‘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: 9.18). 04/2010; 39 Suppl 1(Suppl 1):i144-54. DOI: 10.1093/ije/dyq031
Source: PubMed


'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.

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Available from: Bernardo Horta, Oct 07, 2015
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    • "KMC led to a decrease in neonatal mortality (RR 0.49; 95% CI: 0.31, 0.77) [79] (RR 0.68; 95% CI: 0.48, 0.96) [80], as well as severe morbidity (RR 0.34; 95% CI: 0.18, 0.65) [79], (RR 0.57; 95% CI: 0.40, 0.80) [80]. This evidence is sufficient to recommend the routine use of KMC in facilities for babies <2000 g at birth. "
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    ABSTRACT: Childbirth and the postnatal period, spanning from right after birth to the following several weeks, presents a time in which the number of deaths reported still remain alarmingly high. Worldwide, about 800 women die from pregnancy- or childbirth-related complications daily while almost 75% of neonatal deaths occur within the first seven days of delivery and a vast majority of these occur in the first 24 hours. Unfortunately, this alarming trend of mortality persists, as287,000 women lost their lives to pregnancy and childbirth related causes in 2010. Almost all of these deaths were preventable and occurred in low-resource settings, pointing towards dearth of adequate facilities in these parts of the world. The main objective of this paper is to review the evidence based childbirth and post natal interventions which have a beneficial impact on maternal and newborn outcomes. It is a compilation of existing, new and updated interventions designed to help physicians and policy makers and enable them to reduce the burden of maternal and neonatal morbidities and mortalities. Interventions during the post natal period that were found to be associated with a decrease in maternal and neonatal morbidity and mortality included: advice and support of family planning, support and promotion of early initiation and continued breastfeeding; thermal care or kangaroo mother care for preterm and/or low birth weight babies; hygienic care of umbilical cord and skin following delivery, training health personnel in basic neonatal resuscitation; and postnatal visits. Adequate delivery of these interventions is likely to bring an unprecedented decrease in the number of deaths reported during childbirth.
    Reproductive Health 08/2014; 11(Suppl 1):S3. DOI:10.1186/1742-4755-11-S1-S3 · 1.88 Impact Factor
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    • "Evidence synthesized from a number of RCTs shows that Kangaroo Mother Care (KMC) has a large effect on mortality and is also effective in reducing morbidity [69,70]. This evidence is sufficient to recommend the routine use of KMC in facilities in babies <2000g at birth. "
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    ABSTRACT: In an effort to accelerate progress towards achieving Millennium Development Goal (MDG) 4 and 5, provision of essential reproductive, maternal, newborn and child health (RMNCH) interventions is being considered. Not only should a state-of-the-art approach be taken for services delivered to the mother, neonate and to the child, but services must also be deployed across the household to hospital continuum of care approach and in the form of packages. The paper proposed several packages for improved maternal, newborn and child health that can be delivered across RMNCH continuum of care. These packages include: supportive care package for women to promote awareness related to healthy pre-pregnancy and pregnancy interventions; nutritional support package for mother to improve supplementation of essential nutrients and micronutrients; antenatal care package to detect, treat and manage infectious and noninfectious diseases and promote immunization; high risk care package to manage preeclampsia and eclampsia in pregnancy; childbirth package to promote support during labor and importance of skilled birth attendance during labor; essential newborn care package to support healthy newborn care practices; and child health care package to prevent and manage infections. This paper further discussed the implementation strategies for employing these interventions at scale.
    Reproductive Health 08/2014; 11(Suppl 1):S5. DOI:10.1186/1742-4755-11-S1-S5 · 1.88 Impact Factor
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    • "Both low BW (<2500 g) and high BW (>4000 g) are associated with different short-term and/or long-term health problems. These include, but are not limited to, delays in childhood motor, cognitive and social development, birth injuries, obesity and chronic diseases later in the child's life (Halileh et al. 2008; Lawn et al. 2010). It is, therefore, important to identify factors that could affect BW. "
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    ABSTRACT: Birth weight is a good indicator of mothers' and neonates' nutritional status, and it contributes to the newborn baby's survival, health, growth and development. This study identified social factors associated with differences in the mean birth weight of newborn babies in Jordan. This retrospective study analysed medical records to determine possible risk factors associated with differences in newborn BW in the Irbid governorate of Jordan. All full-term singleton births during the year 2010 were reviewed. Abstracted data included mother's age, educational level, and monthly family income. Newborn information included birth weight, gender and birth order. A total of 5414 full-term singleton births were included. Of these, 15.1% were low birth weight, 73.6% were normal birth weight, and 11.3% were high birth weight. Bivariate analysis of variance revealed that low mean birth weight was associated with female gender, first-born babies, higher maternal age (>35 years), lower educational level and lower income (<500 JD). Multivariate analysis of variance revealed that mean birth weight was lower in female infants, first-born infants, infants of less educated mothers, higher age and low monthly income. The findings can be generalized to full-term singleton pregnancies in countries who share similar cultural and traditional values. Education of mothers is a modifiable variable that can positively influence birth weight, particularly in the case of female and first-born infants. The findings inform our understanding of some social factors affecting birth weights of neonates in Jordan and development of effective public health interventions that could reduce the adverse effects of such factors on newborn birth weight. Preconception and antenatal care is also important for early detection of such possible risk and targeting mothers who require early interventions and support.
    International Nursing Review 08/2014; 61(3). DOI:10.1111/inr.12120 · 0.95 Impact Factor
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