A method of care involving skin-to-skin contact between a mother and her prematurely born baby may improve the child’s chances of survival significantly, according to a review of studies conducted in India. The research, published in the BMJ Global Health journal, found that starting the intervention within 24 hours of birth and carrying it out for at least eight hours a day both appear to make the approach even more effective in reducing mortality and infection.
The method of care known as “kangaroo mother care” (KMC) involves an infant being carried, usually by the mother, in a sling with skin-to-skin contact and many studies already carried out have shown this is a way of reducing mortality and risk of infection for the child, they said. The World Health Organization recommends it as the standard of care among low birth weight infants after clinical stabilisation. However, less is known about the ideal time at which to begin the intervention.
The researchers at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry and All India Institute of Medical Sciences (AIIMS), New Delhi, reviewed numerous large multi-country and community-based randomised trials on the subject. They compared KMC with conventional care, starting the approach early (within 24 hours of the birth) with later initiation of KMC to see what effect this had on neonatal and infant mortality and severe illness among low birth weight and preterm infants.
The review looked at 31 trials that included 15,559 infants collectively and of these, 27 studies compared KMC with conventional care, while four compared early with late initiation of KMC. Analysis of the results showed that compared with conventional care, KMC appeared to reduce the risk of mortality by 32 per cent during birth hospitalisation or by 28 days after birth, while it seemed to reduce the risk of severe infection, such as sepsis, by 15 per cent, the researchers said.
It also emerged that the reduction in mortality was noted regardless of gestational age or weight of the child at enrollment, time of initiation, and place of initiation of KMC (hospital or community), they said. The study found that the mortality benefits were greater when the daily duration of KMC was at least eight hours per day than with shorter duration KMC.
Studies that compared early with late-initiated KMC demonstrated a reduction in neonatal mortality of 33 per cent and a probable decreased risk of 15 per cent in clinical sepsis until 28 days following early initiation of KMC. The researchers acknowledged some limitations in that the studies looked at involved an intervention that was known about by participants so that it could be seen as biased, and very low birth weight, extremely preterm neonates, and severely unstable neonates were often excluded from studies.
However, the review authors said that the risk of bias in the included studies was generally low, and because their review had included a comprehensive and systematic search of existing studies, the certainty of the evidence for the primary outcomes was moderate to high.
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