XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support.

AIM: This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). METHODS: The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. RESULTS: Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. CONCLUSION: Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia.

BACKGROUND: Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS: Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS: At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION: This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.

Comparing long-term educational effects of two early childhood health interventions.

We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

AIM: The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. METHOD: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. RESULTS: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. CONCLUSION: Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Randomized Clinical Trial of Metoclopramide as Prophylaxis of Gastroesophageal Reflux Disease in Preterm Infants.

BACKGROUND: Gastroesophageal reflux (GER) is more frequent in premature infants. Metoclopramide was introduced routinely in premature babies followed in ambulatory care by the Colombian Kangaroo Mother Care program (KMCP), based on a 2004 Cochrane review. AIM: Because of the recent controversy on the use of metoclopramide in children, this study was conducted to evaluate the effectiveness and safety of metoclopramide given as GER disease (GERD) prophylaxis. METHODS: A randomized clinical trial was conducted between April 2017 and January 2019 in 466 premature infants discharged home and followed at a KMCP. Double-blind allocation to metoclopramide versus placebo was performed, 0.2 mg/kg three times daily, administered 15 min before feeding, up to term. Exclusion criteria were oxygen dependency, any perinatal neurological problem or parent's participation refusal. The incidence of GERD symptoms and adverse events that could be associated with the use of metoclopramide were recorded by parents weekly (e.g., emesis, cyanosis or apnea, post-prandial crying episodes, extrapyramidal symptoms, tremor, and drowsiness). RESULTS: A total of 466 subjects were recruited, most of them late preterm. The groups' baseline characteristics were similar. Median duration of the intervention was approximately 3 weeks, at which time most patients were at term. In the longitudinal mixed effects analysis, we did not find clinically significant differences in GERD-related symptoms between groups, either in minor or severe side effects. CONCLUSION: Results show absence of effectiveness in the systematic use of metoclopramide as prophylaxis of GERD symptoms in premature infants. Additionally, no adverse effects attributable to the drug were found. ClinicalTrials.gov: NCT02907632; September 20, 2016. Retrospectively registered.

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

BACKGROUND: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES: (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS: A prospective cohort study. Descriptive and multivariate analysis. RESULTS: Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth.

AIM: A 2016 Cochrane review showed that Kangaroo mother care (KMC) had a moderate impact on preterm growth, with high heterogeneity among studies. This systematic review and meta-analysis considered new evidence on KMC, particularly the duration. METHOD: Databases were searched for papers published in English, French, Spanish and Portuguese up to 2017. Randomised controlled trials (RCT) of preterm or low birth weight infants were included if they compared growth between KMC and conventional care. Anthropometric measures were related to duration. RESULTS: We identified 1368 papers, and 13 RCTs covering 743 KMC infants and 718 controls met the selection criteria. Infants held in KMC for at least 6 h/d gained more weight than the controls, with a mean difference of 8.99 g/d (95% confidence interval 8.14-9.84, I2  = 0%). This difference persisted between 2 and 6 h/d and disappeared with 2 hours or less. When we used g/kg/d, the weight gain was higher when the duration was at least 8 h/d. Only babies who received 6 h/d gained more length and head circumference. CONCLUSIONS: The effect of the KMC on growth was directly related to the duration.

Opciones de tratamiento hospitalario de la ictericia. Respuesta de los autores / Hospital treatment options for jaundice. Authors repply

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Impacto nutricional de un minimercado mensual en niños prematuros y/o de bajo peso al nacer / Impact of a few monthly-delivered groceries on preterm or low-birth-weight infants' nutrition

