Kangaroo Mother Care (KMC) has been practiced and studied globally for over four decades. Studies with full-term infants began in the 1970s in the USA1 and were followed by preterm studies in Colombia, South America. Currently, the evidence base for KMC consists of nearly 1600 studies.2 Rigorous experiments and metaanalyses provide compelling evidence of mainly positive effects of KMC. Important associated outcomes reported include increased physiologic stability,3,4 decreased mortality;5,6 increased warmth and prevention of hypothermia;7,8 decreased apnea, irregular breathing, desaturations, and bradycardia, as well as improved heart rate variability; 9,10 decreased incidence of nosocomial infections;11 and decreased pain perception.12,13 Physiologic stability has been documented during interfacility transport in KMC.14 These studies of the physiologic effects of KMC have included small (< 1000 gm), very preterm (< 28 weeks GA, ≤ 30 weeks postmenstrual age when studied)15,16 and very sick infants, as well as more mature, older, and relatively stable preterm infants.17,18|
The research reviewed in this issue corroborates earlier findings that the practice of KMC is safe and effective; supports ongoing efforts to adopt KMC as standard practice in the NICU; and contributes to the body of evidence which asserts that KMC improves outcomes for infants, mothers, and families, with impact that is immediate and sustained.
Adoption of low-tech intervention of KMC has challenged clinicians in NICUs globally. Its implementation in industrialized societies with greater resources has been slow, in part because of the value placed on high-tech and pharmacologic solutions, and in part because of concerns about risk and safety.
The first two studies reviewed address safety concerns. Carbasse et al, in a prospective observational study directed to the safety and efficacy of KMC, report on several positive short term physiologic effects accompanied by none of the undesirable outcomes of concern to careful clinicians. Further, they track various aspects of treatment and present findings that indicate KMC infants developed no additional demands for oxygen, medication, or other interventions. Hendricks-Munoz and Mayers describe an educational program for NICU staff accompanied by simulations to facilitate knowledge and enhance comfort with the practice of KMC. They introduced an approach to monitoring safety that can be useful for clinicians seeking to introduce KMC, and they report none of the negative events during KMC against which late adopters caution. This research team reports that a larger study is in progress.
As the practice of KMC is more broadly adopted and studied, its frequency and duration have been titrated to benefit babies and families. Recent evidence encourages clinicians to provide KMC not just at brief, broadly spaced intervals, but regularly and perhaps even continuously. Blomquist and Nygvist report on a single-facility pilot test of continuous KMC spanning the full hospitalization. They report high satisfaction but some fatigue among 23 mothers who remained skin to skin with their infants throughout the NICU stay. Although this was a small study with nonrandom selection, the authors also report no negative unintended consequences and introduce the potential and the challenge of the next wave of KMC practice.
The last two studies reviewed here address short-term outcomes and long-term impact. KMC was first introduced to the NICU, similarly to the introduction of some other interventions, slowly and with careful, comprehensive monitoring for risk and adverse events. KMC was offered to families thought to be good candidates and begun when each infant was considered sufficiently stable to tolerate the stress KMC might introduce and was limited in duration. Welch and colleagues studied KMC as part of a Family Nurture Intervention (FNI) beginning soon after birth, using EEG activity at 35 weeks and 40 weeks postmenstrual age. They document improved neural functioning associated with KMC as part of FNI. Finally, Feldman et al add to the evidence supporting the assertion that the early practice of KMC has both short-term and long-term outcomes over a ten-year period. They document long-term benefits, including improved executive functioning, more adaptive stress response, and improved relationships between mother and child. As in other studies, this team reported no negative outcomes or long-term harm.
As the Institute of Medicine states, the progress from discovery (research) to application (practice) is complex, commonly spanning more than a decade.19 Even by this standard, the neonatal community has been slow to adopt KMC. The article reviews presented in this issue complement the body of work already available on KMC. KMC is a simple, technology-sparing, family-supporting intervention that promises significant short-term gains and long-term impact. Clinicians are challenged to take action to support KMC implementation while carefully monitoring immediate outcomes and long-term impact. Concerns about safety can be mitigated by careful implementation plans and monitoring. The gains for infants, and benefits for mothers and families are powerful, compelling, and congruent with family-centered care.
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