Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low-birth-weight infants: a randomized controlled trial. Kangaroo mother versus traditional care for newborn infants </=2000 grams: a randomized, controlled trial. Feasibility of kangaroo mother care in Mumbai. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. A comparison of kangaroo mother care and conventional cuddling care. Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia. A randomized controlled trial of a home-visiting intervention on cognition and behavior in term low birth weight infants. Minimizing adverse effects of low birthweight: four-year results of an early intervention program. Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Maternidad Isidro Ayora Study Team. Comparison of heated water-filled mattress and space-heated room with infant incubator in providing warmth to low birthweight newborns. KMC facilitates mother baby attachment in low birth weight infants. Kangaroo Mother Care in very low birth weight infants. Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial. A randomized trial of nurse-midwifery prenatal care to reduce low birth weight.
The aim of this study was to examine the effectiveness of earlier continuous Kangaroo Mother Care (KMC) for relatively stable low-birth-weight (LBW) infants in a resource-limited country.
                A randomized controlled trial was performed in LBW infants at a referral hospital in Madagascar. Earlier continuous KMC (intervention) was begun as soon as possible, within 24 h postbirth, and later continuous KMC (control: conventional care) was begun after complete stabilization (generally after 24 h postbirth). Main outcome measure was mortality during the first 28 days postbirth. This trial was registered with ClinicalTrials.gov, NCT00531492.
                A total of 73 infants (intervention 37, control 36) were included. Earlier continuous KMC had higher but no statistically different mortality in the first 28 days postbirth (1 vs. 2; risk ratio, 1.95; 95% CIs, 0.18-20.53; p = 1.00). There were no differences in incidence of morbidities. Body weight loss from birth to 24 h postbirth was significantly less in earlier KMC infants compared with later KMC infants. (-34.81 g vs. -73.97 g; mean difference, 39.16 g; 95% CIs, 10.30-68.03; p = 0.01; adjusted p = 0.02). Adverse events and duration of hospitalization were not different between the two groups.
                Further evaluations of earlier continuous KMC including measurement of KMC dose, are needed in resource-limited countries. In 1978, kangaroo mother care (KMC) was proposed as a caring alternative for low birth weight (LBW) infants. We are reporting here early outcomes of a randomized, controlled trial comparing KMC to traditional care.
                An open randomized, controlled trial was conducted in a large tertiary care hospital. All newborn infants </=2000 g, surviving the neonatal period and being eligible for a minimal care unit, were included. A total of 1084 newborns </=2000 g were followed, and 746 were randomized-382 to KMC and 364 to traditional care. KMC infants were discharged after randomization, regardless of weight or gestational age. Infants spent 24 hours per day in an upright position, in skin-to-skin contact, and attached to the mother's chest. After randomization, control infants remained at the minimal care unit until meeting usual discharge criteria. Both groups are being followed up to 12 months of corrected age; 679 (90%) were available for evaluation when they reached term (40 to 41 weeks of postconceptional age). The present paper reports early outcomes (when reaching term) including mortality, infectious episodes, hospital stay after eligibility, and growth and feeding patterns.
                Both study groups were similar regarding all baseline variables but weight at eligibility. The risk of dying was similar in both groups (relative risk = 0.59, 95% confidence interval 0.22-1. 6). There were no differences in growth indices. Nosocomial infections were more frequent in control infants. Hospital stay after eligibility was shorter in KMC, primarily for infants </=1800 g.
                These results show that KMC is a safe approach to the care of clinically stable LBW infants. Our findings provide the necessary scientific support to a method that is already incorporated in the care of LBW infants at many hospitals around the world and at different levels of care. The purpose of this study was to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India.
                A randomized controlled trial was performed over one year period in which 89 neonates were randomized into two groups kangaroo mother care (KMC) and conventional method of care (CMC).
                Forty-four babies were randomized into KMC group and 45 to CMC. There was significant reduction in KMC vs CMC group of hypothermia (10/44 vs 21/45, p-value < 0.01), higher oxygen saturations (95.7 vs 94.8%, p-value < 0.01) and decrease in respiratory rates (36.2 vs 40.7, p-value < 0.01). There were no statistically significant differences in the incidence of hyperthermia, sepsis, apnea, onset of breastfeeding and hospital stay in two groups. 79% of mothers felt comfortable during the KMC and 73% felt they would be able to give KMC at home. KMC is feasible, as mothers are already admitted in hospitals and are involved in the care of newborn.
                KMC is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of KMC demonstrated in the study. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all place. To compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) on growth in LBW babies (> 2000 g).
