Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Agustin Conde-Agudelo, José L Díaz-Rossello, Agustin Conde-Agudelo, José L Díaz-Rossello

Abstract

Background: Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants.

Objectives: To determine whether evidence is available to support the use of KMC in LBW infants as an alternative to conventional neonatal care before or after the initial period of stabilization with conventional care, and to assess beneficial and adverse effects.

Search methods: We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches in CENTRAL (Cochrane Central Register of Controlled Trials; 2016, Issue 6), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Science Information database), and POPLINE (Population Information Online) databases (all from inception to June 30, 2016), as well as the WHO (World Health Organization) Trial Registration Data Set (up to June 30, 2016). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google Scholar.

Selection criteria: Randomized controlled trials comparing KMC versus conventional neonatal care, or early-onset KMC versus late-onset KMC, in LBW infants.

Data collection and analysis: Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group.

Main results: Twenty-one studies, including 3042 infants, fulfilled inclusion criteria. Nineteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early-onset KMC with late-onset KMC in relatively stable LBW infants. Sixteen studies evaluated intermittent KMC, and five evaluated continuous KMC. KMC versus conventional neonatal care: At discharge or 40 to 41 weeks' postmenstrual age, KMC was associated with a statistically significant reduction in the risk of mortality (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (RR 0.35, 95% CI 0.22 to 0.54; five trials, 1239 infants), and hypothermia (RR 0.28, 95% CI 0.16 to 0.49; nine trials, 989 infants; moderate-quality evidence). At latest follow-up, KMC was associated with a significantly decreased risk of mortality (RR 0.67, 95% CI 0.48 to 0.95; 12 trials, 2293 infants; moderate-quality evidence) and severe infection/sepsis (RR 0.50, 95% CI 0.36 to 0.69; eight trials, 1463 infants; moderate-quality evidence). Moreover, KMC was found to increase weight gain (mean difference [MD] 4.1 g/d, 95% CI 2.3 to 5.9; 11 trials, 1198 infants; moderate-quality evidence), length gain (MD 0.21 cm/week, 95% CI 0.03 to 0.38; three trials, 377 infants) and head circumference gain (MD 0.14 cm/week, 95% CI 0.06 to 0.22; four trials, 495 infants) at latest follow-up, exclusive breastfeeding at discharge or 40 to 41 weeks' postmenstrual age (RR 1.16, 95% CI 1.07 to 1.25; six studies, 1453 mothers) and at one to three months' follow-up (RR 1.20, 95% CI 1.01 to 1.43; five studies, 600 mothers), any (exclusive or partial) breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age (RR 1.20, 95% CI 1.07 to 1.34; 10 studies, 1696 mothers; moderate-quality evidence) and at one to three months' follow-up (RR 1.17, 95% CI 1.05 to 1.31; nine studies, 1394 mothers; low-quality evidence), and some measures of mother-infant attachment and home environment. No statistically significant differences were found between KMC infants and controls in Griffith quotients for psychomotor development at 12 months' corrected age (low-quality evidence). Sensitivity analysis suggested that inclusion of studies with high risk of bias did not affect the general direction of findings nor the size of the treatment effect for main outcomes. Early-onset KMC versus late-onset KMC in relatively stable infants: One trial compared early-onset continuous KMC (within 24 hours post birth) versus late-onset continuous KMC (after 24 hours post birth) in 73 relatively stable LBW infants. Investigators reported no significant differences between the two study groups in mortality, morbidity, severe infection, hypothermia, breastfeeding, and nutritional indicators. Early-onset KMC was associated with a statistically significant reduction in length of hospital stay (MD 0.9 days, 95% CI 0.6 to 1.2).

Authors' conclusions: Evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care, mainly in resource-limited settings. Further information is required concerning the effectiveness and safety of early-onset continuous KMC in unstabilized or relatively stabilized LBW infants, as well as long-term neurodevelopmental outcomes and costs of care.

Conflict of interest statement

None.

Figures

2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

3
Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.1 Mortality at latest follow‐up.

4
Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.2 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.

5
Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.10 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.

6
Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

**1.1. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 1 Mortality at discharge or at 40 to 41 weeks' postmenstrual age.

