Article

Kangaroo Mother Care To Reduce Morbidity and Mortality in Low Birthweight Infants

Latin American Center for Perinatology and Human Development, Pan American Health Organization, World Health Organization, Hospital de Clinicas, piso 16, Casilla de Correo 627, Montevideo, Uruguay.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2003; 3(2):CD002771. DOI: 10.1002/14651858.CD002771
Source: PubMed

ABSTRACT

Kangaroo mother care (KMC) is an effective and safe alternative to conventional neonatal care in low birthweight (LBW) infants mainly in resource-limited countries. Low birthweight (LBW) (less than 2500 g) is associated with an increased risk of neonatal morbidity and mortality, neurodevelopmental disabilities, and cardiovascular disease at adulthood. Conventional neonatal care of LBW infants is expensive and needs both highly skilled personnel and permanent logistic support. The major component of KMC is skin-to-skin contact (SSC) between a mother and her newborn. The other two components of KMC are frequent and exclusive or nearly exclusive breastfeeding and attempt of early discharge from hospital. Compared with conventional neonatal care, KMC was found to reduce mortality at discharge or 40-41 weeks' postmenstrual age and at latest follow up, severe infection/sepsis, nosocomial infection/sepsis, hypothermia, severe illness, lower respiratory tract disease, and length of hospital stay. Moreover, KMC increased weight, head circumference, and length gain, breastfeeding, mother satisfaction with method of infant care, some measures of maternal-infant attachment, and home environment. There were no differences in neurodevelopmental and neurosensory outcomes at one year of corrected age.

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Available from: José M Belizán, Jan 29, 2014
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    • "Evidence is limited but does suggest plastic wraps preserve babies' temperature initially but there are few data from LMIC and the effect on more substantive outcomes is un- known[18]. For Kangaroo mother care systematic review suggests it is associated with a 40 % reduction in mortality when used in low birthweight babies[10]. However, 16 studies (8 RCT) initiated KMC after babies had stabilized (and therefore after most mortality has occurred ) and only one study of 123 babies initiated KMC within 24 h of birth when they were 'unstable'. "
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    ABSTRACT: Background Pragmatic randomized trials aim to examine the effects of interventions in the full spectrum of patients seen by clinicians who receive routine care. Such trials should be employed in parallel with efforts to implement many interventions which appear promising but where evidence of effectiveness is limited. We illustrate this need taking the case of essential interventions to reduce inpatient neonatal mortality in low and middle income countries (LMIC) but suggest the arguments are applicable in most clinical areas. Discussion A set of basic interventions have been defined, based on available evidence, that could substantially reduce early neonatal deaths if successfully implemented at scale within district and sub-district hospitals in LMIC. However, we illustrate that there remain many gaps in the evidence available to guide delivery of many inpatient neonatal interventions, that existing evidence is often from high income settings and that it frequently indicates uncertainty in the magnitude or even direction of estimates of effect. Furthermore generalizing results to LMIC where conditions include very high patient staff ratios, absence of even basic technologies, and a reliance on largely empiric management is problematic. Where there is such uncertainty over the effectiveness of interventions in different contexts or in the broad populations who might receive the intervention in routine care settings pragmatic trials that preserve internal validity while promoting external validity should be increasingly employed. Summary Many interventions are introduced without adequate evidence of their effectiveness in the routine settings to which they are introduced. Global efforts are needed to support pragmatic research to establish the effectiveness in routine care of many interventions intended to reduce mortality or morbidity in LMIC. Such research should be seen as complementary to efforts to optimize implementation.
    Full-text · Article · Dec 2016 · BMC Medicine
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    • "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]. Although strong evidence exists for the effectiveness of KMC and its components[12,14,15], the uptake of KMC practice and coverage of KMC services have not progressed well in many countries[16]. There is currently a global drive to investigate the reasons for this slow uptake and poor coverage. "
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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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    • "However, adverse outcomes in preterm infants remain high. There are several reports of positive impact of non-medical interventions on outcomes following neonatal intensive care (Als et al., 1994, 2012, Conde-Agudelo et al., 2011, Feldman et al., 2002, 2006, 2010, Vickers et al., 2004), although comprehensive assessments of these interventions suggest that they have limited usefulness in resolving problems of long-term outcome (Ohlsson and Jacobs, 2013, Symington and Pinelli, 2006). The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) focuses on providing care of NICU infants tailored to their observed neurobehavioral characteristics (Als et al., 1994). "
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    ABSTRACT: To assess the impact of Family Nurture Intervention (FNI) on cortical function in preterm infants at term age METHODS: FNI is a NICU-based intervention designed to establish emotional connection between mothers and preterm infants. Infants born at 26-34 weeks postmenstrual age (PMA) were divided into two groups, Standard Care (SC, N=49) and FNI (FNI, N=56). Infants had EEG recordings of ~1 hour duration with 124 lead nets between 37 and 44 weeks PMA. Coherence was measured between all pairs of electrodes in 10 frequency bands. Data were summarized both within and between 12 regions during two sleep states (active, quiet) RESULTS: Coherence levels were negatively correlated with PMA age in both groups. As compared to SC infants, FNI infants showed significantly lower levels of EEG coherence (1 to 18 Hz) largely within and between frontal regions. Coherence in FNI infants was decreased in regions where we previously found robust increases in EEG power. Since coherence decreases with age, results suggest that FNI may accelerate brain maturation particularly in frontal brain regions, which have been shown in research by others to be involved in regulation of attention, cognition and emotion regulation; domains deficient in preterm infants. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Mar 2015 · Acta paediatrica (Oslo, Norway: 1992). Supplement
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