Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care.

UNLABELLED: The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow-up. Current evidence allows the following general statements about KMC in affluent and low-income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low-birth-weight infants should be regarded as extero-gestational foetuses needing skin-to-skin contact to promote maturation. CONCLUSION: Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.

Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study.

AIMS: This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. SETTING: The largest social security hospital in Colombia with a neonatal intensive care unit. SUBJECTS: At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. INTERVENTIONS: Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. OUTCOME MEASURES: The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. RESULTS: 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. CONCLUSION: Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children.

Influence of feeding patterns and other factors on early somatic growth of healthy, preterm infants in home-based kangaroo mother care: a cohort study.

OBJECTIVE: Breast-milk fortifiers recommended for premature infants are seldom available in developing countries. We describe the characteristics of growth in preterm infants under ambulatory Kangaroo Mother Care (KMC) who eventually required supplemental formula because of failure to thrive with exclusive breast feeding. We evaluated the relationship between growth indices at term, nutritional status of the infant at birth, and feeding pattern. DESIGN: Prospective cohort study conducted in the Neonatal Unit at Clínica San Pedro Claver and the KMC program, an ambulatory clinic from the Clínica del Niño tertiary care clinics in Bogotá, Colombia. Included were 115 mothers and their 129 healthy, preterm infants. One hundred twenty-six (98.4%) infants were available for evaluation at term. Infant weights were monitored daily until they achieved 15 g/kg per day for 2 days and then weekly until term. Formula was offered only to infants who did not gain 15 g per kg per day for 3 consecutive days. RESULTS: Sixty (47.6%) infants gained weight adequately with exclusive breast feeding. In 14 of those who needed supplements, adequate weight gain was achieved before reaching term and supplements could be stopped. The more immature infants required supplementation more frequently. With or without supplementation, infants with lower weight for gestational age at birth were less likely to achieve adequate weight by term. CONCLUSIONS: Growth indices at term in premature infants were close to those expected for term infants born in Bogotá (between percentile 10 to percentile 25). Decision on formula supplementation of breast milk should be made not only based on birth weight or gestational age but on a careful monitoring of weight gain while the mother is receiving continuous support to enhance and maintain successful breast-feeding. Small-for-date premature infants thrive less well than other infants even with supplementation.

A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age.

OBJECTIVE: To assess the effectiveness and safety of Kangaroo Mother Care (KMC) for infants of low birth weight. METHODS: An open, randomized, controlled trial of a Colombian social security referral hospital was conducted. A total of 1084 consecutive infants who were born at

Accuracy of fecal lactoferrin and other stool tests for diagnosis of invasive diarrhea at a Colombian pediatric hospital.

OBJECTIVES: Estimate under "real life" conditions the operating characteristics of several stool tests for determining whether a diarrheal episode is invasive-inflammatory. DESIGN: Determination of operating characteristics of diagnostic tests against a standard in a prospectively gathered sample. SETTING: The emergency room of the largest Social Security Pediatric Hospital in Colombia serving referred and nonreferred patients. PATIENTS: Stool samples from children attending the emergency room because of acute diarrhea (three or more loose stools per day lasting <7 days). Patients receiving antibiotics or antiparasitic medications were excluded. INTERVENTIONS: Samples were collected in sterile containers and examined immediately for protozoa, fecal leukocytes, occult blood and lactoferrin. Specimens were inoculated onto culture media for common bacterial fecal pathogens except enteroinvasive Escherichia coli and Clostridium difficile. MAIN OUTCOME MEASURE: Sensitivity, specificity and likelihood ratios of several cutoff levels for fecal lactoferrin, fecal leukocytes and occult blood. RESULTS: Stool samples from 500 infants and children with diarrhea were collected. Patients' median age was 2.66 years (range, 0.5 to 13 years), and 261 (52.2%) were males. In 155 (31%) cases enteroinvasive bacteria and/or Entamoeba histolytica were documented. Fecal leukocytes >5 had the best sensitivity (63.2%; 95% confidence interval, 55.4 to 70.5) and specificity (84.3%; 95% confidence interval, 80.2 to 87.9), although not statistically or clinically significantly different from lactoferrin. CONCLUSIONS: No single test or combination had satisfactory operating characteristics. Nevertheless the use of likelihood ratios derived here can help clinicians identify invasive-inflammatory diarrheal episodes in many instances.

