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Immediate skin-to-skin contact with unstable newborns improves chances of survival

In newborns with a very low birth weight, continuous skin-to-skin contact immediately after delivery, even before the baby has been stabilized, can lower mortality by 25%. This is according to a study published in The New England Journal of Medicine that was organized by the WHO on the initiative of researchers at Karolinska Institutet focusing on low- and middle-income nations. 

One of the most effective approaches to avoid newborn mortality is to keep the newborn and mother in constant skin-to-skin contact, often known as “kangaroo mother care” (KMC). The World Health Organization (WHO) currently recommends that skin-to-skin contact begin as soon as a low-weight infant is stable enough, which usually takes several days for babies weighing less than 2 kg at birth. 

“The idea of giving skin-to-skin contact immediately after delivery to very small, unstable babies has encountered quite strong resistance, but about 75 percent of deaths occur before the infant has been judged sufficiently stable,” says Nils Bergman, doctor and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet, Sweden, and one of the initiators of the study.

In a recent study, researchers looked at whether providing immediate Kangaroo Mother Care, or iKMC, following delivery improves survival chances for newborns weighing 1 to 1.8 kg in low and middle-income countries.

The new research was carried out at five university hospitals in Ghana, India, Malawi, Nigeria, and Tanzania, where the death rate for these newborns was between 20 and 30 percent before the study. 

Before the trial began, training in basic newborn care was offered, as well as basic equipment for detecting the babies’ oxygen levels and providing assisted breathing, in order to enhance and align treatment as much as possible amongst study institutions. Safe skin-to-skin contact for unstable neonates was also taught to the collaborating institutions. The KI researchers, assisted by a colleague from the University of Stavanger in Norway, were in charge of training and, via frequent visits to the study sites, ensuring the quality of basic care in both groups as well as the iKMC methodology in the intervention group. 

The published paper shows that 3,211 newborns were randomly allocated to one of two groups: one that had iKMC and ongoing skin-to-skin contact in the neonatal unit, where the mothers also got medical treatment, and the other that got normal care, in which moms and babies are separated and only reunited for newborn feeding. 

“The main message is that low weight newborns should receive skin-to-skin contact immediately after birth and subsequently at a mother-infant couplet care unit, where mothers and babies are looked after together without having to be separated,” says Björn Westrup, consultant and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet and co-initiator of the study with Nils Bergman. “Our results suggest that this care model, which in itself isn’t resource-demanding, could have significant health effects.”

The iKMC group had a mortality rate of 12 percent within the first 28 days, compared to 15.7 percent in the control group, a reduction of 25%.

In the iKMC group, there were also considerably fewer newborns with a low body temperature or bacterial blood poisoning. According to the experts, iKMC has the potential to save an additional 150,000 premature babies each year. 

“Keeping the mother and baby together right from birth, with zero separation, will revolutionize the way neonatal intensive care is practiced for babies born early or small,” says Dr. Rajiv Bahl, Head of Maternal and Newborn Health Research and Development at WHO and the coordinator of the study. “This study illustrates that kangaroo mother care has the potential to save many more lives if it is started immediately after birth, a finding with relevance for countries of all income levels.”

In light of new research, WHO is revisiting its existing recommendations on kangaroo mother care, which were released in 2015. Although the WHO advises KMC for all newborns, the current study adds to the growing body of research supporting the lifesaving importance of urgent KMC in the treatment of undersized newborns who are in distress. 

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