**1.2. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 2 Mortality at 6 months of age or 6 months' follow‐up.

**1.3. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 3 Mortality at 12 months' corrected age.

**1.4. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 4 Mortality at latest follow‐up.

**1.5. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 5 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.

**1.6. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 6 Severe illness at 6 months' follow‐up ‐ stabilized infants.

**1.7. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 7 Nosocomial infection/sepsis at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

**1.8. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 8 Mild/moderate infection or illness at latest follow‐up ‐ stabilized infants.

**1.9. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 9 Lower respiratory tract disease at 6 months' follow‐up ‐ stabilized infants.

**1.10. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 10 Diarrhea at 6 months' follow‐up ‐ stabilized infants.

**1.11. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 11 Hypothermia at discharge or at 40 to 41 weeks’ postmenstrual age ‐ stabilized infants.

**1.12. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 12 Hyperthermia at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

**1.13. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 13 Length of hospital stay (days) ‐ stabilized infants.

**1.14. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 14 Re‐admission to hospital at latest follow‐up ‐ stabilized infants.

**1.15. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 15 Weight at discharge or at 40 to 41 weeks' postmenstrual age (g) ‐ stabilized infants.

**1.16. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 16 Weight at 6 months' corrected age (g) ‐ stabilized infants.

**1.17. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 17 Weight at 12 months' corrected age (g) ‐ stabilized infants.

**1.18. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 18 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.

**1.19. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 19 Length at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.

**1.20. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 20 Length at 6 months' corrected age (cm) ‐ stabilized infants.

**1.21. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 21 Length at 12 months' corrected age (cm) ‐ stabilized infants.

**1.22. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 22 Length gain at latest follow‐up (cm/wk) ‐ stabilized infants.

**1.23. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 23 Head circumference at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.

**1.24. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 24 Head circumference at 6 months' corrected age (cm) ‐ stabilized infants.

**1.25. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 25 Head circumference at 12 months' corrected age (cm) ‐ stabilized infants.

**1.26. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 26 Head circumference gain at latest follow‐up (cm/wk) ‐ stabilized infants.

**1.27. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 27 Psychomotor development (Griffith quotients) at 12 months' corrected age.

**1.28. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 28 Cerebral palsy at 12 months' corrected age.

**1.29. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 29 Deafness at 12 months' corrected age.

**1.30. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 30 Visual impairment at 12 months' corrected age.

**1.31. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 31 Exclusive breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

**1.32. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 32 Exclusive breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.

**1.33. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 33 Exclusive breastfeeding at 6 to 12 months' follow‐up ‐ stabilized infants.

**1.34. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

**1.35. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 35 Any breastfeeding at 1 to 2 months' follow‐up ‐ stabilized infants.

**1.36. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 36 Any breastfeeding at 3 months' follow‐up ‐ stabilized infants.

**1.37. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 37 Any breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.

**1.38. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 38 Any breastfeeding at 6 months' follow‐up ‐ stabilized infants.

**1.39. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 39 Any breastfeeding at 12 months' follow‐up ‐ stabilized infants.

**1.40. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 40 Onset of breastfeeding (days) ‐ stabilized infants.

**1.41. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 41 Parental and familial satisfaction (continuous KMC).

**1.42. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 42 Mother‐infant attachment: mother's feelings and perceptions according to interval between birth and start of intervention, and infant admission to NICU.

**1.43. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 43 Mother‐infant attachment: mother's responses to the infant according to interval between birth and start of intervention, and infant admission to NICU.

**1.44. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 44 Mother‐infant attachment: infant's responses to the mother according to interval between birth and start of intervention, and infant admission to NICU.

