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: 9.18). 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.

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    • "The three main components of KMC are the following: skin-to-skin position against a mother's or caregiver's chest; exclusive breastmilk feeding as much and as long as possible; and early discharge and ambulatory care with regular followup visits to a healthcare facility9101112. KMC should be accompanied by the prevention, early recognition and appropriate management of complications[7,13]. The practice of skin-to-skin care for more than 20 hours per day in stable infants is known as continuous KMC and is recommended as the preferred method whenever possible[9,10]. "
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    ABSTRACT: Background: Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. Methods: Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. Results: The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Conclusions: This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.
    Full-text · Article · Dec 2016 · BMC International Health and Human Rights
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    • "of the mothers in this community did not have any knowledge of skin to skin care or KMC, and even for mothers with low birth weight or preterm babies most did not practice KMC. KMC has been shown to reduce neonatal mortality among low birth weight and preterm babies and reduce severe morbidity[3]. This practice should be widely scaled up especially in high mortality, low resource settings. "
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    ABSTRACT: . Most information on newborn care practices in Uganda is from rural communities which may not be generalized to urban settings. Methods . A community based cross-sectional descriptive study was conducted in the capital city of Uganda from February to May 2012. Quantitative and qualitative data on the newborn care practices of eligible mothers were collected. Results . Over 99% of the mothers attended antenatal care at least once and the majority delivered in a health facility. Over 50% of the mothers applied various substances to the cord of their babies to quicken the healing. Although most of the mothers did not bathe their babies within the first 24 hours of birth, the majority had no knowledge of skin to skin care as a thermoprotective method. The practice of bathing babies in herbal medicine was common (65%). Most of the mothers breastfed exclusively (93.2%) but only 60.7% initiated breastfeeding within the first hour of life, while a significant number (29%) used prelacteal feeds. Conclusion . The inadequate newborn care practices in this urban community point to the need to intensify the promotion of universal coverage of the newborn care practices irrespective of rural or urban communities and irrespective of health care seeking indicators.
    Full-text · Article · Dec 2015 · International Journal of Pediatrics
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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.
    Preview · Article · Aug 2015 · Pregnancy Hypertension
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