                Randomized controlled trial.
                Level III NICU of a teaching institution in western India.
                206 neonates with birth weight < 2000 g.
                The subjects were randomized into two groups: the intervention group (KMC-103) received Kangaroo mother care. The control group (CMC: 103) received conventional care.
                Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed.
                The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P< 0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home.
                Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home. A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000-1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11,788 vs US$ 29,888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000-1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low-income countries KMC may represent an appropriate use of scarce resources. To compare kangaroo mother care (KMC) and conventional cuddling care (CCC) in premature and small-for-gestational-age infants.
                Thirty mother-infant dyads in two Australian neonatal nurseries were randomly assigned to the KMC group or the CCC group. Both groups of mothers cuddled their babies for a minimum of two hours a day, five days a week while in the study, with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing.
                The main outcome variables were infant weight gain, temperature maintenance during KMC and CCC, and length of hospital stay.
                The results showed no difference between groups on the Parental Stress Scale (NICU) or the Parental Expectations Survey. Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators, equal weight gain, equal length of stay in the hospital, and equal duration of breastfeeding. A randomized controlled trial was conducted over a 1-year period (November 2001-November 2002) in Addis Ababa to study the effectiveness of early Kangaroo mother care before stabilization of low birthweight infants as compared with the conventional method of care. There were 259 babies weighing less than 2000 g during the study period and a total of 123 (47.5 per cent) low birthweight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) cases. The demographic and socioeconomic characteristics for both groups were comparable. The mean age at the time of enrollment was 10 and 9.8 h for KMC and CMC, respectively (p>0.05 with 95 per cent confidence interval). The mean birthweight was 1514.8 g (range 1000-1900 g) for KMC and 1471.8 g (range 930-1900 g) for CMC (p>0.05 with 95 per cent CI) and the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases, respectively. Fifty-eight per cent of KMC and 52 per cent of CMC cases were on i.v. fluid. Twenty-one of 62 (34 per cent) of KMC and 23/61 (37 per cent) of CMC babies were on oxygen through nasopharyngeal catheter. The mean age at exit from the study was 4.6 days for KMC and 5.4 days for CMC. Ninety-one per cent and 88 per cent of babies in KMC and CMC were discharged from the study in the first 7 days of life, respectively. The study showed that 14/62 (22.5 per cent) of KMC vs. 24/63 (38 per cent) CMC babies died during the study (p<0.05 and CI of 95 per cent.) The majority of deaths occurred during the first 12 h of life. Survival for the preterm low birthweight infants was remarkably better for the early kangaroo mother care group than the babies in the conventional method of care in the first 12 h and there after. More than 95 per cent of mothers reported that they were happy to care for their low birthweight babies using the early Kangaroo mother method. It was recommended to study the feasibility and effectiveness of Kangaroo mother care at the community level. To determine whether early psychosocial intervention with low birth weight term (LBW-T) infants improved cognition and behavior and to compare LBW-T with normal birth weight (NBW) infants.
                A randomized controlled trial was carried out in Kingston, Jamaica, with 140 LBW-T infants (weight<2500 g). The intervention comprised weekly home visits by paraprofessionals for the first 8 weeks of life aimed at improving maternal-child interaction. LBW-T and 94 matched NBW (weight 2500 to 4000 g) infants were recruited from the main maternity hospital. Main outcome measures were problem solving (2 means-end tests: cover and support) and 4 behavior ratings at 7 months. Analyses used were the t test for intervention effects and multiple regression to compare LBW and NBW infants.
                LBW-T intervened infants had higher scores than LBW-T control infants on the cover test (P<.05) and were more cooperative (P<.01) and happy (P<.05). LBW-T control infants had poorer scores on both the cover (P<.001) and support tests (P<.01), vocalized less (P<.02), and were less cooperative (P<.001), happy (P<.02), and active (P<.02) than NBW infants. LBW-T intervened infants had lower scores than NBW infants only on the support test (P<.05).
