Abstract
The global position paper describes Kangaroo Mother Care (KMC) as a transformative innovation in health care that organizes the entire maternal–nurse service delivery. The 2022 WHO guidelines recommend starting KMC immediately after birth in every low birth weight and preterm infant irrespective of place of birth or stability This special supplement on Kangaroo Mother Care released to commemorate “International Kangaroo Care Awareness Day” has many research articles that add to the huge body of evidence for this simple intervention that has transformed care of the preterm and/or low birth weight infants.
KMC in India – down the memory lane by Udani et al. describes how KMC was introduced into India and is now an integral part of small and sick newborn care. The supplement has an invited article from Nathalie Charpak, the pioneer of KMC, who conducted the first-ever randomized controlled trial of KMC in Bogota, Colombia. Exploratory analysis of the impact of KMC on brain growth according to the duration in days of KMC position is presented in this article and should help accelerate the systematic introduction of KMC as early as possible and for as long as possible from birth. Invited Commentary by Prof. Shashi Vani highlights the invaluable contribution by Kangaroo Mother Care Foundation, India (KMCFI). KMCFI’s multifaceted approach encompasses advocacy, training, research, and community engagement, all aimed at mainstreaming KMC as an integral component of newborn care in India.
KMC as a tool to reduce pain is emphasized by the cross-over randomized controlled trial by Jajoo et al to study the impact of KMC on heart rate variability and pain score during heel lance. Similar findings were reiterated by Baijnathan et al. Both studies add to the evidence base on neonatal pain.
KMC, being a behavioral intervention, is largely dependent on champions and counseling. Ghoshal et al. show how structured one-to-one counseling with the GALPAC technique improves the duration of KMC and high-impact outcomes such as mortality and weight gain.
Singh et al. demonstrate yet another benefit of KMC. Effective KMC, defined in the study as > 6 hours/day, reduces the risk of retinopathy of prematurity with a NNT of only 5.
A questionnaire-based study by Rao et al. describes prevailing KMC practices in NICUs across India, highlighting the need for further strengthening. KMC is initiated after 48 hours in 44% of units, and the average duration is 4-8 hours in 54% of units. The KAP study by Pradhan et al. discusses multiple barriers faced during the implementation of KMC despite mothers’ good knowledge and positive attitudes towards it.
The feasibility and acceptability of an assistive garment assessed by Murry et al. depicted ease of milk expression and high satisfaction scores compared to the current garments used by KMC providers.
Sinha et al.demonstrated that by quality improvement initiative over 3 months, they could achieve 100% compliance in the early initiation of skin-to-skin contact among newborns delivered vaginally at a tertiary care hospital.
Sameer et al. have drawn attention to the complexities of sustaining grassroots initiatives and called for further research to develop effective models that address the unique needs of marginalized communities regarding the care of preterm infants, which is needed to achieve SDG 3 goal.
While emphasis on early initiation and prolonged KMC continues, these studies show tangible benefits of KMC on important health outcomes. We need more uniform and structured KMC practices across the country, especially upscaling of infrastructure, early initiation and longer duration of KMC, better monitoring of neonates in KMC, and strengthening the follow-up program.