Kangaroo Mother Care for Preterm and Low-Birth-Weight Babies

by | Dec 15, 2023 | Postpartum Issues

“Strong evidence now supports KMC [kangaroo mother care] for routine care of all preterm or LBW [low-birth-weight] newborns born in healthcare facilities and at home, immediately after birth. . . . KMC should be implemented in national maternal, newborn and child health programmes as the foundation of small and/or sick newborn care.”

The World Health Organization recently published its position paper: “Kangaroo mother care: a transformative innovation in health care” (follow the link to download the report), defining kangaroo mother care as:

The care of preterm or [low-birth-weight] infants in continuous and prolonged (8-24 hours per day, for as many hours as possible) skin-to-skin contact recommended to be initiated immediately after birth [exceptions: the infant is unable to breathe spontaneously after resuscitation, is in shock, or requires mechanical ventilation] with support for exclusive breastfeeding or breast-milk feeding.

I thought I couldn’t do better than to summarize the evidence section of the position paper and quote the WHO’s recommendations so that you would have them at your fingertips. Accordingly, this blog post will:

  • Summarize the benefits of kangaroo mother care for newborns together with the citations for the studies reporting those benefits.
  • Summarize the benefits for the parents of preterm or low-birth-weight babies.
  • Summarize the explanations of why kangaroo mother care confers those benefits.
  • Excerpt the WHO’s recommendations.

After that, I’ll wrap up with my usual “Your Takeaway” section.

Before we get started, I can’t help but note that the benefits of kangaroo mother care are well established and have been for quite some time, as a 2016 systematic review in the prestigious Cochrane Library attests. Given the weight of the evidence in its favor, any special care or intensive care nursery that hasn’t made kangaroo mother care the default for preterm and low-birth-weight babies is, to be blunt, practicing substandard care.

Why Kangaroo Mother Care?

Note: The WHO position paper’s sources for newborn outcomes are both systematic reviews pooling data from multiple randomized controlled trials, i.e., trials assigning participants by chance to one form of treatment or another. This makes them very strong evidence for the benefits of kangaroo mother care in general and immediate kangaroo mother care in particular. The two reviews are:

Conde-Agudelo A, Diaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2016;2016(8):CD002771.

Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Glob Health 2023;8(6).

You can follow the links to download them for free.

Newborn outcomes with kangaroo mother care compared with conventional care:
  • Mortality
    • Facility-based KMC initiated after clinical stabilization resulted in a 40% reduction by discharge or 40 weeks postmenstrual age and a 33% reduction at latest follow up.
    • Facility- or community-based KMC resulted in a 32% reduction by discharge or 40 weeks postmenstrual age or 28 days of age and a 25% reduction by 6 months. The magnitude was similar for births at less than or equal to 34 weeks gestation vs. more than 34 weeks to 36 weeks gestation, for birthweights of 2 kg (4 lb 7 oz) vs. more than 2 kg but less than 2.5 kg (5 lb 8 oz) at enrolment, and for daily KMC duration of 8-16 hr per day vs. more than 16 hr per day.
  • Severe infection/sepsis
    • Facility- or community-based KMC resulted in a 15% reduction up to the latest follow up.
  • Hyperthermia (abnormally low body temperature)
    • Facility- or community-based KMC resulted in a 68% reduction at discharge or by 28 days after birth.
  • Exclusive breastfeeding
    • Facility- or community-based KMC resulted in a 48% increase at discharge or 40 weeks postmenstrual age.
Newborn outcomes with early (within the first 24 hr) kangaroo mother care compared with late (more than 24 hr post birth) kangaroo mother care:

Note: Data for these newborn outcomes come from comparisons of  immediate kangaroo mother care with delayed kangaroo mother care, which we already know from the previous section improves outcomes compared with conventional care. This means immediate kangaroo mother care would do even better if compared with conventional care.

