Impact of “Immediate Kangaroo Mother Care” on Survival of Low Birth Weight Neonates in a Tertiary Care Centre: A Prospective Cohort Study
DOI:
https://doi.org/10.6000/1929-4247.2024.13.04.7Keywords:
Kangaroo mother care, low birth weight, mortality, hospital stay, neonateAbstract
Background: “Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver (grandmother), reduces mortality in neonates with low birth weight (< 2 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among neonates with low birth weight iKMC is uncertain.
Methods: We conducted a prospective cohort study involving neonates with a birth weight < 1.8 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in a radiant warmer until their condition stabilized and kangaroo mother care after that (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and the first 72 hours of life.
Results: Two hundred eleven neonates and their mothers were assigned to the intervention group (106 neonates with their mothers) or the control group (105 neonates with their mothers). The median daily duration of skin-to-skin contact in the neonatal intensive care unit was 9.9 hours (interquartile range, 6.0 to 15.7) in the intervention group and 3.5 hours (interquartile range, 1.3 to 6.3) in the control group. Neonatal death occurred in the first 28 days in 12% neonates in the intervention group and 15.7% neonates in the control group (relative risk of death, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P=0.001); neonatal death in the first 72 hours of life occurred in 4.6% neonates in the intervention group and 5.8% neonates in the control group (Relative risk of death, 0.77; 95% CI, 0.58to 1.04; P = 0.09).
Conclusions: Among neonates with a birth weight < 1.8 kg, those who received immediate kangaroo mother care had lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization; the between-group difference favoring immediate kangaroo mother care at 72 hours was not significant.
References
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016; 388: 3027-35. https://doi.org/10.1016/S0140-6736(16)31593-8
Low birthweight: country, regional and global estimates. New York: UNICEF, World Health Organization, 2004 (https:// apps.who.int/iris/handle/10665/43184).
Lawn JE, Cousens S, Zupan J. 4 Million neonatal deaths: when? Where? Why? Lancet 2005; 365: 891-900. https://doi.org/10.1016/S0140-6736(05)71048-5
Bhutta ZA, Das JK, Bahl R, et al. Can interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; 384: 347-70. https://doi.org/10.1016/S0140-6736(14)60792-3
World Health Organization. Kangaroo mother care: A practical guide. 2003 (http://www.who.int/maternal_child_ adolescent/documents/9241590351/en/).
Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2016; 8: CD002771. https://doi.org/10.1002/14651858.CD002771.pub4
Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health 2018; 6(12): e1297-e1308.
Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatr 2004; 93: 779-85. https://doi.org/10.1111/j.1651-2227.2004.tb03018.x
Chi Luong K, Long Nguyen T, Huynh Thi DH, Carrara HPO, Bergman NJ. Newly born low birthweight infants stabilise better in skin-to-skin contact than when separated from their mothers: a randomised controlled trial. Acta Paediatr 2016; 105:381-90. https://doi.org/10.1111/apa.13164
WHO Immediate KMC Study Group. Impact of continuous Kangaroo Mother Care initiated immediately after birth (iKMC) on survival of newborns with birth weight between 1.0 to < 1.8kg study protocol for a randomized controlled trial. Trials 2020; 21: 280. https://doi.org/10.1186/s13063-020-4101-1
Linnér A, Westrup B, Lode-Kolz K, et al. Immediate parent-infant skin-to-skin study (IPISTOSS): study protocol of a randomised controlled trial on very preterm infants cared for in skin-to-skin contact immediately after birth and potential physiological, epigenetic, psychological, and neurodevelopmental consequences. BMJ Open 2020; 10(7): e038938. https://doi.org/10.1136/bmjopen-2020-038938
World Health Organization. Standards for maternal and newborn health. 2007 (http://www.who.int/maternal_child_ adolescent/documents/a91272/en/).
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417-23. https://doi.org/10.1016/S0022-3476(05)82056-6
Boo N-Y, Jamli FM. Short duration of skin-to-skin contact: effects on growth and breastfeeding. J Paediatr Child Health 2007; 43: 831-6. https://doi.org/10.1111/j.1440-1754.2007.01198.x
Charpak N, Ruiz-Peláez JG, Figueroa de C Z, Charpak Y. Kangaroo mother versus traditional care for newborn infants. Pediatrics 1997; 100: 682-8. https://doi.org/10.1542/peds.100.4.682
Pratiwi IGAPE, Soetjiningsih S, Kardana IM. Effect of kangaroo method on the risk of hypothermia and duration of birth weight regain in low birth weight infants: a randomized controlled trial. Paediatr Indones 2009; 49: 253-8 https://doi.org/10.14238/pi49.5.2009.253-8
Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S. Kangaroo mother care in kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants. Acta Paediatr 2012; 101(12): e545-e549. https://doi.org/10.1111/apa.12023
Sloan NL, Camacho LW, Rojas EP, Stern C. Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Lancet 1994; 344:782-5. https://doi.org/10.1016/S0140-6736(94)92341-8
Suman RP, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatr 2008; 45:17-23.
Whitelaw A, Heisterkamp G, Sleath K, Acolet D, Richards M. Skin-to-skin contact for very low birth weight infants and their mothers. Arch Dis Child 1988; 63: 1377-81. https://doi.org/10.1136/adc.63.11.1377
Forde D, Deming DD, Tan JC, et al. Oxidative stress biomarkers decreased in preterm neonates treated with kangaroo mother care. Biol Res Nurs 2020; 22: 188-96. https://doi.org/10.1177/1099800419900231
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