                Early low-cost intervention can improve cognition and behavior of LBW-T infants in developing countries. The outcome of an early intervention program for low-birthweight (LBW) infants was examined in this study. The intervention consisted of 11 sessions, beginning during the final week of hospitalization and extending into the home over a 3-month period. The program aimed to facilitate maternal adjustment to the care of a LBW infant, and, indirectly, to enhance the child's development. Neonates weighing less than 2,200 grams and under 37 weeks gestational age were randomly assigned to experimental or control conditions. A full-term, normal birthweight (NBW) group served as a second control. 6-month analyses of dyads who completed all assessments over a 4-year period (N's = 25 LBW experimental, 29 LBW control, and 28 NBW infant-mother dyads) showed that the experimental group mothers reported significantly greater self-confidence and satisfaction with mothering, as well as more favorable perception of infant temperament than LBW control group mothers. A progressive divergence between the LBW experimental and LBW control children on cognitive scores culminated in significant group differences on the McCarthy GCI at ages 36 and 48 months, when the LBW experimental group caught up to the NBW group. Possible explanations for the observed delay in the emergence of intervention effects on cognitive development and the mediating role of favorable mother-infant transactional patterns are discussed in light of recent evidence from the literature. Because resources for care of low-birthweight (LBW) infants in developing countries are scarce, the Kangaroo mother method (KMM) was developed. The infant is kept upright in skin-to-skin contact with the mother's breast. Previous studies reported several benefits with the KMM but interpretation of their findings is limited by small size and design weaknesses. We have done a longitudinal, randomised, controlled trial at the Isidro Ayora Maternity Hospital in Quito, Ecuador. Infants with LBW (< 2000 g) who satisfied out-of-risk criteria of tolerance of food and weight stabilisation were randomly assigned to KMM and control (standard incubator care) groups (n = 128 and 147, respectively). During 6 months of follow-up the KMM group had a significantly lower rate than the control group of serious illness (lower-respiratory-tract disorders, apnoea, aspiration, pneumonia, septicaemia, general infections; 7 [5%] vs 27 [18%], p < 0.002), although differences between the groups in less severe morbidity were not significant. There was no significant difference in growth or in the proportion of women breastfeeding, perhaps because the proportion breastfeeding was high in both groups owing to strong promotion. Mortality was the same in both groups; most deaths occurred during the stabilisation period before randomisation. KMM mothers made more unscheduled clinic visits than control mothers but their infants had fewer re-admissions and so the cost of care was lower with the KMM. Since the eligibility criteria excluded nearly 50% of LBW infants from the study, the KMM is not universally applicable to these infants. The benefits might be greater in populations where breastfeeding is not so common. Prevention of excessive heat loss is fundamental to survival of low birthweight (LBW) newborns. The use of infant incubators (INC) is beyond the resources of developing countries, and the space-heated room (SHR) has been the only feasible means of providing thermal protection to LBW newborns. Recently a thermostatically controlled, heated, water-filled mattress (HWM) has been developed as a potentially simpler and affordable alternative.
                In a neonatal care ward of a referral hospital in Addis Ababa, 62 < 1 week old newborns, weighing 1000-1999 g, who were well enough to breathe comfortably in room air and tolerate oral feeds, were randomly allocated to INC, HWM or SHR and followed for 3 weeks. The level of cold stress as assessed by core-to-skin temperature gradient and the rate of weight gain were the main outcome measures.
                The level of cold stress was lowest in the INC, intermediate in the HWM and highest in the SHR. Relative to the INC group, the HWM group exhibited a modest increase in the occurrence of clinically important hyperthermic or hypothermic deviations in core temperature (rate ratio (RR) = 2.3; 95% CI: 0.9, 5.6), and the SHR displayed a definite increase (RR = 4.0; 95% CI: 1.7, 9.3). During the first week, the rate of weight gain was highest in the INC group (3.6 g/kg/day), lowest in the SHR group (-2.3 g/kg/day, P < 0.05 versus INC) and intermediate in the HWM group (1.6 g/kg/day, P > 0.1 versus INC).
                Care in the SHR produced clinically significant thermal stresses and was associated with deficient early neonatal growth, but the use of HWM may constitute a feasible and clinically acceptable alternative in providing warmth to LBW newborns during the neonatal period. To determine whether Kangaroo mother care (KMC) facilitates mother baby attachment in low birth weight infants.
                Over 16 month period 110 neonates were randomized into kangaroo mother care group and control group using a random number table. The kangaroo group was subjected to Kangaroo mother care for at least 6 hours per day. The babies also received kangaroo care after shifting out from NICU and at home. The control group received standard care (incubator or open care system). After 3 months followup, structured maternal interview was conducted to assess attachment between mothers and their babies.