RESUMEN Objetivos Evaluar el impacto nutricional de un minimercado mensual de alto valor nutricional entregado, mediante charlas educativas, a familias de recién nacidos prematuros y/o de bajo peso al nacer (BPN), en el marco de los Programas Madre Canguro (PMC), en Bogotá y Cundinamarca; asimismo, identificar los factores de riesgo que predisponen la aparición de la desnutrición (<-2DE). Métodos Estudio observacional, descriptivo y prospectivo de una cohorte de 392 niños inscritos en 10 PMC que presentan en su seguimiento un riesgo alimenticio o una desnutrición confirmada provenientes de familias de ingresos < a 2 salarios mínimos y que reciben mensualmente un minimercado de alto valor nutricional con charla educativa después de los 3 meses de edad corregida (EC). Resultados Según el Sistema de Aseguramiento en Salud, no hubo diferencias en los resultados nutricionales. La entrega de los minimercados no tuvo impacto en la nutrición sino en la adherencia a los PMC. A las 40 semanas, el 19,2% tenía un peso <-2DE, de los cuales 20% tenía Retardo de Crecimiento Intrauterino (RCIU) al nacer. A los 3 y 12 meses de EC, el 24,5% y 36,5% tenía un peso <-2DE. Los demás estaban en riesgo alimenticio. Dos factores de riesgo fueron significativos: la edad de la madre y el grado de desnutrición a la entrada. Conclusión Se requiere un seguimiento prolongado con intervención rápida en los PMC para poder recuperar y vigilar estos niños en riesgo alimenticio o con desnutrición confirmada, conociendo el impacto que tiene en el desarrollo neurológico y cognitivo futuro.

ABSTRACT Objectives To both evaluate the nutritional impact of a high-nutritional- valued, monthly-delivered groceries, combined with educational talks addressed to families of premature and/or low birth weight infant (LBW), followed by Kangaroo Mother Care Program (KMCP) in Bogota and Cundinamarca; and identify the risk factors that predispose the onset of malnutrition. Methods Observational, descriptive, and prospective study of a cohort of 392 children enrolled in 10 KMCP who present in their follow-up a nutritional risk or a malnutrition (Weight <-2 SD [Standard Deviation]); from families with incomes <2 current legal minimum wages and who receive a high-nutritional-valued, monthly-delivered groceries with educational talks after 3 months of corrected age. Results According to the health insurance system, there were no differences in nutritional outcomes. The monthly groceries delivery had no impact on nutrition but on adherence to KMCP. At 40 weeks, 19,2% had a weight of <-2SD, of which 20% had Intrauterine Growth Retardation. At 3 and 12 months of corrected age, 24,5% and 36,5% had a weight of <-2SD, the remaining were at malnutrition risk. Two risk factors were significant: the age of the mother and the level of malnutrition at admission. Conclusion A longer follow-up with faster intervention in the KMCP is necessary, to recover and monitor these children at dietary risk or with confirmed malnutrition, aware of the future impact it may have on neurological and cognitive development.

Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale.

AIM: Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS: The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS: The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION: In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.

Efectividad y seguridad de 2 dispositivos de fototerapia para el manejo humanizado de la ictericia / Effectiveness and safety of two phototherapy devices for the humanised management of neonatal jaundice

INTRODUCCIÓN: La ictericia neonatal es frecuente en los prematuros. El tratamiento oportuno actual con curvas estándar para fototerapia lleva al clínico a separar al bebé de su madre después del nacimiento. Se busca evaluar la efectividad y seguridad de 2 dispositivos innovadores para fototerapia compuestos por mallas de luz LED: una bolsa para dormir y una manta comparadas con fototerapia convencional intrahospitalaria o ambulatoria. MÉTODOS: Se condujeron 2 experimentos clínicos aleatorizados: uno con neonatos >2.000 g en una unidad de recién nacidos y otro con prematuros en un programa de seguimiento ambulatorio. El patrón de oro para la medición de bilirrubinas fue la bilirrubina sérica, y los controles ambulatorios fueron hechos con el Bilicheck(R). Los padres y el personal de salud respondieron una encuesta sobre comodidad con los dispositivos. RESULTADOS: En el estudio correspondiente a la bolsa se realizó regresión lineal para descenso de bilirrubinas en mg/dl/h, controlando por ictericia de aparición temprana (< 36 h) y tipo de dispositivo. No se encontró diferencia significativa entre los dispositivos. Para el estudio en el seguimiento ambulatorio, el descenso de bilirrubina con la manta fue significativamente mayor. En ambos estudios no se encontraron diferencias significativas en temperaturas, duración de fototerapia, readmisiones, mortalidad o efectos secundarios; tampoco en los cuestionarios para padres y equipo médico sobre comodidad con los dispositivos. CONCLUSIONES: Estos 2 pequeños estudios son un «grano de arena» para la humanización del cuidado neonatal, evitando la separación madre-hijo, tanto para el manejo de la hiperbilirrubinemia intrahospitalaria como para la hiperbilirrubinemia de bajo riesgo en el paciente ambulatorio