**1.45. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 45 Mother‐infant attachment at 3 months' follow‐up.

**1.46. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 46 Mother‐infant attachment: stress in NICU.

**1.47. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 47 Mother‐infant attachment: parenting skills.

**1.48. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 48 Mother‐infant interaction at 6 months' follow‐up.

**1.49. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 49 Infant behavior at 40 to 44 weeks’ postmenstrual age.

**1.50. Analysis**
Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 50 Social and home environment.

**2.1. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 1 Mortality at 4 weeks of age.

**2.2. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 2 Morbidity at 4 weeks of age.

**2.3. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 3 Severe infection at 4 weeks of age.

**2.4. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 4 Re‐admission to hospital at 4 weeks of age.

**2.5. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 5 Hypothermia.

**2.6. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 6 Hyperthermia.

**2.7. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 7 Weight gain (grams).

**2.8. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 8 Exclusive breastfeeding.

**2.9. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 9 Length of hospital stay (days).

**2.10. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 10 Mortality at 6 months of age.

**2.11. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 11 Re‐admission to hospital at 6 to 12 months of age.

**2.12. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 12 Stunting at 6 to 12 months of age.

**2.13. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 13 Severe stunting at 6 to 12 months of age.

**2.14. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 14 Wasting at 6 to 12 months of age.

**2.15. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 15 Severe wasting at 6 to 12 months of age.

**2.16. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 16 Underweight at 6 to 12 months of age.

**2.17. Analysis**
Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 17 Severe underweight at 6 to 12 months of age.

References

References to studies included in this review Acharya 2014 {published data only}

1. Acharya N, Singh RR, Bhatta NK, Poudel P. Randomized control trial of Kangaroo Mother Care in low birth weight babies at a tertiary level hospital. Journal of Nepal Paediatric Society 2014;34(1):18‐23.

Ali 2009 {published data only}

1. Ali SM, Sharma J, Sharma R, Alam S. Kangaroo mother care as compared to conventional care for low birth weight babies. Dicle Medical Journal 2009;36(3):155‐60.

Blaymore Bier 1996 {published data only}

1. Blaymore Bier JA, Ferguson AE, Morales Y, Liebling JA, Archer D, Oh W, et al. Comparison of skin‐to‐skin contact with standard contact in low‐birth‐weight infants who are breast‐fed. Archives of Pediatrics & Adolescent Medicine 1996;150(12):1265‐9.

Boo 2007 {published data only}

1. Boo NY, Jamli FM. Short duration of skin‐to‐skin contact: effects on growth and breastfeeding. Journal of Paediatrics and Child Health 2007;43(12):831‐6.

Cattaneo 1998 {published data only}

1. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A, et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatrica 1998;87(9):976‐85.

Charpak 1997 {published data only}

1. Charpak N, Ruiz‐Pelaez JG, Figueroa de CZ, Charpak Y. A randomized, controlled trial of kangaroo mother care: results of follow‐up at 1 year of corrected age. Pediatrics 2001;108(5):1072‐9.
1. Charpak N, Ruiz‐Peláez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants ≤2000 grams: a randomized, controlled trial. Pediatrics 1997;100(4):682‐8.
1. Tessier R, Charpak N, Giron M, Cristo M, Calume ZF, Ruiz‐Peláez JG. Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatrica 2009;98(9):1444‐50.
1. Tessier R, Cristo M, Velez S, Giron M, Calume ZF, Ruiz‐Palaez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics 1998;102(2):e17.
1. Tessier R, Cristo MB, Velez S, Giron M, Nadeau L, Figueroa Z, et al. Kangaroo mother care: a method for protecting high‐risk low birth weight and premature infants against developmental delay. Infant Behavior and Development 2003;26:384‐97.

Eka Pratiwi 2009 {published data only}

1. Eka Pratiwi IGAP, Soetjiningsih, Made Kardane I. Effect of kangaroo method on the risk of hypothermia and duration of birth weight regain in low birth weight infants: a randomized controlled trial. Paediatrica Indonesiana 2009;49(5):253‐8.

Gathwala 2008 {published data only}

1. Gathwala G, Singh B, Balhara B. KMC facilitates mother baby attachment in low birth weight infants. Indian Journal of Pediatrics 2008;75(1):43‐7.
1. Gathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Tropical Doctor 2010;40(4):199‐202.

Ghavane 2012 {published data only}

1. Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S. Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants. Acta Paediatrica 2012;101(12):e545‐9.

Kadam 2005 {published data only}

1. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A. Feasibility of kangaroo mother care in Mumbai. Indian Journal of Pediatrics 2005;72(1):35‐8.

