Kangaroo mother care to reduce morbidity and mortality in low birthweight infants
Open accessAbstract
BACKGROUND: Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. OBJECTIVES: To determine whether evidence is available to support the use of KMC in LBW infants as an alternative to conventional neonatal care before or after the initial period of stabilization with conventional care, and to assess beneficial and adverse effects. SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches in CENTRAL (Cochrane Central Register of Controlled Trials; 2016, Issue 6), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Science Information database), and POPLINE (Population Information Online) databases (all from inception to June 30, 2016), as well as the WHO (World Health Organization) Trial Registration Data Set (up to June 30, 2016). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google Scholar. SELECTION CRITERIA: Randomized controlled trials comparing KMC versus conventional neonatal care, or early-onset KMC versus late-onset KMC, in LBW infants. DATA COLLECTION AND ANALYSIS: Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. MAIN RESULTS: Twenty-one studies, including 3042 infants, fulfilled inclusion criteria. Nineteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early-onset KMC with late-onset KMC in relatively stable LBW infants. Sixteen studies evaluated intermittent KMC, and five evaluated continuous KMC. KMC versus conventional neonatal care: At discharge or 40 to 41 weeks' postmenstrual age, KMC was associated with a statistically significant reduction in the risk of mortality (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (RR 0.35, 95% CI 0.22 to 0.54; five trials, 1239 infants), and hypothermia (RR 0.28, 95% CI 0.16 to 0.49; nine trials, 989 infants; moderate-quality evidence). At latest follow-up, KMC was associated with a significantly decreased risk of mortality (RR 0.67, 95% CI 0.48 to 0.95; 12 trials, 2293 infants; moderate-quality evidence) and severe infection/sepsis (RR 0.50, 95% CI 0.36 to 0.69; eight trials, 1463 infants; moderate-quality evidence). Moreover, KMC was found to increase weight gain (mean difference [MD] 4.1 g/d, 95% CI 2.3 to 5.9; 11 trials, 1198 infants; moderate-quality evidence), length gain (MD 0.21 cm/week, 95% CI 0.03 to 0.38; three trials, 377 infants) and head circumference gain (MD 0.14 cm/week, 95% CI 0.06 to 0.22; four trials, 495 infants) at latest follow-up, exclusive breastfeeding at discharge or 40 to 41 weeks' postmenstrual age (RR 1.16, 95% CI 1.07 to 1.25; six studies, 1453 mothers) and at one to three months' follow-up (RR 1.20, 95% CI 1.01 to 1.43; five studies, 600 mothers), any (exclusive or partial) breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age (RR 1.20, 95% CI 1.07 to 1.34; 10 studies, 1696 mothers; moderate-quality evidence) and at one to three months' follow-up (RR 1.17, 95% CI 1.05 to 1.31; nine studies, 1394 mothers; low-quality evidence), and some measures of mother-infant attachment and home environment. No statistically significant differences were found between KMC infants and controls in Griffith quotients for psychomotor development at 12 months' corrected age (low-quality evidence). Sensitivity analysis suggested that inclusion of studies with high risk of bias did not affect the general direction of findings nor the size of the treatment effect for main outcomes. Early-onset KMC versus late-onset KMC in relatively stable infants: One trial compared early-onset continuous KMC (within 24 hours post birth) versus late-onset continuous KMC (after 24 hours post birth) in 73 relatively stable LBW infants. Investigators reported no significant differences between the two study groups in mortality, morbidity, severe infection, hypothermia, breastfeeding, and nutritional indicators. Early-onset KMC was associated with a statistically significant reduction in length of hospital stay (MD 0.9 days, 95% CI 0.6 to 1.2). AUTHORS' CONCLUSIONS: Evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care, mainly in resource-limited settings. Further information is required concerning the effectiveness and safety of early-onset continuous KMC in unstabilized or relatively stabilized LBW infants, as well as long-term neurodevelopmental outcomes and costs of care.
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A Cochrane review reported that KMC after stabilization reduces mortality in LBW infants by 40% compared to conventional care (Risk Ratio 0.60, 95% CI 0.39-0.92).
“A Cochrane review reported that KMC after stabilization reduces mortality in LBW infants by 40% as compared to conventional care (Risk Ratio 0.60, 95% CI: 0.39–0.92) (12).”
From Community-based Kangaroo Mother Care in low-birth-weight infants: a quality improvement study in the urban slums of Kolkata, West Bengal (2026) · cites this paper as [12]
The Effects of interventions section reports RR 0.60 (95% CI 0.39–0.92) for mortality at discharge or 40–41 weeks’ postmenstrual age versus conventional care. But that estimate includes a trial in which KMC began before stabilization; the after-stabilization subgroup has a different estimate (RR 0.63, 95% CI 0.32–1.23). The claim incorrectly applies the 40% reduction to infants receiving KMC after stabilization. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA recent review of 21 studies of KMC with low birthweight infants showed that KMC benefits infant health and wellbeing, with positive impacts on infant weight, length, head circumference, and selected measures of parent attachment.
“A recent review of 21 studies of KMC with low birthweight infants showed that this practice can benefit infant health and wellbeing, with positive impacts on infant weight, length, and head circumference, as well as selected measures of parent attachment [134].”
From Benefits of a bedtime routine in young children: Sleep, development, and beyond. (2018) · cites this paper as [134]
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“The benefits of early, facility initiated KMC particularly before clinical stabilization, are well established, including improved weight gain, exclusive breastfeeding rates and the reductions in morbidity and mortality among LBW infants (12).”
Influential
- Authors
- Conde-Agudelo, A., & Díaz-Rossello, J. L.
- Affiliations
- Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, and Department of Obstetrics and Gynecology, Wayne State University; Perinatology Research Branch; Detroit Michigan USA
- Universidad de la República de Uruguay (UY)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2016-08-23
- Volume
- 2017
- Issue
- 2
- Pages
- CD002771-CD002771
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6464509
- OpenAlex
- W2164580180
- Cited by
- 1,349
- References
- 3
- Citations by year
- 2026: 42 · 2025: 74 · 2024: 96 · 2023: 101 · 2022: 131 · 2021: 134 · 2020: 114 · 2019: 84 · 2018: 80 · 2017: 84 · 2016: 71 · 2015: 57 · 2014: 59 · 2013: 48 · 2012: 49
- FWCI
- 16.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (13/89/12)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- kangaroo mother care, low birth weight infants, neonatal mortality, nosocomial infections, sepsis, hypothermia, neonatal morbidity, skin-to-skin contact, breastfeeding, neonatal intensive care, neonatal stabilization, neonatal resuscitation, neonatal hypoglycemia
- MeSH terms
- Bacterial Infections, Breast Feeding, Humans, Infant, Infant Care, Infant Mortality, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Diseases, Length of Stay, Object Attachment, Physical Stimulation, Weight Gain, Randomized Controlled Trials as Topic, Kangaroo-Mother Care Method
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