Immediate kangaroo mother care (KMC) reduces risk of sepsis among very small and sick preterm babies, according to a new analysis published in the medical journal, eClinicalMedicine. Among these very vulnerable newborns, immediate KMC - which combines skin-to-skin contact with exclusive breastfeeding, or provision of breastmilk - reduced suspected sepsis by 18%, sepsis-related deaths by 36%, and overall deaths by 25%.
"This research indicates that starting kangaroo mother care as soon as the baby is born - even before they are stabilized - provides preterm and low-birthweight babies with the best protection against severe infections," said Dr Anshu Banerjee, Director of Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. "KMC is an important strategy for infection prevention and control among babies born early or small.".
The secondary analysis looked at outcomes from a multi-country randomized controlled trial in five countries, which involved more than 3 200 very small or preterm babies. In the study, KMC was initiated soon after birth (within two hours) and given continuously before and after stabilization. This means that the mother or surrogate caregiver and the baby needed to be together without separation for as long as possible, within what was called a Mother-Newborn Intensive Care Unit.
"The concept of the Mother-Newborn Intensive Care Unit posed a challenge in the mindset of many health professionals and policymakers, who were concerned about a potential increase in infections caused by the continuous presence of mothers or surrogates within the intensive care facility," said Dr Harish Chellani, one of the Clinical Investigators at the Vardhman Mahavir Medical College and Safdarjung Hospital in Delhi, India.
"In reality, the study showed that enabling immediate kangaroo mother care did not increase neonatal sepsis but rather reduced it," added Dr Sugandha Arya, also a Clinical Investigator at the same site.
The analysis adds to mounting evidence showing the incredible benefits of immediate KMC for small and preterm babies, including improved survival, lower infection rates, reduced hypothermia and better feeding.
For all preterm or low birthweight babies - including babies that are very small or sick - WHO now recommends starting KMC as soon as possible after birth. For many health facilities, this will require a fundamental change in the way neonatal care is provided to ensure families and small babies can stay together, without any period of separation.
While data on blood culture was limited, the analysis also provided a promising indication that bacterial isolates might be different among those babies receiving immediate KMC compared to those getting conventional care in an incubator or a radiant warmer. Of note, the former had fewer gram-negative bacteria that are more likely to be drug-resistant - potentially contributing to lower mortality rates. More research is needed, however, to confirm this part of the analysis.
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About the analysis
Conducted by WHO and several external investigators, the secondary analysis assessed data from the immediate Kangaroo Mother Care Study that took place between 2017 and 2020. This study was conducted in five Newborn Intensive Care Units (NICUs) in Ghana, India, Malawi, Nigeria, and Tanzania, in newborns with birth weight ranging from 1 to 1.8 kg. The study compared outcomes for babies where KMC was initiated immediately after birth, compared to babies who received conventional care in a warmer or incubator followed by KMC only once clinical stabilization was achieved.
