Mother-Newborn Care Unit (MNCU) Experience in India: A Paradigm Shift in Care of Small and Sick Newborns

Abstract

While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the “mother–newborn care unit (MNCU).” Mother–newborn care unit or mother–newborn intensive care unit (M–NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24 × 7, making the concept of zero-separation a reality.

Mother-newborn couplet care: Nordic country experiences of organization, models and practice

“…While the natural condition is for a newborn infant to stay in close physical contact with their mother after birth, separation is still common when newborns need specialized care [ 2 ]. There is however, an increasing awareness of and evidence for the importance of keeping parents and infants together after birth and integrating medical technology and pharmaceutical treatments with caregiving that ensures parent-infant closeness [ 3 – 6 ]. The vision of non-separation of the mother-newborn dyad is stressed in the new World Health Organization (WHO) recommendations for care of the preterm or low-birthweight infant and supported by several meta-analyses.…”

“…Recently, the immediate KMC Study, a large multinational randomized controlled trial (RCT) in low- and middle-income countries demonstrated a mortality reduction of 25 percent in the group of immediate skin-to-skin contact and non-separation compared to conventional care in very low birth-weight infants [ 6 , 10 ]. Several trials in high-resource settings have demonstrated the benefits of keeping mothers and their infants physically and emotionally close even after very preterm or complicated births.…”

A Narrative Review of Kangaroo Mother Care (KMC) and Its Effects on and Benefits for Low Birth Weight (LBW) Babies

“…KMC entails infant and direct and ongoing skin-to-skin contact between mother and child. It aids in the prevention of growth retardation, the improvement of weight gain, and the reduction of infection [ 25 ]. In neonatal care facilities, unwell and young babies receive treatment in the NICU, which is staffed 24 hours a day, seven days a week [ 26 ].…”

Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial

“…MNCU is a facility where sick and small neonates are cared for with their mothers, with all facilities of level 2 newborn care and provision for postnatal care to mothers (Mother-Newborn Couplet Care). 3 The mother has her bed inside the Newborn Intensive Care Unit (NICU) and stays there day and night unlike conventional NICUs where mothers visit intermittently. When mother was not available, iKMC was provided by another person (surrogate) designated by the parents.…”