  • Mortality
    • 23% reduction at 28 days of age.
  • Hospital-based sepsis
    • 15% reduction.
  • Hypothermia
    • 26% reduction up to discharge.
  • Exclusive breastfeeding
    • 12% increase at discharge.
Improvements in outcomes beyond infancy:
  • Less severe abnormal neurologic results
  • Improved academic performance
  • Calmer demeanor
  • Less tendency to be antisocial
  • Reduced school dropout
  • Improved brain maturation (intelligence, attention, memory, coordination)
Benefits for mothers:
  • Empowers new mothers as primary care providers
  • Builds confidence and comfort in caring for their infants
  • Strengthens maternal-newborn attachment
  • Reduces likelihood of depression
Benefits for fathers:
  • Empowers fathers as protectors and nurturers of their infant
  • Increases bonding and attachment to their infants
  • Increases confidence as a caregiver
  • Reduces depression and relationship problems
  • Improves father/partner-infant interactions

What Explains Kangaroo Mother Care’s Benefits?

Prolonged skin-to-skin contact
  • Decreases handling by multiple healthcare workers, which decreases risk of infection.
  • Transfers microbes from the mother’s skin to the baby’s skin, which decreases risk of colonization by pathologic microbes.
  • Aids somatosensory system maturation, which improves sensory processing and cognitive functioning.
Oxytocin release in mother and child
  • Increases breastmilk production, which increases exclusive breastfeeding [and therefore the provision of its nutritive and protective benefits].
  • Promotes bonding, which fosters development of social behavior in the infant and secure attachment between mother and child.
  • Contributes to immune system regulation (the development of T-cells, the suppression of inflammatory cytokines).
Other endocrine effects
  • Decreases stress hormones (cortisol) that regulate arousal, which helps to stabilize heart rate and increase weight gain.
  • Activates the dopamine and opioid systems in the newborn brain, which aids the development of the neural circuits involved in social cognitive processes.

The WHO’s Recommendations

 Kangaroo mother care trials have been carried out in high income as well as middle- and low-income countries. These recommendations are for all preterm and low-birth-weight infants, not just those cared for in environments lacking high-tech monitoring and treatment capability.

Based on high-certainty evidence, the position paper strongly recommends:

Recommendation A1a: Any KMC

KMC is recommended as routine care for all preterm or [low-birth-weight] infants. KMC can be initiated in the health-care facility or at home and should be given for 8-24 hours per day (as many hours as possible).

  • KMC can be given at home or at the health-care facility.
  • Infants who receive KMC should be secured firmly to the mother’s chest with a binder that ensures a patent airway.
  • Whenever possible, the mother should provide KMC. If the mother is not available, fathers or partners and other family members can also provide KMC.
  • Infants who need intensive care should be managed in special units, where mothers, fathers, partners and other family members can be with their preterm or [low-birth-weight] infants 24 hours a day.
Recommendation A1b: Immediate KMC

KMC for preterm or low-birth-weight infants should be started as soon as possible after birth.

  • At home, immediate KMC should be given to infants who have no danger signs.

  • At health-care facilities, immediate KMC can be initiated before the infant is clinically stable unless the infant is unable to breathe spontaneously after resuscitation, is in shock, or requires mechanical ventilation. The infant’s clinical condition (including heart rate, breathing, colour, temperature and oxygen saturation, where possible) must be monitored.

Your Takeaway

All nations should explore how to convert or adapt, where possible, the existing newborn units to allow the mother to stay with her infant on a 24/7 basis even when her infant is sick and needs care inside the newborn care unit. Countries establishing new newborn care units should plan for combined and respectful medical and supportive care for all mothers and their preterm or [low-birth-weight] infants from the start.

  • Get the word out on an ongoing basis to pregnant women and birthing people about kangaroo mother care (which, as you can see in the WHO’s recommendations, need not necessarily be delivered solely by the mother) so that should they give birth preterm or to a low-birth-weight baby, they will be prepared to insist on kangaroo mother care (provided their baby is eligible, i.e., able to breathe spontaneously, is not in shock, and does not require mechanical ventilation).
  • If you work in a hospital that doesn’t routinely practice kangaroo mother care, advocate for making it the standard of care for all eligible infants, including implementing mother- and family-friendly policies for its management and renovating infrastructure to accommodate it. (The position paper has more details on this.)
  • Lobby government, institutional, and professional policy-making bodies about implementing kangaroo mother care as a means of significantly reducing neonatal mortality and morbidity in preterm and low-birth-weight infants.

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