An estimated 4 million infants die each year during their first 4 weeks of life.1 Although important progress has been made toward Millennium Development Goal 4 to reduce mortality in children <5 years old, less improvement has been achieved in the neonatal period.2 Infants born before term or at low birth weight (LBW) are at elevated risk of neonatal mortality and morbidity, inhibited growth and development, and chronic disease.1,3,4 Health technologies such as incubators can help improve outcomes in high-risk infants; however, such equipment is not widely available in low- and middle-income countries, where 99% of all neonatal deaths occur.1 Effective and low-cost alternative methods of neonatal care are needed.
In 1978, Dr Edgar Rey Sanabria introduced kangaroo mother care (KMC) in Bogotá, Colombia as an alternative to incubators for LBW infants.5 The World Health Organization defines KMC with 4 components: early, continuous, and prolonged skin-to-skin contact (SSC) between the newborn and mother, exclusive breastfeeding, early discharge from the health facility, and close follow-up at home.6 KMC is postulated to improve neonatal outcomes by maintaining the infant’s temperature and other vital sign parameters through SSC and by providing the benefits of breastfeeding.5 These effects are thought to be beneficial for all newborns but may be especially advantageous for preterm infants.
In previous meta-analyses, KMC was found to reduce the risk of morbidity and mortality among LBW infants.7,8 In randomized controlled trials (RCTs), SSC alone has also been associated with improved breastfeeding, cardiorespiratory stability, and improved responses to procedural pain.9,10 Although these reviews have provided important evidence on the effectiveness of KMC, they are limited to specific outcome measures and newborn populations, and they have included only RCTs, with the exception of Lawn et al 2010.7 To give a more complete understanding of the potential benefits and drawbacks of KMC, this systematic review and meta-analysis aims to provide a comprehensive summary of observational studies and RCTs on KMC and neonatal outcomes.