Skin-to-skin contact with their mothers before incubation is now being recommended for premature or small newborns who are clinically unstable, says the World Health Organisation (WHO), switching its former stance on “kangaroo care” .
The New Scientist reports that the information is according to updated guidance from the WHO.
“The guidelines apply to all babies except those that need mechanical ventilation,” said Harish Chellani at the Vardhman Mahavir Medical College in India.
Around 15% to 20% of newborns globally are premature – born before 37 weeks – or have a low birth weight, below 2.5kg, which can make them clinically unstable. This is partly defined as needing intravenous fluids or having an unhealthy breathing or heart rate.
Since 2015, the WHO had recommended that such babies were incubated until they became clinically stable and only then receive kangaroo care. This was based on research that examined the care of newborns in hospital, with the results suggesting that having kangaroo care post-incubation cuts the risk of death by 40% compared with incubation alone.
However, the new advice follows a trial with more than 3 200 low-birth-weight infants and their mothers who gave birth in hospitals in five African or Asian countries.
Chellani and his colleagues compared babies who received immediate, prolonged kangaroo care before incubation with those who had limited skin-to-skin contact after incubation.
The babies who had immediate kangaroo care that continued for about 17 hours a day until they were discharged were 25% less likely to die within one month than those who were incubated first.
This 25% drop occurred on top of the previously mentioned 40% fall. Outside this 17-hour window, the babies were in an incubator.
Kangaroo care may boost a baby’s immunity and lower stress.
Study details
Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight
WHO Immediate KMC Study Group
Published in the New England Journal of Medicine on 27 May 2021
Abstract
Background
“Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilisation, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain.
Methods
We conducted a randomised, controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania involving infants with a birth weight between 1.0 and 1.799 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in an incubator or a radiant warmer until their condition stabilised and kangaroo mother care thereafter (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life.
Results
A total of 3211 infants and their mothers were randomly assigned to the intervention group (1609 infants with their mothers) or the control group (1602 infants with their mothers). The median daily duration of skin-to-skin contact in the neonatal intensive care unit was 16.9 hours (interquartile range, 13.0 to 19.7) in the intervention group and 1.5 hours (interquartile range, 0.3 to 3.3) in the control group. Neonatal death occurred in the first 28 days in 191 infants in the intervention group (12.0%) and in 249 infants in the control group (15.7%) (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 74 infants in the intervention group (4.6%) and in 92 infants in the control group (5.8%) (relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P=0.09). The trial was stopped early on the recommendation of the data and safety monitoring board owing to the finding of reduced mortality among infants receiving immediate kangaroo mother care.
Conclusions
Among infants with a birth weight between 1.0 and 1.799 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 favouring immediate kangaroo mother care at 72 hours was not significant.
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