Immediate kangaroo mother care decreased mortality in low-birth-weight infants

1. Immediate kangaroo mother care after birth for low-birth-weight infants was shown to lower mortality at 28 days compared to conventional care initiated after stabilization.

2. Infants with immediate care had a lower incidence of hypothermia and suspected sepsis compared to infants with conventional care.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Infants with low-birth-weight account disproportionately for neonatal deaths. “Kangaroo mother care,” characterized by continuous skin-to-skin contact with the mother and exclusive breastfeeding, is highly effective in preventing infant death. The current recommendation is to initiate intermittent care during the stabilization period and continuous kangaroo mother care thereafter. This study compared the effect of continuous kangaroo mother care initiated immediately after birth (intervention group) to the current recommendation (control group). The study determined the intervention group had a significantly lower mortality rate in the first 28 days of life. The lower mortality rate was attributed to lower rates of hypothermia and suspected sepsis in the intervention group causing early termination of the trial. The study was limited by the inability for blinding in the study because of the nature of the intervention. Nonetheless, the study’s results are significant in providing a strong rationale for the immediate initiation of kangaroo mother care as an approach to further reduce neonatal death in infants with low birth weights in low-resource settings.

Clicker to read the study in NEJM

Relevant Reading: Newly born low birthweight infants stabilise better in skin-to-skin contact than when separated from their mothers: a randomised controlled trial

In-Depth [randomized controlled trial]: This randomized controlled trial was performed at five tertiary hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Following pre-screening, 2944 mothers and 3211 infants were enrolled and underwent randomization. Infants were eligible for study inclusion if their birth weight was between 1.0 and 1.799kg, regardless of gestational age, delivery methods, or singleton or twin status. Mother-infant pairs were excluded from the study if the mother was under 15 years of age or unable to provide kangaroo mother care within three days after birth. Mother-infant pairs underwent 1:1 randomization into either immediate kangaroo mother care (intervention group) or conventional care (control group). The primary outcomes were mortality rates from enrolment to 72 hours of age and 28 days of age. During the stabilization period, the median daily duration of skin-to-skin contact in the intervention group was 16.9 hours (interquartile range [IQR], 13.0 to 19.7) compared to 1.5 hours (IQR, 0.3 to 3.3) in the control group. At 28 days of age, 191 (12.0%) infants in the intervention group and 24 (15.7%) in the control group died (risk ratio [RR], 0.75; 95% confidence interval [CI], 0.64 to 0.89; P=0.001). Additionally, the number needed to treat to prevent one death was 27 infants (95% CI, 17 to 77). Similarly, at 72 hours of age, 72 (4.6%) infants in the intervention group and 92 infants (5.8%) in the control group died (RR, 0.77; 95% CI, 0.58 to 1.04; P=0.09). The proportion of infants with suspected sepsis in the intervention group was 22.9% compared to 27.8% in the control group (adjusted RR, 0.82; 95% CI, 0.73 to 0.93). Finally, the proportion of infants with hypothermia in the intervention group was 5.6% compared to 8.3% in the control group (adjusted RR, 0.65; 95%CI, 0.51 to 0.83). Overall, the study showed the implementation of immediate kangaroo mother care as a method to reduce deaths in low-birth-weight infants, especially in low-resource settings.

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