2024-05-28 / News
© Quirin Leppert
The 13th International Conference on Kangaroo Mother Care (KMC) held in Madrid from 21-22 November gathered 272 participants from 47 countries to discuss KMC practices, focusing on good practices, immediate implementation, nutrition, and basic ventilation. The present study summarises the results of the conference and highlights the importance of KMC for maternal and neonatal care.
Initially developed in Colombia, KMC has spread globally as an evidence-based method for reducing adverse outcomes in preterm or low birth weight infants. The WHO defines Kangaroo Mother Care as involving continuous skin-to-skin contact for 8–24 hours daily, exclusive breastfeeding or breastmilk feeding, and timely discharge from the NICU to a lower level of care or home with ongoing monitoring. Benefits include lower mortality, reduced infection and hypothermia, and improved breastfeeding rates .
The study authors argue that countries should adopt official recommendations promoting KMC as essential care. In Colombia, the Ministry of Health has published technical guidelines for KMC. Workshop participants agreed that policies should support parents’ rights to stay with their infants and advocated for guidelines to be updated every 3-5 years. Additionally, hospital infrastructure should accommodate parents around the clock with beds, food, and bathroom access. Well-coordinated multidisciplinary teams and staff training in KMC are crucial, despite challenges like high staff turnover.
KMC should start as soon as possible, ideally within the first hours of life. Immediate Kangaroo Mother Care (iKMC) involves initiating skin-to-skin contact immediately after birth, even if the newborn is not clinically stable. This approach aims to prevent the stressful separation of mother and infant and has significant benefits, including reduced parental stress, shorter hospital stays, fewer infections, and better long-term outcomes. Neonatal Intensive Care Units (NICUs) should therefore be open to parents at all times.
Implementation of (i)KMC varies by country. In high-income countries, early discharge in the kangaroo position is uncommon. Typically, infants are not discharged until they attain a specific gestational age, a predetermined length of hospital stay, or a certain weight. Middle- and low-income countries, however, often transition infants to KMC wards or home with close monitoring. Conference participants state that follow-up is generally essential, starting daily, then weekly, until the infant reaches 40 weeks gestational age. Continuous multidisciplinary follow-up up to 12 months corrected age, potentially extended further, is also advised.
Current iKMC criteria differ significantly across countries. A WHO study showed lower mortality at 28 days for infants receiving iKMC compared to those with conventional care [1]. Implementation requires professional training, space adaptation, and resuscitation equipment. In some countries, iKMC is practiced extensively, while in others, logistical challenges limit its application.
General contraindications include severe asphyxia, severely depressed infants, fear of the mother or the health team, and situations where no bed is available for both newborn and mother to receive care together. Caesarean sections are not considered as contraindications.
Recognising the crucial role of nutrition, especially breastmilk, in KMC, participants discussed the need for standardised guidelines. Growth charts like Fenton-2013 and Intergrowth-21 are used to monitor growth. Access to fortifiers varies; some countries lack them, while others have detailed protocols for their use. Feeding is supplemented by tube initially, gradually reducing as suckling improves. Non-nutritive sucking usually starts at 28-32 weeks gestational age, progressing to direct breastfeeding at 34-35 weeks.
Maintaining respiratory stability is essential for the successful implementation of KMC. Nasal Continuous Positive Airway Pressure (nCPAP) is unavailable in many resource-limited countries. It benefits preterm infants with respiratory distress and can prevent lung collapse. Challenges include skin and nasal injuries from nCPAP use. Some countries have developed protective measures, but transferring preterm infants to NICUs remains problematic, especially where facilities are separate. The conference highlighted inequalities in care for low birth weight and preterm infants.
Suggested improvements include public health policies, staff training, encouraging parental involvement, and multidisciplinary follow-up programmes. Ensuring proper care immediately after birth is critical, with iKMC being an effective intervention. Nutritional assessments should be routine, and a basic neonatal package including nCPAP and iKMC protocols is recommended.
In summary, KMC provides significant benefits for preterm and low birth weight infants, but its implementation varies globally. Efforts to standardise and support KMC practices are crucial for improving newborn health outcomes.
Paper available at: https://pubmed.ncbi.nlm.nih.gov/37667990/
Full list of authors: Carmen Pallás-Alonso, Adriana Montealegre, María Teresa Hernández-Aguilar, Bárbara Muñoz-Amat, Laura Collados-Gómez, Lucía Jiménez-Fernández, Nadia García-Lara, Marta Cabrera-Lafuente, María Teresa Moral-Pumarega, María López-Maestro, Nathalie Charpak
https://doi.org/10.1111/apa.16960
[1] Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight. N Engl J Med. 2021;384(21):2028–38.