RESUMO
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.