INTRODUCTION: Neonatal jaundice is common, especially in premature infants. Compliance with treatment protocols and standard serum bilirubin curves forces the clinician to separate the child from the mother after birth for short phototherapy. The objective of this study is to evaluate the effectiveness and safety of two innovative devices for phototherapy including a LED light mesh: one sleeping bag and one blanket compared to conventional hospital or ambulatory phototherapy. METHODS: Two randomised clinical trials were conducted: one with newborns > 2,000 g at birth in the Neonatal Care Unit and the other with premature infants followed-up in an outpatient clinic (PMC). The gold standard for bilirubin measurement was serum bilirubin, and ambulatory controls were performed with the Bilicheck(R). Parents and health personnel completed a questionnaire on comfort and perceptions. Results; In the study using the bag, a linear regression was performed for the decrease in bilirubin in mg/dL/h, controlling by early jaundice (< 36 h) and the device type. The results were similar between the 2 devices. For the blanket trial in the PMC, the decrease in bilirubin levels with the new device was significantly greater with no differences in temperatures, duration of phototherapy, re-admission, mortality, or side effects for both trials. Parents and staff satisfaction with the two devices was identical for the 2 trials. CONCLUSION: These 2 small studies add a 'grain of sand' to humanisation of newborn care, avoiding the mother-and-child separation for both the intra-hospital high-risk hyperbilirubinaemia, as well as for the lower-risk hyperbilirubinaemia in an outpatient clinic

Systematic review and meta-analysis suggest that Kangaroo position protects against apnoea of prematurity.

AIM: The aim of this study was to determine whether the Kangaroo position decreased apnoea events in preterm newborns compared with conventional care in incubator. METHODS: We conducted a systematic review of clinical trials published in English, French, Spanish and Portuguese. A comprehensive literature search was realised until 2017. The main outcome was apnoea events. Data were extracted and combined in a fixed-effects model. The quality of the evidence was assessed according to the GRADE framework (grading the quality of evidence and the strength of recommendations). RESULTS: Four original clinical trials were selected. These trials were conducted in India and Nepal, between 2005 and 2016. The systematic review comprised 416 preterm newborns. Three studies were randomised controlled trials and one was quasi-experimental. Meta-analysis showed a statistically significant reduction in apnoea episodes (relative risk [RR] 0.41; 95% confidence interval [CI] 0.22, 0.78). The result remained significant when only the three clinical trials were analysed (RR 0.43; 95% CI 0.23, 0.83). Quality analysis indicated moderate quality because of lack of an appropriate method of randomisation in one study. CONCLUSION: The Kangaroo position could have protective effect against apnoea events in preterm infants, decreasing the associated risk of death or long-term disability.

[Impact of a few monthly-delivered groceries on preterm or low-birth-weight infants' nutrition]. / Impacto nutricional de un minimercado mensual en niños prematuros y/o de bajo peso al nacer.

