Article

‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications

Saving Newborn Lives/Save the Children-USA, Cape Town, South Africa.
International Journal of Epidemiology (Impact Factor: 9.2). 04/2010; 39 Suppl 1(Suppl 1):i144-54. DOI: 10.1093/ije/dyq031
Source: PubMed

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

Full-text

Available from: Bernardo Horta, May 04, 2015
0 Followers
 · 
133 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: State-of-the-art Newborn Intensive Care Units (NICUs), instrumental in the survival of high-risk and ever-earlier-born preterm infants, often have costly human repercussions. The developmental sequelae of newborn intensive care are largely misunderstood. Developed countries eager to export their technologies must also transfer the knowledge-base that encompasses all high-risk and preterm infants' personhood as well as the neuro-essential importance of their parents. Without such understanding, the best medical care, while assuring survival jeopardizes infants' long-term potential and deprives parents of their critical role. Exchanging the womb for the NICU environment at a time of rapid brain growth compromises preterm infants' early development, which results in long-term physical and mental health problems and developmental disabilities. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) aims to prevent the iatrogenic sequelae of intensive care and to maintain the intimate connection between parent and infant, one expression of which is Kangaroo Mother Care. NIDCAP embeds the infant in the natural parent niche, avoids over-stimulation, stress, pain, and isolation while it supports self-regulation, competence, and goal orientation. Research demonstrates that NIDCAP improves brain development, functional competence, health, and life quality. It is cost effective, humane, and ethical, and promises to become the standard for all NICU care.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Decolonization with topical antibiotics is necessary to control outbreaks of multidrug-resistant bacterial infection in the Neonatal Intensive Care Unit (NICU), but can trigger bacterial resistance. The objective of this study was to determine whether skin-to-skin contact of newborns colonized with Methicillin-Oxacillin Resistant Staphylococcus aureus or Methicillin-Oxacillin-Resistant Coagulase-Negative Staphylococcus aureus (MRSA/MRSE) with their mothers could be an effective alternative to promote bacterial decolonization of newborns' nostrils. We performed a randomized clinical trial with 102 newborns admitted to the NICU in three hospitals in São Luís, Brazil. Inclusion criteria were birth weight of 1300 to 1800 g, more than 4 days of hospitalization, newborns with positive nostril cultures for MRSA and/or multidrug-resistant coagulase-negative Staphylococcus and mothers not colonized by these bacteria. We used a random number algorithm for randomization. Allocation was performed using sealed opaque envelopes. Skin-to-skin contact was given twice a day for 60 minutes for seven consecutive days. The control group received routine care without skin-to-skin contact. There was no masking of newborn's mothers or researchers but the individuals who carried out bacterial cultures and assessed results were kept blind to group allocation. The primary outcome was colonization status of newborns' nostrils after 7 days of intervention. The directional hypothesis was that more newborns who receive skin-to-skin holding 2 hours/day for 7 days than newborns who receive normal care will be decolonized. Decolonization of MRSA/MRSE was greater in the intervention group (Risk Ratio = 2.27; 95% CI 1.27-4.07, p-value = 0.003). Number Needed to Treat (NNT) was 4.0 (95% CI 2.2 - 9.4). After adjustment for the possible confounding effects of small for gestational age birth, antibiotic use, need for resuscitation, sex and cesarean delivery, skin-to-skin contact remained strongly associated with decolonization of newborns' nostrils from MRSA/MRSE bacteria (p = 0.007). There was no need to interrupt the trial for safety reasons. Skin-to-skin contact might be an effective and safe method for promoting decolonization of newborns' nostrils colonized by MRSA/MRSE. The study was registered with ClinicalTrials.gov ( NCT01498133 , November 21, 2011).
    BMC Pregnancy and Childbirth 01/2015; 15(1):63. DOI:10.1186/s12884-015-0496-1 · 2.15 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Preterm birth is an emerging global public health problem. The aim was to determine the epidemiological, clinical, and prognostic aspects of preterm newborns delivered at a sanitary training centre in Ouagadougou, Burkina Faso and describe the mothers of preterm newborns, the circumstances of childbirth, and the clinical characteristics of preterm newborns in order to calculate and study mortality. Material and methods: This retrospective study includes all preterm newborns hospitalized in the neonatology unit of Clinique El Fateh-Suka over a 10-year period. Results: The frequency of preterm birth was 193 of 574 gestational age-specified newborns (33.6%). Insufficient antenatal consultation, premature rupture of membranes, and pathology during pregnancy comprised 58%, 64.9%, and 82.6% of preterm birth cases, respectively. The main pathologies associated with preterm birth included hemorrhagic and hematological disorders (42.5%), neonatal infections (23.3%), congenital malaria (21.8%), and intrauterine hypoxia and birth asphyxia (13.5%). The incidence of mortality was 21.2%, and the major causes of mortality included hemorrhagic and hematological disorders (46.3%), intrauterine hypoxia and birth asphyxia (22%), and neonatal infections (14.6%). These deaths were more frequent in the early neonatal period than late neonatal period (30.8% vs. 6.1%) (OR = 6.91; 95% CI [2.34–20.40]; P = 0.000). Conclusion: Preterm birth occurs frequently in our neonatology unit, and the involved complications are as expected. Providing high-quality antenatal consultations will reduce the incidence of preterm birth. An improved system of care for newborns would also greatly reduce preterm mortality. Keywords: Newborn, Premature, Diseases, Mortality