Kangaroo mother care for preterm or low birth weight infants: A systematic review and meta-analysis

ABSTRACT Importance The Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight (LBW) infants. New evidence from large multi-center randomized trials has been available since its publication. Objective The objective of the systematic review was to compare the effects of KMC vs. conventional care and early (i.e., within 24 hours of birth) vs. late initiation of KMC on critical outcomes such as neonatal mortality. Methods Eight electronic databases, including PubMed, Embase, and Cochrane CENTRAL, until March 2022, were searched. All randomized trials comparing KMC versus conventional care or early vs. late initiation of KMC in LBW or preterm infants were included. Data extraction and synthesis The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO. Main outcomes and measures The primary outcome was mortality by 28 days of life. Other outcomes included severe infection, hypothermia, exclusive breastfeeding rates, and neurodevelopmental impairment. Results were pooled using fixed-effect and random-effects meta-analyses in RevMan 5.4 or Stata 15.1 (StataCorp, College Station, TX). Results In total, 31 trials with 15,559 infants were included in the review; 27 studies compared KMC with conventional care, while 4 compared early vs. late initiation of KMC. Compared to conventional care, KMC significantly reduced the risks of mortality (relative risk [RR] 0.68; 95% CI 0.53 to 0.86; 11 trials, 10505 infants; high certainty evidence) at discharge or 28 days of age and severe infection till the latest follow-up (RR 0.85, 95% CI 0.79 to 0.92; 9 trials; moderate certainty evidence). On subgroup analysis, KMC provided for a duration of at least 8 hours per day had more significant benefits compared to lesser duration KMC. Studies comparing early vs. late-initiated KMC demonstrated a significant reduction in neonatal mortality (RR 0.77, 95% CI 0.66 to 0.91; 3 trials, 3693 infants; high certainty evidence) and clinical sepsis till 28-days (RR 0.85, 95% CI 0.76 to 0.96; 2 trials; low certainty evidence) favoring early initiation of KMC. Conclusions and Relevance The review provides updated evidence on the effects of KMC on mortality and other critical outcomes in low birth weight infants. The findings suggest that KMC should preferably be initiated within 24 hours of birth and provided for at least 8 hours daily.