Kumbhojkar 2016 {published data only}

1. Kumbhojkar S, Mokase Y, Sarawade S. Kangaroo mother care (KMC): an alternative to conventional method of care for low birth weight babies. International Journal of Health Sciences and Research 2016;6(3):36‐42.

Nagai 2010 {published data only}

1. Nagai S, Andrianarimanana D, Rabesandratana N, Yonemoto N, Nakayama T, Mori R. Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low‐birth‐weight infants: a randomized controlled trial. Acta Paediatrica 2010;99(6):827‐35.
1. Nagai S, Yonemoto N, Rabesandratana N, Andrianarimanana D, Nakayama T, Mori R. Long‐term effects of earlier initiated continuous Kangaroo Mother Care (KMC) for low‐birth‐weight (LBW) infants in Madagascar. Acta Paediatrica 2011;100(12):e241‐7.

Neu 2010 {published data only}

1. Neu M, Robinson J. Maternal holding of preterm infants during the early weeks after birth and dyad interaction at six months. Journal of Obstetric, Gynecologic and Neonatal Nursing 2010;39(4):401‐14.
1. Neu M, Robinson J, Schmiege SJ. Influence of holding practice on preterm infant development. MCN. American Journal of Maternal Child Nursing 2013;83(3):136‐43.

Nimbalkar 2014 {published data only}

1. Nimbalkar SM, Patel VK, Patel DV, Nimbalkar AS, Sethi A, Phatak A. Effect of early skin‐to‐skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology 2014;34(5):364‐8.

Ramanathan 2001 {published data only}

1. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G. Kangaroo Mother Care in very low birth weight infants. Indian Journal of Pediatrics 2001;68(11):1019‐23.

Roberts 2000 {published data only}

1. Roberts KL, Paynter C, McEwan B. A comparison of kangaroo mother care and conventional cuddling care. Neonatal Network 2000;19(4):31‐5.

Rojas 2003 {published data only}

1. Rojas MA, Kaplan M, Quevedo M, Sherwonit E, Foster LB, Ehrenkranz RA, et al. Somatic growth of preterm infants during skin‐to‐skin care versus traditional holding: a randomized, controlled trial. Journal of Developmental and Behavioral Pediatrics 2003;24(3):163‐8.

Sloan 1994 {published data only}

1. Sloan NL, Camacho LW, Rojas EP, Stern C. Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low‐birthweight infants. Lancet 1994;344(8925):782‐5.

Suman 2008 {published data only}

1. Suman RP, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatrics 2008;45(1):17‐23.

Whitelaw 1988 {published data only}

1. Whitelaw A, Heisterkamp G, Sleath K, Acolet D, Richards M. Skin to skin contact for very low birthweight infants and their mothers. Archives of Disease in Childhood 1988;63(11):1377‐81.

Worku 2005 {published data only}

1. Worku B, Kassie A. Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia. Journal of Tropical Pediatrics 2005;51(2):93‐7.

References to studies excluded from this review Ahn 2010 {published data only}

1. Ahn HY, Lee J, Shin HJ. Kangaroo care on premature infant growth and maternal attachment and post‐partum depression in South Korea. Journal of Tropical Pediatrics 2010;56(5):342‐4.

Anderson 2003 {published data only}

1. Anderson GC, Chiu SH, Dombrowski MA, Swinth JY, Albert JM, Wada N. Mother‐newborn contact in a randomized trial of kangaroo (skin‐to‐skin) care. Journal of Obstetric, Gynecologic and Neonatal Nursing 2003;32(5):604‐11.

Arandia 1993 {published data only}

1. Arandia R, Morales L. Program kangaroo mother [Programa Madre‐Canguro]. Gaceta Medica Boliviana 1993;17:51‐5.

Badiee 2014 {published data only}

1. Badiee Z, Faramarzi S, MiriZadeh T. The effect of kangaroo mother care on mental health of mothers with low birth weight infants. Advanced Biomedical Research 2014;3:214.

