“Kangaroo Mother Care” (KMC) is a technique for newborn care that includes skin-to-skin contact between a child and a guardian and frequent breastfeeding of the infant. Many studies support the efficacy of Kangaroo Mother Care as an intervention for mortality in preterm and low birth weight newborns. However, most low birth weight neonates die before they reach stabilization, before KMC is implemented.
While mortality for children under five years of age has decreased dramatically over the years, the WHO says that most of the causes for deaths under five are “preventable and treatable”.
KMC has been shown by many studies to significantly reduce mortality and morbidity in low birth weight infants. Low birth weight infants are neonates born with a weight of 2.5 kg or lower, due to preterm birth or preterm complications, such as malnutrition and unfavorable environmental conditions. Kangaroo Mother Care provides warmth, social interaction, stimulation, immunological support, and nourishment for the child when coupled with breastfeeding. Studies suggest that KMC has favorable neurological implications for both the child and the parent that performs KMC. While KMC has been shown to support the survival of preterm and low birth weight infants, most low birth weight infants that die, die before stabilization, and will never receive KMC, as KMC is usually implemented after stabilization.
In a 2021 study performed by the WHO Immediate KMC Study Group, 3211 low birth weight neonates and mothers in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania received Kangaroo Mother Care. Half of the participants received immediate kangaroo mother care while the other half received kangaroo mother care after stabilization and the standard neonatal incubation procedure. The participants were infants weighing 1.0-1.79 kg upon birth and born to mothers 15 years of age and older that were not ill and did not deliver more than two infants during the same pregnancy. The infants and their mothers were randomly selected to be in either the control and intervention group from willing participants. The study found that immediate kangaroo mother care for low birth weight infants as opposed to kangaroo mother care after stabilization for low birth weight infants resulted in a 25% higher survival rate. Immediate kangaroo mother care as opposed to kangaroo mother care after stabilization resulted in lower rates of hypothermia and suspected sepsis. There was no significant difference in the time required for stabilization or feeding behaviors between the control and intervention groups. However, other studies suggest that the time required for stabilization and breastfeeding ability may be lowered by immediate KMC intervention, which could also promote survival.
While there is a wealth of research supporting the use of Kangaroo Mother Care, not much research exists on immediate Kangaroo Mother Care and the efficacy of immediate Kangaroo Mother Care on neonatal survival. According to the World Health Organization, about 45% of deaths in neonates occur in the first 24 hours of life and about 80% of deaths in neonates occur within the first week of life. This suggests that intervention is needed before or during stabilization in order to most effectively prevent neonatal deaths. Immediate Kangaroo Mother Care provides warmth, nourishment, immune support, and safety to newborns without cost, training or resources and may prevent the mortality and morbidity of children that would otherwise not survive to stabilization.
By Julia Doo
Arya, Sugandha, Helga Naburi, Kondwani Kawaza, Sam Newton, Chineme H. Anyabolu, Nils Bergman, Suman PN Rao et al. "Immediate" Kangaroo Mother Care" and Survival of Infants with Low Birth Weight."The New England journal of medicine 384, no. 21 (2021): 2028-2038.
Chan, G. J., Valsangkar, B., Kajeepeta, S., Boundy, E. O., & Wall, S. (2016). What is kangaroo mother care? Systematic review of the literature.Journal of global health,6(1).
Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M. & Worku, B. (2005). Kangaroo mother care: 25 years after.Acta Paediatrica,94(5), 514-522.
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World Health Organization. (2020). Children: improving survival and well-being.WHO Fact Sheets.
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.