'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications

Abstract

Background: 'Kangaroo mother care' (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC's mortality benefit, and did not report neonatal-specific data.

Objectives: The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth.

Methods: We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken.

Results: We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight <2000 g (assumed preterm). The one community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29-0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58-0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17-0.65).

Conclusion: This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries.

Figure 1

Synthesis of study identification in review of the effects of KMC on neonatal morbidity and mortality in preterm labour. Bold boxes signifies new meta-analysis undertaken (searches from 1970 to 9 September 2009)

Figure 2

(a) Meta-analysis of three RCTs comparing KMC with standard care showing cause-specific mortality effect for babies of birth weight <2000 g (assumed to be deaths due to direct complications of preterm birth) and excluding studies where KMC was started after the first week of life. (b) A meta-analysis of five RCTs comparing KMC with standard care showing effect on severe morbidity (severe pneumonia, sepsis, jaundice and other severe illness) for babies of birthweight <2000 g and excluding studies where KMC was started after the first week of life. Unpublished neonatal specific data courtesy of authors, Charpak and Suman

Figure 3

A meta-analysis of three observational trials comparing KMC with standard incubator care showing cause specific mortality effect for babies of birthweight <2000 g (assumed to be deaths due to direct complications of preterm birth). Pattinson data restricted to sites with comparable before/after data