Initiating ‘kangaroo mother care’ immediately after birth lowers infant mortality
“Kangaroo mother care,” the practice of a caregiver participating in skin-to-skin contact with a newborn, was associated with a reduced risk for mortality in low-birth-weight infants at 28 days, a randomized controlled trial showed.
Previous studies have linked kangaroo mother care to reductions in mortality in newborns weighing less than 2 kg when it occurs after infant stabilization. However, “there is a critical knowledge gap regarding the effect of initiating continuous kangaroo mother care soon after birth” in infants with low birth weight, Sugandha Arya, MD, and colleagues in the WHO Immediate KMC Study Group wrote in The New England Journal of Medicine.
The researchers randomly assigned infants weighing between 1 kg to 1.799 kg to receive kangaroo mother care immediately after birth (n = 1,609 mother-infant dyads) or traditional care in an incubator or a radiant warmer until their condition stabilized and then kangaroo mother care (n = 1,602 mother-infant dyads). The trial took place in Ghana, India, Malawi, Nigeria and Tanzania. These countries are targeted under the U.N.’s Sustainable Development Goal, which aims to reduce infant mortality to no fewer than 12 deaths for each 1,000 births in all countries by 2030, according to Arya and colleagues.
The primary outcomes were infant mortality at 28 days and at 72 hours. Secondary outcomes included hypothermia, hypoglycemia, suspected sepsis, time to clinical stabilization, solely breastfeeding when discharged and solely breastfeeding at the end of 28 days, as well as satisfaction with care and depression among the mothers.
The median daily time that kangaroo mother care was provided in the neonatal ICU was 16.9 hours (interquartile range = 13 to 19.7 hours) in the intervention cohort and 1.5 hours (interquartile range = 0.3 to 3.3 hours) in the control cohort.
Arya and colleagues reported that 12% of newborns in the intervention group and 15.7% of those in the control group (RR = 0.75; 95% CI, 0.64-0.89) died in the first 28 days of life, and 4.6% of newborns in the intervention group and 5.8% in the control group (RR = 0.77; 95% CI, 0.58-1.04) died in the first 72 hours after birth.
In addition, the proportion of infants with suspected sepsis was 22.9% in the intervention group and 27.8% in the control group (adjusted RR = 0.82; 95% CI, 0.73-0.93), and the occurrence of hypothermia was 5.6% in the intervention cohort and 8.3% in the control cohort (aRR = 0.65; 95% CI, 0.51-0.83). The mean score for maternal satisfaction on a scale of one to 10, with 10 being the best score, was 9.2 among the 1,282 mothers in the intervention cohort with and 9.1 among the 1,233 mothers in the control cohort (aRR = 0.11; 95% CI, 0.03–0.19). Two mothers in the intervention group and seven in the control group exhibited signs of maternal depression (aRR = 0.11; 95% CI, 0.05–1.14), as gauged by Public Health Questionnaire-9, according to the researchers. Other outcomes, including the time to stabilization and the incidences of hypoglycemia and exclusively breastfeeding at the time of discharge and the end of the neonatal period, were comparable among both groups.
“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,” Arya and colleagues wrote.
The researchers added that the diversity in the infrastructure, staff, practices and potential differences in patient profiles across trial locations “should increase the generalizability of our findings.”