Intervention in close contact between a mother and her premature baby can reduce the risk of infant mortality by almost a third

A method of care involving skin-to-skin contact between a mother and her preterm or low-birth-weight baby appears to significantly affect the infant’s chances of survival, suggests a study published online in the journal BMJ Global Health.

Starting the intervention within 24 hours of birth and carrying it out for at least eight hours a day both appear to make the approach even more effective in reducing mortality and infection, researchers found.

The method of care known as “kangaroo mother care” (KMC) involves carrying a baby, usually by the mother, in a sling with skin-to-skin contact, and many studies have shown that this is a way to reduce mortality and the risk of infection for the child.

The World Health Organization recommends it as the standard of care in low birth weight infants after clinical stabilization.

However, less is known about the ideal time to start the intervention. Therefore, researchers from India have reviewed numerous large randomized studies on this topic in multiple countries and in the community.

By looking at existing studies, they wanted to compare KMC to conventional care and compare starting the approach early (within 24 hours of birth) to starting KMC later to see what effect this had on neonatal and infant mortality and major illness among low birth weight and premature infants.

Their review looked at 31 studies involving a total of 15,559 infants and of these, 27 compared KMC with conventional care, while four compared early with late onset of KMC.

Analysis of the results showed that, compared to conventional care, KMC appeared to reduce the risk of death by 32% during hospital birth or by 28 days after birth, while reducing the risk of serious infection, such as sepsis, seemed to decrease by 15%.

It was also found that the reduction in mortality was noted regardless of gestational age or infant weight at enrollment, time of initiation, and place of initiation of KMC (hospital or community).

It was also noted that mortality benefits were greater when the daily duration of KMC was at least eight hours per day than with shorter KMC.

Those studies that compared early to late-onset KMC showed a 33% reduction in neonatal mortality and a 15% probable reduced risk of clinical sepsis up to 28 days after early initiation of KMC.

The review had some limitations because the studies examined involved an intervention that participants were clearly aware of so could be considered biased, and very low birth weight, extremely preterm neonates, and severely unstable neonates were often excluded from studies.

However, the review authors said the risk of bias in the included studies was generally low, and because their review included an extensive and systematic review of existing studies, the certainty of the evidence for the primary outcomes was moderate to high.

They concluded: “Our findings support the practice of KMC for preterm and low birth weight infants as soon as possible after birth and for at least eight hours per day.”

“Future research should focus on overcoming barriers and facilitators to large-scale implementation of KMC in facility and community settings. Data on long-term neurodevelopmental outcomes are also needed.”