Kangaroo Mother Care and Neonatal Outcomes: A Meta-Analysis

CQ #3 - July 27, 2016

by Anne Eglash MD, IBCLC, FABM

Kangaroo Mother Care (KMC) is a term that is used interchangeably with skin-to-skin. The act of skin-to-skin involves placing a newborn chest-to-chest with mom, and in some cases dad or another individual/guardian. The adult and newborn both have their shirts off so that there is direct skin contact between their chests. According to the authors, KMC was introduced by Dr. Edgar Rey Sanabria in 1978 in Bogota Columbia as an alternative to the incubator to keep low birth weight infants warm and stable.

Hospitals that are Baby Friendly Certified employ KMC after birth and as often as possible. Many other hospitals also encourage KMC, based on the evidence that it is safe and effective as a way to stabilize newborns.

Why all the hype about KMC? Allowing the infant to spend time chest-to-chest with mom and others has been associated with many benefits for premature, late preterm, and full term infants.

The authors of this analysis reviewed 124 studies on the benefits of KMC for premature, low birth weight, and full term newborns, to determine what the research evidence tells us.

Based on these authors’ findings, what do you think is not a benefit of KMC for any newborn?

Decrease risk of infant mortality
Increased rates of breastfeeding at hospital discharge and at 4 months postpartum
A slower heart rate
Improved blood sugars (less hypoglycemia)
Improved temperature stability (less hypothermia)
Lower risk of re-admission to the hospital after infant illness
Improved oxygen in the blood

Click here to view the answer to this question.

Correct Answers: The answer is #3

Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Liberman E, Kajeepeta S, Wall S, Chan GJ Pediatrics 2016 Jan; 137(1)

Link to the Abstract
Context
Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns.
Objective
Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes.
Data Sources
PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM).
Methods: Data were from the Infant Feeding Practices Study II; mothers were recruited from a nationally distributed consumer opinion panel. Mothers were asked about breast pump use, problems, and injuries at infant ages 2, 5, and 7 months. Survival analysis was used to identify factors associated with pump-related problems and injuries.
Study Selection
We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. Data Exraction
Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures.
Results
1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality (RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth.
Limitations
Lack of data on KMC limited the ability to assess dose-response.
Conclusions
Interventions to scale up KMC implementation are warranted.
Copyright © 2016 by the American Academy of Pediatrics.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

It is refreshing to have such clear cut evidence for the benefits of KMC, a behavior that is low tech and that encourages parents to stay wired with their newborn infant rather than with social media. In addition, by protecting the infant’s blood sugar, body temperature and oxygenation, infants are able to nurse earlier and more effectively, more likely to stay with their mothers, and less likely to spend time in the neonatal intensive care unit.

We need to teach parents what we are trying to accomplish with KMC, so that they understand how the infant’s rooting and movement are reflexive feeding behaviors. It is also important to teach parents how to hold their babies safely while skin-to-skin. We are fortunate to have the work of Susan Ludington RN, CNM, PhD, FAAN, a champion of KMC. She created and maintains a marvelous website, www.kangaroocareusa.org, where anyone can watch videos of KMC and skin-to-skin in various birthing situations. She also provides educational resources for anyone who is working to establish KMC in their hospitals, and for families who would like to know how KMC works after delivery.

Kangaroo Mother Care and Neonatal Outcomes: A Meta-Analysis

Based on these authors’ findings, what do you think is not a benefit of KMC for any newborn?

Correct Answers: The answer is #3

IABLE Comment by Anne Eglash MD, IBCLC, FABM

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