Premature babies who were breastfed exclusively and kept warm through continuous skin-to-skin contact have become young adults with larger brains, higher salaries and less stressful lives than babies who received conventional incubator care, according to a study published this week.
The research (pdf), in the journal Pediatrics, compared 18- to 20-year-olds who, as premature and low birth-weight infants, were randomised at birth in Colombia to receive either traditional incubator care or kangaroo mother care (KMC) – a technique whereby parents or caregivers become a baby’s incubator and its main source of food and stimulation – until they could maintain their own body temperature.
The kangaroo method involves the baby nestling in a “kangaroo” position on the caregiver’s chest as soon as possible after birth, accompanied by exclusive breastfeeding. Parent and child leave the hospital together as soon as possible after birth, after which there is rigorous monitoring of baby and mother for one year after the infant’s original due date (rather than the actual birth date).
Researchers investigated 264 of the KMC participants who weighed less than 1.8kg at birth, and found that the technique offered significant protection against early death. The mortality rate among incubator-treated babies was 7.7%, more than double that of those in the KMC group (3.5%). Almost every other area investigated revealed further advantages: average hourly wages of the KMC group were nearly 53% higher than their counterparts; cerebral development was significantly higher; family life was found to be more nurturing and protective; and children spent more time in school and were less aggressive, hyperactive and stressed.
“This study indicates that kangaroo mother care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” said lead researcher Dr Nathalie Charpak, of the Kangaroo Foundation in Bogotá.
“We firmly believe that this is a powerful, efficient, scientifically based healthcare intervention that can be used in all settings, from those with very restricted to unrestricted access to healthcare.”
According to the World Health Organisation, nearly one in 10 babies worldwide is born preterm (before 37 completed weeks of gestation), with resulting birth complications the leading cause of death among children under five. Preterm birth rates are rising globally every year, yet more premature babies are born in low-income countries (9%) – where they face a greater risk of complications – than high-income countries (12%). In Malawi, for example, 18 in every 100 births are preterm.
Many survivors face a lifetime of disability – including learning disabilities and visual and hearing problems – and require extra care to avoid illness and death from secondary, preventable complications including hypothermia. In developing countries, where incubators are often scarce and unreliable, kangaroo mother care could save lives, said Dr Peter Singer, chief executive officer of Grand Challenges Canada, which supported the research.
“A premature infant is born somewhere in the world every two seconds,” he said. “This study shows that kangaroo mother care gives premature and low birth-weight babies a better chance of thriving. Kangaroo mother care saves brains and makes premature and low birth-weight babies healthier and wealthier.”
While the technique does not replace modern science or neonatology, it is an excellent complement, said Charpak. Hospitals in Scandinavia, among them the NICU in Uppsala, Sweden, are using KMC to stabilise preterm babies. Grand Challenges Canada is funding two “centres of excellence” and 10 treatment centres to deliver kangaroo care across Cameroon and Mali, where preterm birth rates are among the highest in the world.
The study’s positive findings are impossible to attribute to one reason alone, said Charpak. Rather, they result from a multidisciplinary approach involving regular skin-to-skin contact, breastfeeding, education of the mother and family, and support over a 12-month follow-up period.
“One of our hypotheses is that, by placing the infant in the mother, father or caregiver’s chest, the infant’s brain is in a less stressful environment,” said Charpak. “KMC also creates a climate in which the parents become progressively more aware of the child and more prone to sensitive caring.”
In contrast, said Charpak, a preterm baby born at 30 weeks could spend seven weeks in an incubator, where it is separated from its mother and faces a steady stream of light and noise. “It is easy to understand why this may not be the place for the baby’s immature brain to grow correctly,” she added.
Although a Cochrane review of 21 randomised control trials concluded that kangaroo mother care significantly reduces mortality among preterm babies and is a safe and effective alternative to conventional care, global use of the technique remains low. The Every Newborn action plan, endorsed by the World Health Organisation in 2014, set a target to reach at least 50% of the world’s low birth-weight infants with kangaroo mother care by 2020.
Charpak is hopeful that research efforts like the Colombia study will change attitudes to the care of preterm babies, not least among health workers.
“There are barriers related to the implementation of KMC programmes, particularly from health staff,” she said. “We believe long-term results will help convince the doubtful about the benefits of implementing KMC.”
"Kangaroo care" makes premature babies healthier and wealthier, study finds
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