, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an estimated 7,000 deaths in approximately 150 countries (1). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic (2). Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19-associated illness and death than are younger persons (3). Although the majority of reported COVID-19 cases in China were mild (81%), approximately 80% of deaths occurred among adults aged ≥60 years; only one (0.1%) death occurred in a person aged ≤19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12-March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups. Data from cases reported from 49 states, the District of Columbia, and three U.S. territories (5) to CDC during February 12-March 16 were analyzed. Cases among persons repatriated to the United States from Wuhan, China and from Japan (including patients repatriated from cruise ships) were excluded. States and jurisdictions voluntarily reported data on laboratory-confirmed cases of COVID-19 using previously developed data collection forms (6). The cases described in this report include both COVID-19 cases confirmed by state or local public health laboratories as well as those with a positive test at the state or local public health laboratories and confirmation at CDC. No data on serious underlying health conditions were available. Data on these cases are preliminary and are missing for some key characteristics of CDC COVID-19 Response Team

CONTEXT: Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns.OBJECTIVE: Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. STUDY SELECTION:We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. DATA EXTRACTION:Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures.RESULTS: 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. LIMITATIONS:Lack of data on KMC limited the ability to assess dose-response. CONCLUSIONS:Interventions to scale up KMC implementation are warranted. Epidemiology, c Biostatistics, and d Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Departments of b Global Health and Population, and f Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts; e Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; g Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; h Save the Children, Washington, DC; and i Department of Medicine, Boston Children's Hospital, Boston, Massachusetts Dr Boundy conceptualized and designed the study, conducted the literature review, collected the data, conducted the analyses, created the tables and fi gures, and drafted and revised the manuscript; Dr Dastjerdi conducted the literature review, collected and cleaned the data, assisted with table and fi gure creation, and critically reviewed the manuscript; Dr Spiegelman contributed to the study design, statistical analyses, and data interpretation and critically reviewed the manuscript; Drs Fawzi, Missmer, and Lieberman contributed to the study design and data interpretation and critically reviewed the manuscript; Ms Kajeepeta conducted the literature review, collected the data, assisted with fi gure creation, and critically reviewed the manuscript;Dr Wall contributed to the conceptualization and design of the study and data interpretation and critically reviewed the manuscript; Dr Chan conceptualized and designed the study, designed...

BackgroundKangaroo mother care (KMC), often defined as skin–to–skin contact between a mother and her newborn, frequent or exclusive breastfeeding, and early discharge from the hospital has been effective in reducing the risk of mortality among preterm and low birth weight infants. Research studies and program implementation of KMC have used various definitions. ObjectivesTo describe the current definitions of KMC in various settings, analyze the presence or absence of KMC components in each definition, and present a core definition of KMC based on common components that are present in KMC literature.MethodsWe conducted a systematic review and searched PubMed, Embase, Scopus, Web of Science, and the World Health Organization Regional Databases for studies with key words “kangaroo mother care”, “kangaroo care” or “skin to skin care” from 1 January 1960 to 24 April 2014. Two independent reviewers screened articles and abstracted data.FindingsWe screened 1035 articles and reports; 299 contained data on KMC and neonatal outcomes or qualitative information on KMC implementation. Eighty–eight of the studies (29%) did not define KMC. Two hundred and eleven studies (71%) included skin–to–skin contact (SSC) in their KMC definition, 49 (16%) included exclusive or nearly exclusive breastfeeding, 22 (7%) included early discharge criteria, and 36 (12%) included follow–up after discharge. One hundred and sixty–seven studies (56%) described the duration of SSC.ConclusionsThere exists significant heterogeneity in the definition of KMC. A large number of studies did not report definitions of KMC. Skin–to–skin contact is the core component of KMC, whereas components such as breastfeeding, early discharge, and follow–up care are context specific. To implement KMC effectively development of a global standardized definition of KMC is needed.

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