Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

Abstract

Background: In a randomized controlled trial (RCT) with 8402 stable low birthweight (LBW) infants, majority being late preterm or term small for gestational age, community-initiated KMC (ciKMC) showed a significant improvement in survival. However, the effect of ciKMC on neurodevelopment is unclear. This is important to elucidate as children born with low birth weight are at high risk of neurodevelopmental deficits. In the first 552 stable LBW infants enrolled in the above trial, we evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy. Method: This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500-2250 g at birth. The intervention comprised of promotion of skin-to-skin contact and exclusive breastfeeding by trained intervention delivery team through home visits. The intervention group mother-infant-dyads were supported to practice ciKMC till day 28 after birth or until the baby wriggled-out. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers. Cognitive, language, motor and socio-emotional outcomes were assessed at infant-ages 6-and 12-months using Bayley Scale of Infant Development (BSID-III). Other outcomes measured were infant temperament, maternal depression, maternal sense of competence, mother-infant bonding and home-environment. We performed post-hoc equivalence testing using two one-sided tests of equivalence (TOST) to provide evidence that ciKMC does not do harm in terms of neurodevelopment. Results: In the intervention arm, the median (IQR) time to initiate ciKMC was 48 (48 to 72) hours after birth. The mean (SD) duration of skin-to-skin-contact was 27.9 (3.9) days with a mean (SD) of 8.7 (3.5) hours per day. We did not find significant effect of ciKMC on any of the child developmental outcomes during infancy. The TOST analysis demonstrated that composite scores for cognitive, language and motor domains at 12 months among the study arms were statistically equivalent.

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

“…A Cochrane review by Conde-Agudelo et al in 2011 found that infants who received KMC had reduced infection rates, increased breastfeeding, better infant growth as demonstrated by increased head circumference and improved mother-infant attachment [ 43 ]. On the other hand, community KMC did not have an effect on infants’ neurodevelopmental outcomes in India [ 45 ], probably due to late initiation following birth.…”

Home Intervention For Mother And Premature Infant: A Literature Review

“…The health education given to mothers with premature babies is about knowledge and skill about the concept of prematurity, skin to skin contact with kangaroo mother care, breastfeeding premature babies, exclusive breastfeeding, management of premature babies after discharged from hospital, effective parenting strategies, and about parental coping. It also provided knowledge related to premature babies about how to recognize baby stress signs, facial expressions, quality of motor behavior, posture and muscle tone, how to provide stimulation, how to prevent babies from excessive stimulation, touch, movement, massage and multi sensory stimulation (12)(13)(14)(15)(16).…”

“…Health workers also carried out care for premature babies with the aim of stabilizing their body temperature by checking the baby's body temperature and practicing KMC during home visits with mother and family (12,28). KMC is useful for attaching emotion between mothers and premature babies and also maintaining the baby's body temperature to normal (the same as the mother's body temperature) because the mother can transfer her body temperature to the baby.…”

Home Intervention For Mother And Premature Infant: A Literature Review

“…The health education given to mothers with premature babies is about knowledge and skill about the concept of prematurity, skin to skin contact with kangaroo mother care, breastfeeding premature babies, exclusive breastfeeding, management of premature babies after discharged from hospital, effective parenting strategies, and about parental coping. It also provided knowledge related to premature babies about how to recognize baby stress signs, facial expressions, quality of motor behavior, posture and muscle tone, how to provide stimulation, how to prevent babies from excessive stimulation, touch, movement, massage and multi sensory stimulation (14,18,(20)(21)(22).…”

“…Health workers also carried out care for premature babies with the aim of stabilizing their body temperature by checking the baby's body temperature and practicing KMC during home visits with mother and family (20,38). KMC is useful for attaching emotion between mothers and premature babies and also maintaining the baby's body temperature to normal (the same as the mother's body temperature) because the mother can transfer her body temperature to the baby.…”