Effects of MMK in preterm and low birth weight infants

A method of care involving skin-to-skin contact between a mother and her premature or low birth weight baby appears to have a significant impact on a child’s chances of survival, suggests a study published online in the journal BMJ Global Health.

Starting the intervention within 24 hours of birth and carrying it out for at least eight hours a day appears to make the approach even more effective in reducing mortality and infection, the researchers found.

The method of care known as “Kangaroo Mother Care” (KMC) involves carrying an infant, usually by the mother, in a sling with skin-to-skin contact and numerous studies already carried out have shown that this is a way to reduce mortality. and the risk of infection for the child.

The World Health Organization recommends it as the standard of care for low birth weight infants after clinical stabilization.

However, less is known about the ideal time to begin the procedure. Therefore, Indian researchers conducted a review of many large multi-country and community-based randomized trials on the subject.

Reviewing existing studies, they set out to compare MMK to conventional care and to compare starting the approach early (within 24 hours of birth) versus initiating MMK later to see what effect it had on neonatal and infant mortality and serious illnesses in low birth weight and premature infants.

Their review looked at 31 trials that collectively included 15,559 infants and of these, 27 studies compared MMK to conventional care, while four compared early and late initiation of MMK.

Analysis of the results showed that compared to conventional care, MMK seemed to reduce the risk of mortality by 32% when hospitalized at birth or 28 days after birth, while it seemed to reduce the risk of severe infection, such as sepsis, by 15%.

It also emerged that the reduction in mortality was noted regardless of the gestational age or the weight of the child at registration, the time of initiation and the place of initiation of the MMK (hospital or community ).

It was also noted that the mortality benefits were greater when the daily duration of KMC was at least eight hours per day than with a shorter duration KMC.

Studies that compared early MMK to late MMK demonstrated a 33% reduction in neonatal mortality and a probable 15% reduced risk of clinical sepsis up to 28 days after early initiation of MMK.

The review had some limitations in that the studies reviewed involved an intervention that was obviously known to participants, so it could be considered biased, and very low birth weight, extremely preterm infants and Severely unstable newborns were often excluded from studies.

However, the review authors said the risk of bias in the included studies was generally low, and because their review included a comprehensive and systematic search of existing studies, the certainty of evidence for the primary outcomes was moderate. to high.

They concluded: “Our results support the practice of MMK for preterm and low birth weight infants as soon as possible after birth and for at least eight hours daily.

“Future research should focus on overcoming barriers and facilitators to large-scale implementation of MMK in institutional and community settings. Data on long-term neurodevelopmental outcomes are also needed.