Kangaroo mother versus traditional care for newborn infants

BACKGROUND: In 1978, kangaroo mother care (KMC) was proposed as a caring alternative for low birth weight (LBW) infants. We are reporting here early outcomes of a randomized, controlled trial comparing KMC to traditional care. METHOD: An open randomized, controlled trial was conducted in a large tertiary care hospital. All newborn infants

Current knowledge of Kangaroo Mother Intervention.

Kangaroo Mother Intervention (KMI) started in 1978 in Colombia as a way of dealing with overcrowding and scarcity of resources in hospitals caring for low birth weight infants. Currently the intervention comprises three components: kangaroo position (skin-to-skin contact), kangaroo nutrition (exclusive or nearly exclusive breast-feeding), and kangaroo discharge policies (early discharge in kangaroo position regardless of weight or gestational age). Different authors have adopted and adapted diverse components of the KMI to suit the particular needs of their parents. We discuss different modalities of kangaroo care reported in developed and in developing countries and also describe in some detail the components of the whole KMI program. In addition, results from a systematic review of kangaroo-related papers published in English between 1991 and 1995 are provided, together with a summary of current knowledge (evidence-based) and research needs.

PIP: The "kangaroo mother intervention" (KMI) was developed in Colombia in the late 1970s in response to overcrowding in hospitals providing care for low-birth-weight infants. In addition to promoting maternal-infant bonding and successful breast feeding, this strategy can be used in sites without appropriate neonatal care facilities such as incubators or as an alternative to neonatal minimal care units. Components of the intervention include 24 hour/day skin-to-skin contact in an upright position, exclusive breast feeding, and hospital discharge (regardless of weight or age) as soon as the kangaroo position and nutrition have been mastered. Studies of skin-to-skin contact published during 1991-95 have reported temperature regulation similar to or better than that in an incubator, regular breathing patterns, longer periods of alertness, and improved maternal adaptation to having a fragile infant. KMI nutrition (exclusive breastfeeding) has been associated with substantial reductions in mortality in infants weighing less than 1500 grams and weight gains within acceptable limits. The only study to compare all three components of KMI with standard practices for the care of low-birth-weight infants found less growth in the first three months of life and more developmental delay at 12 months in the KMI group; however, there were large baseline differences in infant health and socioeconomic status. More methodologically sound controlled clinical trials are required before widespread use of KMI can be recommended. Specific issues in need of investigation include the provision of KMI on an outpatient basis, its long-term effects on neuropsychological and emotional development, and KMI's cost-effectiveness.

Rey-Martinez Kangaroo Mother Program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study.

OBJECTIVES: To assess the effectiveness and safety of the Kangaroo mother intervention (KMI). DESIGN: Observational, analytic, prospective (two cohorts) study. SETTING: Two large tertiary care obstetric hospitals, one offering "traditional" care and the other KMI. PATIENTS: Newborn infants with birth weights < or = 2000 g, who survive the neonatal period and are eligible for an in-patient minimal care unit (MCU) (having overcome major adaptation problems to extra uterine life). INTERVENTIONS: "Kangaroo infants" (KI) were discharged as soon as they were eligible for MCU, regardless of weight or gestational age. Infants were kept 24 hours a day in an upright position, in skin-to-skin contact and firmly attached to the mother's chest until the KMI was not tolerated anymore. Control babies (from the other facility) were kept in incubators at the MCU until they satisfied usual discharge criteria for the control hospital. Both groups were followed periodically up to the age of 1 year. RESULTS: Three hundred thirty-two eligible infants were recruited, 162 at the Kangaroo hospital and 170 at the control hospital. KI came from a much lower socio-economic class and were more ill before eligibility. Relative risk of death was higher for KI (RR 1.9), although this figure was reversed after adjusting for weight at birth and gestational age (RR 0.5). KI grew less in the first 3 months and had a higher proportion of developmental delay at 1 year, and a multivariate analysis failed to control for the large baseline differences in socioeconomic levels and babies' health status between the two cohorts. CONCLUSIONS: In spite of major baseline differences between studied cohorts, the survival of LBW infants in Bogotá is similar between the KMI and the "traditional care". Questions remain about quality of life, especially regarding weight gain and neurodevelopment, that may be answered by a Randomized Controlled Trial.