NEW YORK (Reuters Health) – Quickly placing a low-birth-weight newborn on the bare chest of the mother and not waiting for the baby to stabilize cuts the neonatal death rate by 25%, according to a new international study of children weighing 1.0 to 1.8 kg at birth.
In the test of the technique, known as kangaroo mother care, the 28-day infant death rate was 15.7% when the baby wasn’t placed on top of the mother until the child was stabilized using an incubator or a radiant warmer. The rate was 12.0% when the skin-to-skin contact was immediate (P=0.001).
The kangaroo care also improved infection rates.
“We think this should shake up care all around the world, although more so in the lower- and middle-income countries,” coauthor Dr. Rajiv Bahl, head of the newborn unit in the department of material, newborn, child, and adolescent health at the World Health Organization, told Reuters Health by phone. “In higher-income countries, infant mortality has been more controlled.”
The neonatal death rate during the first 72 hours of life was also lower with immediate kangaroo care, although not significantly so: 4.6% versus 5.8% in the control group (P=0.09).
The new study of 3,211 infants and their mothers, reported in the New England Journal of Medicine and financed by the Bill and Melinda Gates Foundation, was done at five hospitals in Ghana, India, Malawi, Nigeria and Tanzania.
The study’s data-safety-monitoring board halted the trial early because “we were finding such large differences,” said Dr. Bahl.
Seventy percent of all neonatal deaths are among low-birth-weight children.
The origins of modern kangaroo care go back to the 1990s, at a time when incubators had long been considered vital for stabilizing a premature newborn’s body temperature.
“In Colombia, a doctor found they didn’t have enough incubators so he tried this method,” Dr. Bahl said. “The surprise was, the children did so much better.”
Today, kangaroo care, which also includes feeding exclusively with breast milk, is considered an effective intervention. Current World Health Organization guidelines recommend short amounts of direct skin-to-skin contact as the child is beginning to stabilize, followed by continuous kangaroo care once stabilization has been achieved.
“Doctors have been scared of putting non-stable babies on the mother’s chest immediately after birth because they were much more used to stabilizing them in a warmer,” said Dr. Bahl.
The new study, which did not include babies who were unable to breathe spontaneously an hour after birth or had a major congenital malformation, may change that.
In the intervention group, skin-to-skin contact began after a median of 1.3 hours. In the control group it was 53.6 hours. Infants in the kangaroo-care group were required to be with the mother or a surrogate 24 hours a day.
The test also required the development of special neonatal intensive-care units that could accommodate the mother or the surrogate.
“The equipment and staffing were exactly the same” in both groups, Dr. Bahl said. At some study centers, “it was not a new facility but kind of a new room, or a new care unit. But in other countries, the same space was divided into two. Could that have had some impact on the findings? Maybe. I can’t say no. But is it likely? I would say no,” said Dr. Bahl.
Until the babies were stabilized, skin-to-skin contact was 16.9 hours a day in the intervention group versus 1.5 hours daily in the control group. After that, the contact time was essentially the same.
The researchers calculated that one death would be prevented for every 27 underweight babies treated.
Not only was the death rate lower with faster kangaroo care, those infants were less likely to have hyperthermia and suspected sepsis.
“Infections were reduced by 18%,” probably because the babies had less contact with healthcare workers, Dr. Bahl said.
The kangaroo strategy did not affect other metrics. The median neonatal intensive-care unit stay lasted 6.4 days in both groups. Neither technique showed any advantage when it came to time to stabilization.
“The results of the study are generalizable to most hospitals in low-resource settings in which immediate kangaroo mother care can be implemented,” the researchers said.
However, they noted that “approximately 20% of the infants weighing between 1.0 and 1.799 kg who were born in study hospitals were not enrolled because the mother or the newborn was determined to be too sick to participate.”
SOURCE: https://bit.ly/3hLMLCH The New England Journal of Medicine, online May 26, 2021.
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