Bera 2014 {published data only}

1. Bera A, Ghosh J, Singh AK, Hazra A, Mukherjee S, Mukherjee R. Effect of kangaroo mother care on growth and development of low birthweight babies up to 12 months of age: a controlled clinical trial. Acta Paediatrica 2014;103(6):643‐50.

Bergman 1994 {published data only}

1. Bergman NJ, Jürisoo LA. The 'kangaroo‐method' for treating low birth weight babies in a developing country. Tropical Doctor 1994;24(2):57‐60.

Bergman 2004 {published data only}

1. Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin‐to‐skin contact from birth versus conventional incubator for physiological stabilization in 1200‐ to 2199‐gram newborns. Acta Paediatrica 2004;93(6):779‐85.

Broughton 2013 {published data only}

1. Broughton EI, Gomez I, Sanchez N, Vindell C. The cost‐savings of implementing kangaroo mother care in Nicaragua. Revista Panamericana de Salud Publica 2013;34(3):176‐82.

Charpak 1994 {published data only}

1. Charpak N, Ruiz‐Peláez JG, Charpak Y. Rey‐Martinez. Kangaroo Mother Program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Pediatrics 1994;94(6):804‐10.

Chiu 2009 {published data only}

1. Chiu SH, Anderson GC. Effect of early skin‐to‐skin contact on mother‐preterm infant interaction through 18 months: randomized controlled trial. International Journal of Nursing Studies 2009;46(9):1168‐80.

Christensson 1998 {published data only}

1. Christensson K, Bhat GJ, Amadi BC, Eriksson B, Höjer B. Randomised study of skin‐to‐skin versus incubator care for rewarming low‐risk hypothermic neonates. Lancet 1998;352(9134):1115.

Chwo 2002 {published data only}

1. Chwo MJ, Anderson GC, Good M, Dowling DA, Shiau SH, Chu DM. A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity. Journal of Nursing Research 2002;10(2):129‐42.

Dala Sierra 1994 {published data only}

1. Dala Sierra E, Pineda Barahona E, Banegas RM. Kangaroo mother experience [Experiencia madre canguro]. Revista Medica Hondureña 1994;62:43‐6.

Darmstadt 2006 {published data only}

1. Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, et al. Introduction of community‐based skin‐to‐skin care in rural Uttar Pradesh, India. Journal of Perinatology 2006;26(10):597‐604.

de Almeida 2010 {published data only}

1. Almeida H, Venancio SI, Sanches MT, Onuki D. The impact of kangaroo care on exclusive breastfeeding in low birth weight newborns. Jornal de Pediatria (Rio J) 2010;86(3):250‐3.

Dehghani 2015 {published data only}

1. Dehghani K, Movahed ZP, Dehghani H, Nasiriani K. A randomized controlled trial of kangaroo mother care versus conventional method on vital signs and arterial oxygen saturation rate in newborns who were hospitalized in neonatal intensive care unit. Journal of Clinical Neonatology 2015;4(1):26‐31.

de Macedo 2007 {published data only}

1. Macedo EC, Cruvinel F, Lukasova K, D'Antino ME. The mood variation in mothers of preterm infants in Kangaroo mother care and conventional incubator care. Journal of Tropical Pediatrics 2007;53(5):344‐6.

Feldman 2002 {published data only}

1. Feldman R, Eidelman AI, Sirota L, Weller A. Comparison of skin‐to‐skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002;110(1):16‐26..

Gregson 2011 {published data only}

1. Gregson S, Blacker J. Kangaroo care in pre‐term or low birth weight babies in a postnatal ward. British Journal of Midwifery 2011;19(9):566‐75.

Hake Brooks 2008 {published data only}

1. Hake‐Brooks SJ, Anderson GC. Kangaroo care and breastfeeding of mother‐preterm infant dyads 0‐18 months: a randomized, controlled trial. Neonatal Network 2008;27(3):151‐9.

Huang 2006 {published data only}

1. Huang YY, Huang CY, Lin SM, Wu SC. Effect of very early kangaroo care on extrauterine temperature adaptation in newborn infants with hypothermia problems [In Chinese]. Hu Li Za Zhi Journal of Nursing 2006;53(4):41‐8.