                Mean birth weight was 1.69 +/- 0.11 Kg in KMC group compared to 1.690 +/- 0.12 Kg in control group (p>0.05). Mean gestational age was 35.48 +/- 1.20 week in KMC group and 35.04+/-1.09 week in the control group (p>0.05). KMC was initiated at a mean age of 1.72+/-0.45 days. The duration of KMC in first month was 10.21+/-1.50 hour, in the 2nd month was 10.03+/-1.57 hour and in the 3rd month was 8.97+/-1.37 hours. The duration of hospital stay was significantly shorter in the KMC group (3.56+/-0.57 days) compared to control group (6.80+/-1.30 days). The total attachment score (24.46+/-1.64) in the KMC group was significantly higher than that obtained in control group (18.22+/-1.79, p< 0.001). In KMC group, mother was more often the main caretaker of the baby. Mothers were significantly more involved in care taking activities like bathing, diapering, sleeping with their babies and spent more time beyond usual care taking. They went out without their babies less often and only for unavoidable reasons. They derived greater pleasure from their babies.
                KMC facilitates mother baby attachment in low birth weight infants. This study was conducted (i) to study through a randomized control trial the effect of Kangaroo Mother Care (KMC) on breast feeding rates, weight gain and length of hospitalization of very low birth neonates and (ii) to assess the acceptability of Kangaroo Mother Care by nurses and mothers.
                Babies whose birth weight was less than 1500 Grams were included in the study once they were stable. The effect of Kangaroo Mother Care on breast feeding rates, weight gain and length of hospitalization of very low birth weight neonates was studied through a randomized control trial in 28 neonates. The Kangaroo group (n = 14) was subjected to Kangaroo Mother Care of at least 4 hours per day in not more than 3 sittings. The babies received Kangaroo Care after shifting out from NICU and at home. The control group (n = 14) received only standard care (incubator or open care system). Attitude of mothers and nurses towards KMC was assessed on Day 3 +/- 1 and on day 7 +/- 1 after starting Kangaroo Care in a questionnaire using Likert's scale.
                The results of the clinical trial reveal that the neonates in the KMC group demonstrated better weight gain after the first week of life (15.9 +/- 4.5 gm/day vs. 10.6 +/- 4.5 gm/day in the KMC group and control group respectively p < 0.05) and earlier hospital discharge (27.2 +/- 7 vs. 34.6 +/- 7 days in KMC and control group respectively, p < 0.05). The number of mothers exclusively breastfeeding their babies at 6 week follow-up was double in the KMC group than in the control group (12/14 vs. 6/14) (p < 0.05).
                KMC managed babies had better weight gain, earlier hospital discharge and, more impressively, higher exclusive breast-feeding rates. KMC is an excellent adjunct to the routine preterm care in a nursery. Exclusive breastfeeding increases survival and optimizes growth of low-birthweight (LBW) infants. If supported, mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo. We tested the efficacy of postnatal peer counselling among first-time mothers that aimed to increase exclusive breastfeeding of term LBW infants.
                In a Manila hospital, 204 mothers were randomized into three groups. Two intervention groups receiving home-based counselling visits, one by counsellors trained in breastfeeding counselling (n=68), the other by counsellors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive counselling.
                Eighty-eight per cent of the participating pairs completed the trial. At 6 mo, 44% of the breastfeeding counselled mothers, 7% childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding. More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo. Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea. All groups had improved mean weight-for-age Z-scores at 6 mo.
                This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants. By improving health outcomes, enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants. In a randomized, controlled trial in five regional centers with state health department clinics, 1458 women at high risk for low birth weight (LBW) outcome received either prenatal interventions provided by nurse-midwives and nurses under their supervision or the standard high-risk prenatal care provided by obstetricians. The intervention administered by the nurse-midwives included patient education to identify the signs and symptoms of preterm labor, activity counseling in response to monitoring of the cervix by frequent examinations, stress reduction by enhancing social support, nutrition counseling with emphasis on weight gain, and substance-abuse counseling. For women in the control group, care was provided by obstetricians according to local standards for the management of high-risk pregnancies. We hypothesized that the LBW rate among live births to women who had received care from nurse-midwives would be lower than that in the control group. Although the LBW rate was lower in the intervention group than in the control group, the observed difference was not statistically significant. Race was not prespecified as a possible effect modifier, but examination of the data post hoc suggested that black women at high statistical risk of giving birth to an LBW infant may have derived benefit from the program. Although the results do not suggest any striking advantage of the nurse-midwifery intervention over standard obstetric care for women at high statistical risk of having an LBW infant, neither do they suggest any disadvantage. Nurse-midwives could provide care to certain populations of high-risk women and facilitate future coverage of these presently underserved populations.
The 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 effectiveness and safety of early onset continuous KMC in unstabilized LBW infants, long term neurodevelopmental outcomes, and costs of care.