'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications


Lawn, JE; Mwansa-Kambafwile, J; Horta, BL; Barros, FC; Cousens, S; (2010) 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications. International journal of epidemiology, 39. pp. 144-154. ISSN 0300-5771 DOI: https://doi.org/10.1093/ije/dyq031

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Abstract

Background '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. Objectives 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. Methods We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. Results 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). Conclusion 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.

Item Type: Article
Keywords: Neonatal mortality, newborn care, preterm births, prematurity, low, birthweight, Kangaroo Mother Care, Kangaroo Care, skin-to-skin care, randomized controlled-trial, weight infants, mortality, follow, save, Breast Feeding, Child Rearing, Female, Humans, Infant Care, methods, Infant Mortality, Infant, Newborn, Infant, Premature, growth & development, Male, Parent-Child Relations, Physical Stimulation, Premature Birth, Randomized Controlled Trials as Topic
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Tropical Epidemiology Group
PubMed ID: 20348117
Web of Science ID: 277315100018
URI: http://researchonline.lshtm.ac.uk/id/eprint/3692

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