Low-cost intervention keeps small newborns alive

Immediate “kangaroo mothercare” for low birth weight infants significantly reduced the risk of premature death, the researchers reported.

Interventions in which the mother maintained skin-to-skin contact with the newborn immediately after birth reduced infant mortality at 28 days by almost 4 percentage points compared to controls receiving conventional care until stable. (12.0% vs. 15.7%; RR 0.75, 95% CI 0.64-0.89), Randomized controlled trial Organized by the WHO Immediate KMC Research Group, five resources were implemented in limited countries.

Deaths within the first 72 hours were also numerically lower in kangaroo immediate maternal care, at 4.6% compared to 5.8% in the control group, the group reported. New England Journal of Medicine.. However, this difference was slightly below the statistical significance.

The authors of the study estimated that providing interventions to 27 babies could prevent one neonatal death.

“The results of the study can be generalized to most hospitals in a low-resource environment where immediate care of kangaroo mothers can be provided,” said Suman Rao, MD of WHO in Geneva, Switzerland. And colleagues. However, the intervention was expensive. The hospital needed to adapt the Neonatal Intensive Care Unit (NICU) so that the mother (and agent) could be with the newborn 24 hours a day, or build something special from scratch.

The WHO study was not the first trial of kangaroo mother care. Others have shown that it reduces the mortality rate of low birth weight infants. However, those studies required that infants begin after they have stabilized in standard NICU care. Rao et al. Stated that most neonatal deaths occur before stabilization. Therefore, they sought to investigate whether it would be beneficial to provide kangaroo mother care immediately after childbirth.

Approximately 3,200 infant-mother pairs were enrolled in an open-label study conducted in Ghana, Malawi, Nigeria, Tanzania, and India. Low birth weight was defined as 1.0-1.799 kg. The average number of participants was 1.5 kg (SD 0.02) and the average gestational age was 32.6 weeks. Infants and mothers were not extremely ill and mothers had to be at least 15 years old. The average age of the mother was 27 years. Approximately 20 infants were excluded from the final 28-day mortality analysis because the mother stopped studying or could not find a newborn.

Participants were randomized to blocks, 1,609 were assigned to immediate maternal care for kangaroos and 1,602 were assigned to the control group. The latter received standard NICU care until the baby was clinically stable. Respiratory rate is 40-60 breaths per minute, no apnea or CPAP is required, room air oxygen saturation is over 90% and heart rate is 80-160 beats per minute. , And axillary temperature of 36.0-37.4 ° C-then received kangaroo mothercare.

Each mother was asked to appoint one or two other adults to act on behalf of the kangaroo’s mother’s care during the period when the mother needed to leave the NICU. This care included tying the baby to the mother’s or surrogate’s chest, loose enough to ensure airway patency. The median time from birth to initiation of kangaroo mother care was 1.3 hours in the intervention group and 54 hours in the control group.

Secondary results were not significantly different between groups, but tended to favor immediate care of kangaroo mothers over some controls.

• Hypothermia: 5.6% vs. 8.3%
• Suspected sepsis: 22.9% vs. 27.8%
• Maternal depression: 0.2% vs. 0.6%

A subgroup analysis of 28-day mortality with stratification by birth weight, gestational age, type of birth, and hospital location did not show many differences. One exception: On the Ghanaian site, there were no hints of benefits for immediate care of kangaroo mothers.

Overall, Rao et al. Conclude that the study results reflect the results of previous studies in clinically stable newborns. As in these previous studies, the underlying mechanism of the reported benefits remains speculative. Rao’s group suggested that colonization by the maternal microflora could possibly play a role in minimizing the risk of infection, as well as the reduced treatment of babies by others. Interventions will probably reduce that to the extent that the newborn is stressed from the separation of the mother.

Limitations of the analysis include the lack of blindness (although the results were determined from records reviewed by researchers who were unaware of the infant assignment), and research sites and providers in detail of how the intervention was performed. Included potential differences between.

Last updated: May 26, 2021