Ibe 2004 {published data only}

1. Ibe OE, Austin T, Sullivan K, Fabanwo O, Disu E, Costello AM. A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants < 2000 g in Nigeria using continuous ambulatory temperature monitoring. Annals of Tropical Paediatrics 2004;24(3):245‐51.

Kambarami 1998 {published data only}

1. Kambarami RA, Chidede O, Kowo DT. Kangaroo care versus incubator care in the management of well preterm infants ‐ a pilot study. Annals of Tropical Paediatrics 1998;18(2):81‐6.

Karimi 2014 {published data only}

1. Karimi FZ, Bagheri S, Tara F, Khadivzadeh T, Mercer SMM. Effect of kangaroo mother care on breastfeeding self‐efficacy in primiparous women, 3 month after child birth [in Persian]. Iranian Journal of Obstetrics, Gynecology and Infertility 2014;17(120):1‐8.

Kashaninia 2015 {published data only}

1. Kashaninia Z, Dehghan M. The effect of kangaroo care on weight gain of premature neonates hospitalized in neonatal intensive care units. Biosciences Biotechnology Research Asia 2015;12(2):1405‐10.

Kristoffersen 2016 {published data only}

1. Kristoffersen L, Stoen R, Hansen LF, Wilhelmsen J, Bergseng H. Skin‐to‐skin care after birth for moderately preterm infants. Journal of Obstetric, Gynecologic and Neonatal Nursing 2016;45(3):339‐45.

Kumar 2008 {published data only}

1. Kumar V, Mohanty S, Kumar A, Misra RP, Santosham M, Awasthi S, et al. Saksham Study Group. Effect of community‐based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster‐randomised controlled trial. Lancet 2008;372(9644):1151‐62.

Lai 2006 {published data only}

1. Lai HL, Chen CJ, Peng TC, Chang FM, Hsieh ML, Huang HY, et al. Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants' responses. International Journal of Nursing Studies 2006;43(2):139‐46.

Lamy Filho 2008 {published data only}

1. Lamy Filho F, Silva AA, Lamy ZC, Gomes MA, Moreira ME. Evaluation of the neonatal outcomes of the kangaroo mother method in Brazil. Jornal de Pediatria (Rio J) 2008;84(5):428‐35.

Lamy Filho 2015 {published data only}

1. Lamy Filho F, Sousa SH, Freitas IJ, Lamy ZC, Simões VM, Silva AA, et al. Effect of maternal skin‐to‐skin contact on decolonization of methicillin‐oxacillin‐resistant Staphylococcus in neonatal intensive care units: a randomized controlled trial. BMC Pregnancy and Childbirth 2015;15:63.

Legault 1993 {published data only}

1. Legault M, Goulet C. Comparative study of two methods of holding premature infants: the kangaroo method versus the traditional method [Etude comparative de deux méthodes de sortie du prématuré: méthode kangourou versus méthode traditionnelle]. Canadian Journal of Nursing Research 1993;25(4):67‐80.

Legault 1995 {published data only}

1. Legault M, Goulet C. Comparison of kangaroo and traditional methods of removing preterm infants from incubators. Journal of Obstetric, Gynecologic and Neonatal Nursing 1995;24(6):501‐6.

Lincetto 2000 {published data only}

1. Lincetto O, Nazir AL, Cattaneo A. Kangaroo mother care with limited resources. Journal of Tropical Pediatrics 2000;46(5):293‐5.

Lizarazo‐Medina 2012 {published data only}

1. Lizarazo‐Medina JP, Ospina‐Diaz JM, Ariza‐Riaño NE. The kangaroo mothers' programme: a simple and cost‐effective alternative for protecting the premature newborn or low‐birth‐weight babies [Programa madre canguro: una alternativa sencilla y costo eficaz para la protección de los recién nacidos prematuros o con bajo peso al nacer]. Revista de Salud Publica 2012;14(Suppl 2):32‐45.

Ludington‐Hoe 1991 {published data only}

1. Ludington SM, Hadeed AJ, Anderson G. Cardiorespiratory, thermal and state effects of kangaroo care for preterm infants: randomized controlled trial. Pediatric Research 1991;29(4):223A.