OBJECTIVES: To both evaluate the nutritional impact of a high-nutritional- valued, monthly-delivered groceries, combined with educational talks addressed to families of premature and/or low birth weight infant (LBW), followed by Kangaroo Mother Care Program (KMCP) in Bogota and Cundinamarca; and identify the risk factors that predispose the onset of malnutrition. METHODS: Observational, descriptive, and prospective study of a cohort of 392 children enrolled in 10 KMCP who present in their follow-up a nutritional risk or a malnutrition (Weight <-2 SD [Standard Deviation]); from families with incomes <2 current legal minimum wages and who receive a high-nutritional-valued, monthly-delivered groceries with educational talks after 3 months of corrected age. RESULTS: According to the health insurance system, there were no differences in nutritional outcomes. The monthly groceries delivery had no impact on nutrition but on adherence to KMCP. At 40 weeks, 19,2% had a weight of <-2SD, of which 20% had Intrauterine Growth Retardation. At 3 and 12 months of corrected age, 24,5% and 36,5% had a weight of <-2SD, the remaining were at malnutrition risk. Two risk factors were significant: the age of the mother and the level of malnutrition at admission. CONCLUSION: A longer follow-up with faster intervention in the KMCP is necessary, to recover and monitor these children at dietary risk or with confirmed malnutrition, aware of the future impact it may have on neurological and cognitive development.

OBJETIVOS: Evaluar el impacto nutricional de un minimercado mensual de alto valor nutricional entregado, mediante charlas educativas, a familias de recién nacidos prematuros y/o de bajo peso al nacer (BPN), en el marco de los Programas Madre Canguro (PMC), en Bogotá y Cundinamarca; asimismo, identificar los factores de riesgo que predisponen la aparición de la desnutrición (<-2DE). MÉTODOS: Estudio observacional, descriptivo y prospectivo de una cohorte de 392 niños inscritos en 10 PMC que presentan en su seguimiento un riesgo alimenticio o una desnutrición confirmada provenientes de familias de ingresos < a 2 salarios mínimos y que reciben mensualmente un minimercado de alto valor nutricional con charla educativa después de los 3 meses de edad corregida (EC). RESULTADOS: Según el Sistema de Aseguramiento en Salud, no hubo diferencias en los resultados nutricionales. La entrega de los minimercados no tuvo impacto en la nutrición sino en la adherencia a los PMC. A las 40 semanas, el 19,2% tenía un peso <-2DE, de los cuales 20% tenía Retardo de Crecimiento Intrauterino (RCIU) al nacer. A los 3 y 12 meses de EC, el 24,5% y 36,5% tenía un peso <-2DE. Los demás estaban en riesgo alimenticio. Dos factores de riesgo fueron significativos: la edad de la madre y el grado de desnutrición a la entrada. CONCLUSIÓN: Se requiere un seguimiento prolongado con intervención rápida en los PMC para poder recuperar y vigilar estos niños en riesgo alimenticio o con desnutrición confirmada, conociendo el impacto que tiene en el desarrollo neurológico y cognitivo futuro.

[Effectiveness and safety of two phototherapy devices for the humanised management of neonatal jaundice]. / Efectividad y seguridad de 2 dispositivos de fototerapia para el manejo humanizado de la ictericia.

INTRODUCTION: Neonatal jaundice is common, especially in premature infants. Compliance with treatment protocols and standard serum bilirubin curves forces the clinician to separate the child from the mother after birth for short phototherapy. The objective of this study is to evaluate the effectiveness and safety of two innovative devices for phototherapy including a LED light mesh: one sleeping bag and one blanket compared to conventional hospital or ambulatory phototherapy. METHODS: Two randomised clinical trials were conducted: one with newborns >2,000g at birth in the Neonatal Care Unit and the other with premature infants followed-up in an outpatient clinic (PMC). The gold standard for bilirubin measurement was serum bilirubin, and ambulatory controls were performed with the Bilicheck®. Parents and health personnel completed a questionnaire on comfort and perceptions. RESULTS: In the study using the bag, a linear regression was performed for the decrease in bilirubin in mg/dL/h, controlling by early jaundice (<36h) and the device type. The results were similar between the 2 devices. For the blanket trial in the PMC, the decrease in bilirubin levels with the new device was significantly greater with no differences in temperatures, duration of phototherapy, re-admission, mortality, or side effects for both trials. Parents and staff satisfaction with the two devices was identical for the 2 trials. CONCLUSION: These 2 small studies add a 'grain of sand' to humanisation of newborn care, avoiding the mother-and-child separation for both the intra-hospital high-risk hyperbilirubinaemia, as well as for the lower-risk hyperbilirubinaemia in an outpatient clinic.

