The Cochrane Review has carried out a systematic review on whether Kangaroo care – skin-to-skin contact between a mother and child has an effect on reducing mortality rates in low birthweight infants.
Kangaroo mother care (KMC) is defined by the World Health Organization (WHO) as early, continuous and prolonged skin-to-skin contact between mother and baby.
Implementing exclusive breastfeeding that begins in hospital and can be continued at home is ideal. The baby must be placed between the mother's breasts in an upright position, chest to chest – the kangaroo position (WHO 2003).
The aim of this Cochrane review was to establish if there is sufficient evidence available to support the use of KMC in low birthweight infants as an alternative to conventional neonatal care and to determine beneficial or adverse effects before or following an initial period of stabilisation with conventional care.
This Cochrane review carried out a systematic review using the standard search strategy of the Cochrane Neonatal Review Group. Randomised controlled trials comparing KMC versus conventional neonatal care or early-onset versus late onset KMC in low birthweight infants were selected and included in the data set.
KMC was associated with significant reduction in the risk of mortality, sepsis/nosocomial infection and hypothermia. KMC increased weight, length and head circumference gain at the latest follow-up. Early onset KMC is associated with a reduced hospital stay for preterm infants.
This systematic review supports the use of KMC in low birthweight infants, describing the intervention as effective and safe as an alternative to conventional care, particularly in resource-limited settings. The authors called for further research into the safety of KMC in unstabilised or relatively stabilised infants.
It is reported by the British Association of Perinatal Medicine (2016) that 60,000 to 70,000 infants require some type of neonatal intervention each year in the UK, roughly 10% of all babies born in England. WHO (2015) found a 40% decrease in mortality rates in neonatal units worldwide through the adoption of KMC.
KMC is practised across the UK, however most research into the practice is in resource-limited settings, and environments that can differ markedly from NHS hospitals.
Despite this, many neonatal units follow guidance supplied by United Nations Children's Fund UK (2013), which encourages KMC as part of the Baby Friendly Initiative.
The National Institute for Health and Care Excellence (NICE) (2015) encourages skin-to-skin care and breastfeeding for mother and baby soon after birth.
More recently, the National Institute for Health Research (2016) published a signal, which states that the survival of premature infants can be boosted by KMC. From a pool of 16 studies, there was a 23% reduced risk of death for infants receiving KMC than those receiving conventional care, though the author stresses that many of these studies are from resource-limited settings and may not be as relevant to NHS hospitals.
However, an article in the British Journal of Hospital Medicine (Bailey 2012) attributed improved outcomes in infants receiving KMC in contrast to those receiving conventional care. These outcomes included increased breast feeding rates, better ability to regulate their own temperature, increased growth including weight, length and head circumference, reduced incidence of mortality, morbidity and increased maternal bonding.
Moreover, one study that took place in an NHS hospital in Kent reported that KMC reduces the length of hospital stay and improved breastfeeding outcomes in their study of 214 infants who were either premature, small for gestational age or at high risk of hypoglycaemia (Gregson and Blackwell 2013).
Literature and policy in the UK echoes that of research across the world. KMC is supported in the literature, not only as being equal to care provided by conventional services, but with improved outcomes for infants in a variety of settings.
Bailey S (2012) Kangaroo mother care. British Journal of Hospital Medicine. 73, 5, 278-281.
British Association of Perinatal Medicine (2016) Neonatal Critical Care E08/5/a.
Gregson S, Blacker J (2011) Kangaroo care in pre-term or low birth weight babies in a postnatal ward. British Journal of Midwifery. 19, 9, 568-577.
National Institute for Health and Care Excellence (2015) Intrapartum care. Quality Standard 105. Quality statement 2: One-to-One Care. Updated 2017.
National Institute for Health Research (2016) Kangaroo Mother Care May Boost the Survival of Newborn, Premature Babies.
United Nations Children's Fund UK (2013) The Evidence and Rationale for the UNICEF UK Baby Friendly Initiative Standards. UNICEF, London.
World Health Organization (2003) Kangaroo Mother Care: a Practical Guide. WHO, Geneva.
World Health Organization (2015) WHO Recommendations on Interventions to Improve Preterm Birth Outcomes.