Ludington‐Hoe 2000 {published data only}

1. Ludington‐Hoe SM, Nguyen N, Swinth JY, Satyshur RD. Kangaroo care compared to incubators in maintaining body warmth in preterm infants. Biological Research for Nursing 2000;2(1):60‐73.

Ludington‐Hoe 2004 {published data only}

1. Ludington‐Hoe SM, Anderson GC, Swinth JY, Thompson C, Hadeed AJ. Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants. Neonatal Network 2004;23(3):39‐48.

Ludington‐Hoe 2006 {published data only}

1. Ludington‐Hoe SM, Johnson MW, Morgan K, Lewis T, Gutman J, Wilson PD, et al. Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics 2006;117(5):e909‐23.

Lyngstad 2014 {published data only}

1. Lyngstad LT, Tandberg BS, Storm H, Ekeberg BL, Moen A. Does skin‐to‐skin contact reduce stress during diaper change in preterm infants?. Early Human Development 2014;90(4):169‐72.

Miles 2006 {published data only}

1. Miles R, Cowan F, Glover V, Stevenson J, Modi N. A controlled trial of skin‐to‐skin contact in extremely preterm infants. Early Human Development 2006;82(7):447‐55.

Miltersteiner 2005 {published data only}

1. Miltersteiner AR, Dalle Molle L, Marchetto Claus S, Rotta NT. Length of hospital stay of preterm infants observed in the Kangaroo position and prone position in incubator [Tempo de internação hospitalar de bebês pré‐termos observados na Posição Mãe‐Canguru e na Posição Prona na incubadora]. Revista AMRIGS 2005;49(1):20‐6.

Mitchell 2013 {published data only}

1. Mitchell AJ, Yates C, Williams K, Hall RW. Effects of daily kangaroo care on cardiorespiratory parameters in preterm infants. Journal of Neonatal‐Perinatal Medicine 2013;6(3):243‐9.

Mörelius 2015 {published data only}

1. Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin‐to‐skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Human Development 2015;91(1):63‐70.

Ohgi 2002 {published data only}

1. Ohgi S, Fukuda M, Moriuchi H, Kusumoto T, Akiyama T, Nugent JK, et al. Comparison of kangaroo care and standard care: behavioral organization, development, and temperament in healthy, low‐birth‐weight infants through 1 year. Journal of Perinatology 2002;22(5):374‐9.

Samra 2015 {published data only}

1. Samra HA, Dutcher J, McGrath JM, Foster M, Klein L, Djira G, et al. Effect of skin‐to‐skin holding on stress in mothers of late‐preterm infants: a randomized controlled trial. Advances in Neonatal Care 2015;15(5):354‐64.

Silva 2016 {published data only}

1. Silva MG, Barros MC, Pessoa ÚM, Guinsburg R. Kangaroo‐mother care method and neurobehavior of preterm infants. Early Human Development 2016;95:55‐9.

Sloan 2008 {published data only}

1. Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, et al. Community‐based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 2008;121(5):e1047‐59.

Swarnkar 2016 {published data only}

1. Swarnkar K, Vagha J. Effect of kangaroo mother care on growth and morbidity pattern in low birth weight infants. Journal of Krishna Institute of Medical Sciences University 2016;5(1):91‐9.

Tallandini 2006 {published data only}

1. Tallandini MA, Scalembra C. Kangaroo mother care and mother‐premature infant dyadic interaction. Infant Mental Health Journal 2006;27(3):251‐75.

Udani 2008 {published data only}

1. Udani R, Nanavati R, Mauskar AV, Suman R. Innovation: KEM Kangaroo bag for Kangaroo care. 2008 (accessed June 30, 2010).

References to studies awaiting assessment Holditch‐Davis 2014 {published data only}

1. Holditch‐Davis D, White‐Traut R, Levy J, Williams KL, Ryan D, Vonderheid S. Maternal satisfaction with administering infant interventions in the neonatal intensive care unit. Journal of Obstetric, Gynecologic and Neonatal Nursing 2013;42(6):641‐54.
1. Holditch‐Davis D, White‐Traut RC, Levy JA, O'Shea TM, Geraldo V, David RJ. Maternally administered interventions for preterm infants in the NICU: effects on maternal psychological distress and mother‐infant relationship. Infant Behavior and Development 2014;37(4):695‐710.
1. Tully KP, Holditch‐Davis D, White‐Traut RC, David R, O'Shea TM, Geraldo V. A test of kangaroo care on preterm infant breastfeeding. Journal of Obstetric, Gynecologic and Neonatal Nursing 2016;45(1):45‐61.