Randomised controlled trial on the impact of kinesthetic stimulation on early somatic growth of preterm infants in Kangaroo position.

AIM: Evaluation of early growth in preterm infants receiving kinesthetic stimulation with massage in Kangaroo position or in incubator. METHODS: A cohort of 66 infants between 30 and 33 weeks of gestational age (GA), born at a university hospital in 2013 in Bogota, were randomised when eligible to intervention. We measured weight gain (g/kg/day) at five days and 15 days postrandomisation and weight at 40 weeks, according to chronological age at randomisation. RESULTS: Daily weight gain was significantly higher (p = 0.02) with kinesthetic stimulation in Kangaroo position with a growth at five days of 11.0 g/kg/day (95% CI 5.7;16.3) and at 15 days of 12.1 g/kg/day (95% CI 10.4;13.7) versus 2.1 g/kg/day (95% CI -3.1;7.4) at five days and 9.4 g/kg/day (95% CI 7.7;11.1) at 15 days in incubator. Weight at 40 weeks was higher (p = 0.05) in Kangaroo position group (2.904 g) than in incubator group (2.722 g) (95% CI 2.784;3.007). Daily weight gain according to chronological age at randomisation was higher when kinesthetic stimulation initiates before five days of life in Kangaroo position with 1.53 g/kg/day (95% CI 5.9;9.0) versus -11.9 g/kg/day (95% CI -19.0;-4.8) in incubator. CONCLUSION: Early kinesthetic stimulation in Kangaroo position reduces the initial weight loss in infants between 30-33 weeks born without major health problems.

[The Kangaroo Mother Care Program of Yopal, Colombia: an opportunity to keep track of preterm infants]. / El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro.

OBJECTIVE: In Colombia, the incidence of prematurity and low birth weight (LBW) is 12.8%. To describe a standardized follow-up until 12 months of 1138 premature and/or LBW included in the Yopal KMCP (2014 -2015). MATERIALS AND METHODS: Prospective cohort. RESULTS: the patients are from the subsidized health care system (Colombia government), 58.2% live in the city and 24.6% at more than two hours from the city; 80.6% of parents are stable couples and 78.9% are employed; 69% of mothers started prenatal control from the first trimester. The most frequent obstetric pathologies were urinary tract infection and pre-eclampsia; 97% of deliveries were in the hospital; 55% by caesarean section. Majority of infants were late preterm; 13.3% passed through the Neonatal Intensive Care Unit (NICU) with 27% ventilated and 5.9% oxygen-dependent at discharge. At 6 months more than 50% had exclusive breastfeeding. Ophthalmology screening was performed in 54% (4.6% retinopathy), optometry in 72% and audiology in 70% (4.7% with hearing deficit). At 12 months 4.4% had abnormal neurological exam and 95% complete vaccines schedule. Lost to follow up was 35% and mortality 0.4%. CONCLUSION: It is important to implement KMCP in intermediate and isolated cities to ensure a high-risk follow-up for all LBW and / or premature babies, to detect somatic, sensory or neuro-psychomotor development anomalies and to perform timely interventions.

OBJETIVO: En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015. MATERIALES Y MÉTODOS: Estudio de cohorte prospectiva. RESULTADOS: Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%. CONCLUSIONES: Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.