CI 0.12-0.41,I²=71%).
Chan said that the new World Health Organization (WHO) preterm guidelines include KMC in stabilized babies weighing less than 2 kg,but that the level of KMC implementation remains low around the world.

"One of the main challenges is how to implement KMC in different settings,from NICUs in the U.S.to health facilities in developing countries," she said."In each type of setting,barriers to implementation need to be understood and addressed to optimize KMC use."
Two studies that examined hypoglycemia and hospital readmission found that KMC had a protective effect on infants (RR 0.12,95% CI 0.05-0.32,I²=0%).Two studies found that KMC was associated with a 58% reduction in hospital readmission compared to controls (95% CI 0.23-0.76,I²=0%).

Not surprisingly,among the 13 studies examining exclusive breastfeeding,KMC was linked to a 50% increase in the likelihood of breastfeeding at hospital discharge or 40 to 41 weeks postmenstrual age,albeit with substantial heterogeneity (95% CI 1.26-1.78,I²=93%).

The meta-analysis examined studies from a variety of geographic locations,including the U.S.,South America,the Caribbean,Southeast Asia,and Africa.Chan said one of the more surprising findings was that,despite the slight variations in KMC around the world,the intervention showed neonatal benefits consistently across different countries and settings.

There were 124 studies included,89% of which were published between 2000 to 2014.Skin-to-skin contact was the primary component of KMC,as 71 studies (68%) defined KMC as skin-to-skin contact only.The majority of studies were conducted on preterm infants <37 weeks gestation (68%) and most had <100 participants (61%).A little less than half (49%) were observational or nonrandomized intervention studies.Two-thirds (66%) of examined studies promoted <4 hours of skin-to-skin contact per day.

The inability to examine the dose-response relationship between the duration of skin-to-skin contact and neonatal outcomes was a limitation,because there were a small number of studies with duration of 4 to 21 hours per day.
Chan said that efficacy trials are needed to understand when to initiate KMC (either immediately after birth or once the infant has been stabilized) and what is the effective minimal duration of the intervention for an infant.

"Additional studies on KMC among full-term and normal birth weight infants,in newborns after cesarean section,and on the effectiveness of skin-to-skin contact provided by caregivers other than the mother would all be helpful understanding how different infant populations may benefit from this intervention," she stated.