Additional references Barker 1995

1. Barker DJ. The fetal and infant origins of disease. European Journal of Clinical Investigation 1995;25(7):457‐63.

Bassler 2010

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Boundy 2016

1. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, et al. Kangaroo mother care and neonatal outcomes: a meta‐analysis. Pediatrics 2016;137(1):e20152238.

Chan 2016

1. Chan GJ, Valsangkar B, Kajeepeta S, Boundy EO, Wall S. What is kangaroo mother care? Systematic review of the literature. Journal of Global Health 2016;6(1):010701.

Charpak 1996

1. Charpak N, Ruiz‐Peláez JG, Figueroa de Calume Z. Current knowledge of kangaroo mother Intervention. Current Opinion in Pediatrics 1996;8(2):108‐12.

Diaz‐Rossello 2008

1. Díaz‐Rossello JL, Ferreira‐Castro A. Maternology: when a baby is born, a mother is born. NeoReviews 2008;9(8):e326‐e331.

Egger 1997

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GRADEpro 2008 [Computer program]

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Higgins 2003

1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. British Medical Journal 2003;327(7414):557‐60.

Higgins 2011

1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011; Vol. www.cochrane‐.

Johnston 2014

1. Johnston C, Campbell‐Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin‐to‐skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD008435.pub2]

Lawn 2010

1. Lawn JE, Mwansa‐Kambafwile J, Horta BL, Barros FC, Cousens S. 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications. International Journal of Epidemiology 2010;39(Suppl 1):i144‐54.

Lawn 2014

1. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Lancet Every Newborn Study Group. Every Newborn: progress, priorities, and potential beyond survival. Lancet 2014;384(9938):189‐205.

Moore 2012

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Nyqvist 2010

1. Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, et al. Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care. Acta Paediatrica 2010;99(6):820‐6.

RevMan 2014 [Computer program]

1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Rey 1983

1. Rey E, Martinez H. Rational management of the premature infant [Manejo racional del niño prematuro]. I Curso de Medicina Fetal y Neonatal. Bogota, Colombia: Universidad Nacional, 1983:137‐51.

Roberts 2010

1. Roberts G, Anderson PJ, Doyle LW, the Victorian Infant Collaborative Study Group. The stability of the diagnosis of developmental disability between ages 2 and 8 in a geographic cohort of very preterm children born in 1997. Archives of Disease in Childhood 2010;95(10):786‐90.

Ruiz‐Peláez 2004

1. Ruiz‐Peláez JG, Charpak N, Cuervo LG. Kangaroo Mother Care, an example to follow from developing countries. British Medical Journal 2004;329(7475):1179‐81.

Schünemann 2013

1. Schünemann H, Broek J, Guyatt G, Oxman A (editors). GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013.

UNICEF 2015

1. United Nations Inter‐agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality. Report 2015. New York, NY: UNICEF, 2015.

WHO 2014

1. World Health Organization. Global Nutrition Targets 2025: Low Birth Weight Policy Brief (WHO/NMH/NHD/14.5). Geneva: World Health Organization,. New York, 2014.

References to other published versions of this review Conde‐Agudelo 2000

1. Conde‐Agudelo A, Diaz‐Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2000, Issue 4. [DOI: 10.1002/14651858.CD002771]

Conde‐Agudelo 2003

1. Conde‐Agudelo A, Diaz‐Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD002771]

Conde‐Agudelo 2011

1. Conde‐Agudelo A, Belizán JM, Diaz‐Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD002771.pub2]

Conde‐Agudelo 2014

1. Conde‐Agudelo A, Diaz‐Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2014, Issue 4. [DOI: 10.1002/14651858.CD002771.pub3]

Source: PubMed

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

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