Kangaroo care for well low birth weight infants at Harare Central Hospital Maternity Unit--Zimbabwe.

OBJECTIVE: To describe the experience in a newly established Kangaroo Care Unit (KCU) at a tertiary level hospital and to identify factors associated with poor outcome in this unit. DESIGN: Cross sectional study. SETTING: Kangaroo Care Unit at Harare Central Hospital, Zimbabwe. SUBJECTS: Mothers admitted to the KCU and their well preterm infants. MAIN OUTCOME MEASURES: Discharge home or referral back to the Neonatal Unit (NNU) for conventional care. RESULTS: 613 mother infant pairs were studied from May 1994 to December 1996. The median age for all mothers was 23 years (Q1 = 15, Q3 = 26). Fifty four percent of the infants were female. Median age at admission to KCU was 12 days (Q1 = 1, Q3 = 25). Seventy two percent of infants were discharged home from the KCU. The rest (28%) were referred back to NNU for conventional care. The odds of being referred back to the NNU were significantly higher if the infant was male OR = 1.82 (95% CI: 1.25 to 2.66); if the birth weight was < 1 500 gms OR = 1.52 (95% CI: 1.04 to 2.22); if the admission weight to the KCU was < 1500 grams OR = 2.16 (95% CI: 1.42 to 3.29) or if the age on admission to KCU was 14 days or more OR = 2.15 (95% CI: 1.44 to 3.29). These factors remained significant after adjusting for confounding. Mother's age, parity, booking status or whether admission was during the cold months or not had no significant bearing on the outcome in this unit. Reasons for referral back to NNU included apnoea (27%); respiratory distress (27%); aspiration pneumonia (18%); neonatal jaundice (8%); poor feeding (7%); ill mother (5%); sepsis (4%) and diarrhoea (3%). On multivariate analysis birth weight was the strongest predictor for being referred back to the NNU OR = 10.753 (95% CI: 6.026-19.186). CONCLUSION: Establishment of a KCU at a tertiary level hospital is feasible. Kangaroo care for well preterm infants is suitable for most mothers and their preterm infants. Infants were more likely to be referred back for conventional care if they were male, very low birth weight and if the age at admission was greater than two weeks. Further studies are needed to determine the long term survival of these infants.

Kangaroo care versus incubator care in the management of well preterm infants--a pilot study.

This pilot study was conducted to compare the effectiveness of the kangaroo care method with current, mainly incubator-based care in managing well preterm infants in a tertiary level hospital in a developing country. Altogether, 74 infants (37 per group) were consecutively allocated to receive either kangaroo care or incubator care. After adjusting for age and weight on admission to the study, we found that infants in the kangaroo care group gained twice as much weight per day (20.8 vs 10.2 g, p = 0.0001), had a shorter stay in hospital (16.6 vs 20.7 days, p = 0.0457) and had a better survival rate (0% vs 9% deaths). Also, they were ill less frequently, but after adjusting for age and weight this difference was not significant. This pilot study suggests that the kangaroo care method has major advantages over incubator care of preterm infants in our hospital. Hospitals which cannot use incubators optimally may find kangaroo care to be a better method of improving perinatal and neonatal morbidity and mortality.