‘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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    • "First, perinatal risk in the very early preterm period before 32 weeks gestation would be driven almost entirely by gestational age. Second , in under-resourced settings, neonatal survival is unlikely when delivery occurs prior to 32 weeks, but thereafter, survival is likely in any setting with basic newborn care [17]. Having a model that identifies those women likely to benefit from facilitybased care for their high-risk neonates after 32 weeks gestation is therefore needed. "
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    ABSTRACT: Objective: To develop and internally validate a prognostic model for perinatal death that could guide community-based antenatal care of women with a hypertensive disorder of pregnancy (HDP) in low-resourced settings as part of a mobile health application. Study design: Using data from 1688 women (110 (6.5%) perinatal deaths) admitted to hospital after 32. weeks gestation with a HDP from five low-resourced countries in the miniPIERS prospective cohort, a logistic regression model to predict perinatal death was developed and internally validated. Model discrimination, calibration, and classification accuracy were assessed and compared with use of gestational age alone to determine prognosis. Main outcome measures: Stillbirth or neonatal death before hospital discharge. Results: The final model included maternal age; a count of symptoms (0, 1 or ≥2); and dipstick proteinuria. The area under the receiver operating characteristic curve was 0.75 [95% CI 0.71-0.80]. The model correctly identified 42/110 (38.2%) additional cases as high-risk (probability >15%) of perinatal death compared with use of only gestational age <34. weeks at assessment with increased sensitivity (48.6% vs. 23.8%) and similar specificity (86.6% vs. 90.0%). Conclusion: Using simple, routinely collected measures during antenatal care, we can identify women with a HDP who are at increased risk of perinatal death and who would benefit from transfer to facility-based care. This model requires external validation and assessment in an implementation study to confirm performance. © 2015 International Society for the Study of Hypertension in Pregnancy.
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    • "Kangaroo Mother Care is defined as " early, prolonged and continuous skin-toskin contact between the mother and low birthweight infant, both in the hospital and after discharge, with exclusive breastfeeding and proper follow-up " (Rey & Martinez, 1983). Kangaroo Mother Care regularises heart rate and respirations, deepens sleep and alert inactivity, reduces crying, prevents infections, shortens the neonatal hospital stay, enhances weight gain, improves physical growth and breastfeeding rates, decreases pain from heel prick procedure and lessens maternal depression (Anderson, 1991; Alencar et al, 2009; Lawn et al, 2010; Conde-Agudelo et al, 2011; Nimbalkar et al, 2013). "
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    ABSTRACT: Massage therapy (MT) and Kangaroo Mother Care (KMC) are both effective in increasing the weight of low birthweight preterm infants. However no comparisons have been made until now between the two.
    12/2014; 25(3):103. DOI:10.5463/dcid.v25i3.290
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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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