Leading Lactation Insights - June 2023

Kangaroo Mother Care: Improving Survival for LBW Infants 

Maria Lennon, MSN, CNM, IBCLC

When talking about Kangaroo Mother Care (KMC), many people think it’s holding baby skin-to-skin, but there’s a whole lot more to Kangaroo Mother Care than that. KMC is sometimes confused with skin-to-skin (sts) care after birth. The World Health Organization recommends sts care immediately after delivery for every newborn regardless of birth weight, but Kangaroo Mother Care is a special intervention for low birth weight (LBW) or preterm infants.

What is Kangaroo Mother Care?

Kangaroo Mother Care is an intervention to care for preterm or low birth weight (LBW) infants, which involves continuous skin-to-skin care starting as soon as possible after birth and exclusive breastfeeding, allowing for early discharge from the hospital to home and close follow-up afterward. This type of care has been shown to decrease mortality and morbidity in preterm and low birth weight infants by providing warmth, regulating temperature, heart rate, and respirations, and contributing to the growth and neurological development of infants. According to a 2016 study, KMC is highly effective in preventing neonatal mortality – up to 40%. 

A recent study published in the NEJM in 2021 showed an additional 25% decrease in morbidity and mortality for newborns who began KMC immediately after birth compared to those who began KMC after stabilization, especially in infants weighing between 1000 – 1790 grams. KMC care can begin while stabilizing care is being provided to the mother and newborn.

How Kangaroo Mother Care Began

In the 1970s at San Juan de Dios Hospital in Bogota, Colombia, Dr. Edgar Rey Sanabria and Dr. Hector Martinez faced overcrowding in the hospital and an extremely high mortality rate for premature babies that were often squeezed three at a time into incubators. By studying how kangaroo mothers care for their newborns by constantly carrying them in a pouch, these doctors tested the theory on humans by encouraging new mothers or surrogates to hold these vulnerable babies skin-to-skin continuously after birth. Newborn deaths and infections declined immediately.

Survival of babies weighing 501-1000 grams rose from zero with conventional special baby care unit care in 1975-76 to 72% in 1979-81 with Kangaroo Mother Care!  Survival of babies weighing 1001-1500 g rose from 27% in 1975-76 to 89% in 1979-81! 

Latest research

A Cochrane Review published in 2016 reviewed the data available on kangaroo care for low birth-weight babies, mainly in developing countries.  The analysis included 18 studies with more than 2,700 infants. Compared with conventional neonatal care, the review found that kangaroo care reduced the risk of infection, hypothermia, respiratory disease, and death.  Babies who experienced kangaroo care grew more quicker and were more likely to breastfeed.

Current World Health Organization (WHO) recommendations indicate starting kangaroo mother care only after the baby is stabilized in an incubator or warmer, which can take 3-7 days, on average. In 2021 a clinical trial published in the New England Journal of Medicine suggests that when compared with the existing practice of waiting to begin kangaroo mother care until after a baby is stable, starting immediately after birth can increase survival by another 25%. This would save up to 150,000 more lives each year! In light of the new evidence, the World Health Organization is reviewing the current KMC guidelines published in 2015. 

In some countries, Mother-Newborn ICUs have been established so that mothers can always be with their babies to provide continuous kangaroo care. Mothers are able to receive postpartum care without being separated from their infants. If a mother is not well enough to care for her baby, a surrogate provides care so that KMC is continuous.

Kangaroo Mother Care has been shown to be an effective medical treatment for LBW and premature babies. This low-tech option offers the opportunity to improve babies’ health and save lives across the globe. New research suggests KMC would improve infant health around the globe in both high-income countries as well as developing countries.

International Kangaroo Mother Care Awareness Day 

Since 2011, May 15 has been designated as International Kangaroo Care Awareness Day. It is a day to increase awareness and celebrate the practice of kangaroo care. November 17 is recognized as World Prematurity Day, another day to increase awareness and educate on the benefits of the life-saving practice of KMC.

References:

Bhutta, Zulfiqar A., et al. "Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?." The Lancet 384.9940 (2014): 347-370.

Grayson, Claire E., "Kangaroo Mother Care". Embryo Project Encyclopedia (2018-04-11). ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/13060.