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HomeEditor's PickPremature babies’ death rates slashed by skin-to-skin contact – US analysis

Premature babies’ death rates slashed by skin-to-skin contact – US analysis

A large analysis of multiple global studies involving more than 15 000 infants has found early implementation of skin-to-skin contact (kangaroo mother care) significantly improves the rates of survival for premature or low-birth-weight babies.

The researchers found that compared with conventional care, kangaroo mother care reduced mortality by 32% within the first 28 days of life. The study also suggests that the benefits of kangaroo mother care are higher if implemented within 24 hours of birth.

However, reports The Washington Post, babies with extremely young gestational ages, who were severely unstable or who had very low birth weights, were often excluded from the studies, since this method of care may not be practical in extreme cases.

Kangaroo mother care involves placing a newborn on a parent or caregiver’s bare chest, with a blanket covering the baby. It has become a standard form of care for infants worldwide, with benefits including heart rate regulation and stimulating breastfeeding for mothers.

Previous skin-to-skin research regarding premature infants found a decrease in infant mortality rates, but the amount of time needed to achieve optimal benefits was unknown.

The latest study, published by the journal BMJ Global Health, concludes that the length of time is a significant factor in reducing the death rate – at least eight hours daily provided the highest benefits.

Babies who received this form of care also had a decreased risk for severe infection and a reduced likelihood of re-hospitalisations.

Premature babies, usually born before 37 weeks, often have problems breathing and feeding, as well as other health complications. Preterm birth and low birth weight are among the top causes of infant death among US babies, with the country having the highest infant mortality rate compared with other high-income nations.

The standard of care for many preterm babies across the US includes conventional medical interventions, such as applying breathing and heart rate monitors, sometimes while the baby is in an incubator. With doctors focused on a baby’s immediate medical needs, parental engagement is usually not prioritised.

“The usual care was not centred on immediate skin-to-skin contact,” said Manuela Filippa, a developmental psychologist at the University of Geneva who was not involved in the study. “So the key message here is that there must be zero separation between mothers and newborns, especially if they are low birth weight.”

She said most medical procedures in the neonatal intensive care unit should be done during kangaroo mother care, either with continuous skin-to-skin contact or with very few minutes of separation.

The common mental image of a baby in the NICU involves a clear plastic incubator, with the baby hooked up to devices and lying on its back, which does not allow for much contact from others.

However, many babies can have these interventions in place while still maintaining skin-to-skin contact with their mothers.

Kangaroo mother care was developed in the 1970s in Bogotá, Colombia, after a skyrocketing death rate among newborns in the country. The practice made its way to countries worldwide and has become a standard of care for premature infants in many US hospitals, but policies can vary drastically.

As more research emerges, clinicians hope the evidence will encourage healthcare facilities to make their spaces more parent-friendly, such as creating family rooms in NICUs and developing better guidelines for parents to hold babies who need immediate medical care.

“I always thought that more than half of the work that we do in the NICU is done with parents,” said Panagiotis Kratimenos, a neonatologist at Children’s National Hospital in Washington. Kratimenos hopes this research could further influence US hospital policies and reduce mortality rates worldwide.

“We’re talking about three out of 10 babies. It’s a huge number,” Kratimenos said. “This is really telling you that a significant (number) – close to half of the kids – could benefit from this.”

Study details

Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis

Sindhu Sivanandan, Mari Jeeva Sankar.

Published in The BMJ Global Health on 5 June 2023

Abstract

Importance
The Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight infants. New evidence from large multi-centre randomised trials has been available since its publication.

Objective
Our systematic review compared the effects of KMC vs conventional care and early (ie, within 24 hours of birth) vs late initiation of KMC on critical outcomes such as neonatal mortality.

Methods
Eight electronic databases, including PubMed®, Embase, and Cochrane CENTRAL, from inception until March 2022, were searched. All randomised trials comparing KMC vs conventional care or early vs late initiation of KMC in low birth weight or preterm infants were included.

Data extraction and synthesis
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO.

Main outcomes and measures
The primary outcome was mortality during birth hospitalisation or 28 days of life. Other outcomes included severe infection, hypothermia, exclusive breastfeeding rates, and neurodevelopmental impairment. Results were pooled using fixed-effect and random-effects meta-analyses in RevMan 5.4 and Stata 15.1 (StataCorp, College Station, TX).

Results
In total, 31 trials with 15 559 infants were included in the review; 27 studies compared KMC with conventional care, while four compared early vs late initiation of KMC. Compared with conventional care, KMC reduces the risks of mortality (relative risk (RR) 0.68; 95% confidence interval (CI) 0.53 to 0.86; 11 trials, 10 505 infants; high certainty evidence) during birth hospitalisation or 28 days of age and probably reduces severe infection until the latest follow-up (RR 0.85, 95% CI 0.79 to 0.92; nine trials; moderate certainty evidence). On subgroup analysis, the reduction in mortality was noted irrespective of gestational age or weight at enrolment, time of initiation, and place of initiation of KMC (hospital or community); the mortality benefits were greater when the daily duration of KMC was at least 8 hours per day than with shorter-duration KMC. Studies comparing early vs late-initiated KMC demonstrated a reduction in neonatal mortality (RR 0.77, 95% CI 0.66 to 0.91; three trials, 3693 infants; high certainty evidence) and a probable decrease in clinical sepsis until 28-days (RR 0.85, 95% CI 0.76 to 0.96; two trials; low certainty evidence) following early initiation of KMC.

Conclusions and relevance
The review provides updated evidence on the effects of KMC on mortality and other critical outcomes in preterm and low birth weight infants. The findings suggest that KMC should preferably be initiated within 24 hours of birth and provided for at least eight hours daily.

 

BMJ Global Health article – Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis (Creative Commons Licence)

 

The Washington Post article – Skin-to-skin contact significantly reduces death rates for premature babies (Restricted access)

 

See more from MedicalBrief archives:

 

WHO about-turn on preterm babies' contact with mothers before incubation

 

Bonding effect of skin-to-skin contact in preterm infants

 

Gently stroking babies ‘provides pain relief’

 

 

 

 

 

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