Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis
Importance The Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight infants. New evidence from large multi-centre randomised trials has been available since its publication.Objective Our systematic review compared the...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-06-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/8/6/e010728.full |
| _version_ | 1797756151871307776 |
|---|---|
| author | Sindhu Sivanandan Mari Jeeva Sankar |
| author_facet | Sindhu Sivanandan Mari Jeeva Sankar |
| author_sort | Sindhu Sivanandan |
| collection | DOAJ |
| description | Importance The Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight infants. New evidence from large multi-centre randomised trials has been available since its publication.Objective Our systematic review compared the effects of KMC vs conventional care and early (ie, 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, from inception until March 2022, were searched. All randomised trials comparing KMC vs conventional care or early vs late initiation of KMC in low birth weight 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 during birth hospitalization or 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 and 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 four compared early vs late initiation of KMC. Compared with conventional care, KMC reduces the risks of mortality (relative risk (RR) 0.68; 95% confidence interval (CI) 0.53 to 0.86; 11 trials, 10 505 infants; high certainty evidence) during birth hospitalisation or 28 days of age and probably reduces severe infection until the latest follow-up (RR 0.85, 95% CI 0.79 to 0.92; nine trials; moderate certainty evidence). On subgroup analysis, the reduction in mortality was noted irrespective of gestational age or weight at enrolment, time of initiation, and place of initiation of KMC (hospital or community); the mortality benefits were greater when the daily duration of KMC was at least 8 hours per day than with shorter-duration KMC. Studies comparing early vs late-initiated KMC demonstrated a reduction in neonatal mortality (RR 0.77, 95% CI 0.66 to 0.91; three trials, 3693 infants; high certainty evidence) and a probable decrease in clinical sepsis until 28-days (RR 0.85, 95% CI 0.76 to 0.96; two trials; low certainty evidence) following early initiation of KMC.Conclusions and relevance The review provides updated evidence on the effects of KMC on mortality and other critical outcomes in preterm and 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. |
| first_indexed | 2024-03-12T17:57:24Z |
| format | Article |
| id | doaj.art-5aecd8c5fdb44e40ba41b9a8c0c6c656 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-12T17:57:24Z |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-5aecd8c5fdb44e40ba41b9a8c0c6c6562023-08-02T13:20:06ZengBMJ Publishing GroupBMJ Global Health2059-79082023-06-018610.1136/bmjgh-2022-010728Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysisSindhu Sivanandan0Mari Jeeva Sankar11 Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India2 Pediatrics, All India Institute of Medical Sciences, New Delhi, IndiaImportance The Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight infants. New evidence from large multi-centre randomised trials has been available since its publication.Objective Our systematic review compared the effects of KMC vs conventional care and early (ie, 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, from inception until March 2022, were searched. All randomised trials comparing KMC vs conventional care or early vs late initiation of KMC in low birth weight 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 during birth hospitalization or 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 and 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 four compared early vs late initiation of KMC. Compared with conventional care, KMC reduces the risks of mortality (relative risk (RR) 0.68; 95% confidence interval (CI) 0.53 to 0.86; 11 trials, 10 505 infants; high certainty evidence) during birth hospitalisation or 28 days of age and probably reduces severe infection until the latest follow-up (RR 0.85, 95% CI 0.79 to 0.92; nine trials; moderate certainty evidence). On subgroup analysis, the reduction in mortality was noted irrespective of gestational age or weight at enrolment, time of initiation, and place of initiation of KMC (hospital or community); the mortality benefits were greater when the daily duration of KMC was at least 8 hours per day than with shorter-duration KMC. Studies comparing early vs late-initiated KMC demonstrated a reduction in neonatal mortality (RR 0.77, 95% CI 0.66 to 0.91; three trials, 3693 infants; high certainty evidence) and a probable decrease in clinical sepsis until 28-days (RR 0.85, 95% CI 0.76 to 0.96; two trials; low certainty evidence) following early initiation of KMC.Conclusions and relevance The review provides updated evidence on the effects of KMC on mortality and other critical outcomes in preterm and 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.https://gh.bmj.com/content/8/6/e010728.full |
| spellingShingle | Sindhu Sivanandan Mari Jeeva Sankar Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis BMJ Global Health |
| title | Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis |
| title_full | Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis |
| title_fullStr | Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis |
| title_full_unstemmed | Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis |
| title_short | Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis |
| title_sort | kangaroo mother care for preterm or low birth weight infants a systematic review and meta analysis |
| url | https://gh.bmj.com/content/8/6/e010728.full |
| work_keys_str_mv | AT sindhusivanandan kangaroomothercareforpretermorlowbirthweightinfantsasystematicreviewandmetaanalysis AT marijeevasankar kangaroomothercareforpretermorlowbirthweightinfantsasystematicreviewandmetaanalysis |