For premature babies, kangaroo care significantly reduces death rates

Early implementation of a type of skin-to-skin contact called kangaroo mother care appears to significantly improve the odds of survival for premature or low-birth-weight babies, according to a sweeping scientific analysis published Monday.

Researchers analyzed data from multiple studies that collectively included more than 15,000 infants worldwide. They found that, compared to conventional care, kangaroo mother care seemed to reduce mortality by 32 percent within the first 28 days of life. The study also suggests that the benefits of kangaroo mother care are higher when it's implemented within 24 hours of birth.

However, babies with extremely young gestational ages, who were severely unstable or who had very low birth weights were often excluded from the studies, since this method of care may not be practical in extreme cases.

Kangaroo mother care involves placing a newborn on a parent or caregiver's bare chest with a blanket covering the baby. It has become a standard form of care for infants worldwide, with benefits including heart rate regulation and stimulating breastfeeding for mothers.

Previous skin-to-skin research regarding premature infants found a decrease in infant mortality rates, but the amount of time needed to achieve optimal benefits was unknown. The latest study, published by the journal BMJ Global Health, concludes that the length of time is a significant factor in reducing the death rate — at least eight hours per day provided the highest benefits.

Babies who received this form of care also had a decreased risk for severe infection and a reduced likelihood of re-hospitalizations.

Babies born before 37 weeks are considered premature and may have problems breathing and feeding, as well as other health complications. Preterm birth and low birth weight are among the top causes of infant death among U.S. babies, according to the Centers for Disease Control and Prevention. The United States has the highest infant mortality rate compared with other high-income nations.

The standard of care for many preterm babies across the U.S. includes conventional medical interventions, such as applying breathing and heart rate monitors, sometimes while the baby is in an incubator. With doctors focused on a baby's immediate medical needs, parental engagement is usually not prioritized.

"The usual care was not centered on immediate skin-to-skin contact," said Manuela Filippa, a developmental psychologist at the University of Geneva who was not involved in the study. "So the key message here is that there must be zero separation between mothers and newborns, especially if they are low birth weight."

She said most medical procedures in the neonatal intensive care unit (NICU) should be done during kangaroo mother care, either with continuous skin-to-skin contact or with very few minutes of separation.

The common mental image of a baby in the NICU involves a clear plastic incubator, with the baby hooked up to devices and laying on their back, which does not allow for much contact from others. However, many babies can have these interventions in place while still maintaining skin-to-skin contact with their mothers.

"Babies aren't necessarily in an incubator anymore in the NICU. They can be in an open, warmer bed," said Lori Feldman-Winter, a past chair of the American Academy of Pediatrics Section on Breastfeeding. "And what this paper is saying is instead of being in one of those open, warmer beds with all their lines, tubes and everything, they can still have all those devices in place and safely be placed skin-to-skin with their mother."

Experts hope this new data will provide hospitals with a better framework for developing policies and best practices for infants in the NICU, focusing on making parents the center of care.

"Engaging [the parents] in care is not only important and has immediate outcomes, but it also lays the foundation for the parent-child relationship well after they’re in the NICU," said Bobbi Pineda, a pediatric occupational therapist specializing in neonatal care at the University of Southern California.

Kangaroo mother care was developed in the 1970s in Bogotá, Colombia, following a skyrocketing death rate among newborns in the country. The practice made its way to countries worldwide and has become a standard of care for premature infants in many U.S. hospitals, but policies can vary drastically.

"This is an opportunity for the AAP and others to think about a clinical report that could help provide the necessary guidance for NICUs to use to be able to support exactly what this is saying — providing that kangaroo mother care within 24 hours and at least eight hours a day," Feldman-Winter said.

As more research emerges, clinicians hope the evidence will encourage health-care facilities to make their spaces more parent-friendly, such as creating family rooms in NICUs and developing better guidelines for parents to hold babies who need immediate medical care.

"I always thought that more than half of the work that we do in the NICU is done with parents," said Panagiotis Kratimenos, a neonatologist at Children's National Hospital in Washington. Kratimenos hopes this research could further influence U.S. hospital policies and reduce mortality rates worldwide.

"We’re talking about three out of 10 babies. It's a huge number," Kratimenos said. "This is really telling you that a significant [number] — close to half the kids — could benefit out of this."