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“Kangaroo Mother Care” to Prevent Neonatal Death

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More Intervention Effect Estimate Summaries

Reference
Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S.  ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i144-i154.

Background

  • Kangaroo mother care (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition /response to illness. (1)
  • Preterm birth (<37 completed weeks gestation) is the largest direct cause of neonatal mortality, accounting for an estimated 27% of the 4 million neonatal deaths every year (2) and is also the most important risk factor for neonatal deaths for example from infection (3).
  • Although World Health Organization (WHO) guidelines have been published (4), the lack of convincing mortality benefit that has existed to date has been an impediment to uptake of the intervention.
  • A neonatal death in a baby with a birth weight of <2000 g (~32-34 weeks gestation) is most commonly due to complications of prematurity and hence we assume that deaths in this birth weight category can be considered to be cause-specific for direct complications of preterm deaths.

Intervention Effects

Kangaroo Mother Care (KMC) on Neonatal Mortality

  • 3 Randomized Controlled Trials (RCTs) in low/middle income countries of moderate or high quality
  • KMC was associated with 51% reduction in neonatal death for babies <2000g (RR: 0.49, 95% CI 0.29-0.82) – high evidence grade
  • A meta-analysis of 3 observational studies showed a reduction in neonatal mortality in babies <2000 g, which was slightly smaller than observed in the RCTs (RR: 0.68, 95% CI 0.58-0.79) – lower quality of evidence

KMC on Severe Infection (such as sepsis, necrotizing enterocolitis and severe pneumonia)

  • 5 RCTs with high quality evidence, but indirect mortality effect
  • KMC was associated with a 66% reduction in serious neonatal morbidity (RR: 0.34, 95% CI 0.17-0.65)

Intervention Recommendation:  STRONG

  • This mortality estimate (51% reduction in neonatal mortality) has a high evidence grade with the 3 RCTs from low and middle-income countries showing extremely consistent results with only a slight reduction in quality as assessment was not blinded.  The meta-analysis of observational trials provides supportive evidence of a substantial mortality reduction, although largely driven by one large study using before and after audit data.
  • The evidence is sufficient to recommend the routine use of KMC in facilities for all stable babies <2000 g at birth. Up to half a million neonatal deaths due to preterm birth complications could be prevented each year if this intervention were implemented at scale.
  • KMC is also highly effective in reducing severe morbidity (66% reduction in serious morbidity), particularly from infection.

References from Lawn Paper Cited Here

  1. Charpak N, Riuz JG, Zupan J et al. Kangaroo mother care: 25 years after. Acta Paediatrica 2005; 94: 514-22. 
  2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths; when? Where? Why? Lancet 2005; 365: 891-900.
  3. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 2006; 35:706-18.
  4. World Health Organization.  Kangaroo Mother Care: A Practical Guide. Geneva: World Health Organization, 2003.



Background

  • Kangaroo mother care (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition /response to illness. (1)
  • Preterm birth (<37 completed weeks gestation) is the largest direct cause of neonatal mortality, accounting for an estimated 27% of the 4 million neonatal deaths every year (2) and is also the most important risk factor for neonatal deaths for example from infection (3).
  • Although World Health Organization (WHO) guidelines have been published (4), the lack of convincing mortality benefit that has existed to date has been an impediment to uptake of the intervention.
  • A neonatal death in a baby with a birth weight of <2000 g (~32-34 weeks gestation) is most commonly due to complications of prematurity and hence we assume that deaths in this birth weight category can be considered to be cause-specific for direct complications of preterm deaths.

Intervention Effects

Kangaroo Mother Care (KMC) on Neonatal Mortality

  • 3 Randomized Controlled Trials (RCTs) in low/middle income countries of moderate or high quality
  • KMC was associated with 51% reduction in neonatal death for babies <2000g (RR: 0.49, 95% CI 0.29-0.82) – high evidence grade
  • A meta-analysis of 3 observational studies showed a reduction in neonatal mortality in babies <2000 g, which was slightly smaller than observed in the RCTs (RR: 0.68, 95% CI 0.58-0.79) – lower quality of evidence

KMC on Severe Infection (such as sepsis, necrotizing enterocolitis and severe pneumonia)

  • 5 RCTs with high quality evidence, but indirect mortality effect
  • KMC was associated with a 66% reduction in serious neonatal morbidity (RR: 0.34, 95% CI 0.17-0.65)

Intervention Recommendation:  STRONG

  • This mortality estimate (51% reduction in neonatal mortality) has a high evidence grade with the 3 RCTs from low and middle-income countries showing extremely consistent results with only a slight reduction in quality as assessment was not blinded.  The meta-analysis of observational trials provides supportive evidence of a substantial mortality reduction, although largely driven by one large study using before and after audit data.
  • The evidence is sufficient to recommend the routine use of KMC in facilities for all stable babies <2000 g at birth. Up to half a million neonatal deaths due to preterm birth complications could be prevented each year if this intervention were implemented at scale.
  • KMC is also highly effective in reducing severe morbidity (66% reduction in serious morbidity), particularly from infection.

References from Lawn Paper Cited Here

  1. Charpak N, Riuz JG, Zupan J et al. Kangaroo mother care: 25 years after. Acta Paediatrica 2005; 94: 514-22. 
  2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths; when? Where? Why? Lancet 2005; 365: 891-900.
  3. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol 2006; 35:706-18.
  4. World Health Organization.  Kangaroo Mother Care: A Practical Guide. Geneva: World Health Organization, 2003.

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