How ‘kangaroo’ care is saving the lives of thousands of babies every year
Dr Sheila Oyella’s fourth child was born 11 weeks premature. Weighing just three pounds and struggling to breathe and feed, the tiny newborn’s life was ebbing away.
Even as an experienced paediatrician, Dr Oyella, was not prepared for what was to come. One day she was working on a trial for pre-term baby care. The next day she was on the same ward, scared for her son’s life. She placed him on her chest. Amid the steady beat of his mother’s heart and her warmth, the boy began to stabilise.
This simple skin-to-skin technique is known as “kangaroo” care – and it saves thousands of babies lives each year. It seems like magic, but experts say it’s science.
Inspired by the way kangaroos hold their babies close, the method was first objectively tested by Colombian paediatrician Edgar Rey in 1978 and has since been provided to millions of newborns all over the world.
Researchers found the benefits of skin-to-skin contact include reduced deaths, through improved temperature regulation for the baby, with decreased risk of infections and a reduced likelihood of respiratory distress.
An estimated 13.4 million newborns are born pre-term each year. It is the leading cause of child deaths globally, accounting for more than one million under-five deaths, according to the World Health Organization (WHO).
The WHO recommends kangaroo care for all pre-term and low birthweight infants – but only after the dangerously vulnerable newborns have been clinically stabilised, usually in incubators where they are available.
Recently, researchers have been experimenting to see if the guidance for kangaroo care can be taken further for these vulnerable newborns – but with some unexpected results.
A new study from Uganda published in The Lancet found that starting kangaroo care before babies had been clinically stabilised didn’t reduce mortality in the first few days of an infant’s life, but it did save 14 per cent more lives over the first 28 days of life.
Prof Joy Lawn, Paediatrician & Perinatal Epidemiologist at London School of Health & Tropical Medicine (LSHTM) and senior author of the three-year Ugandan trial of 2,200 neonates from five government hospitals, said the trial was the first to show the cost effectiveness of implementing kangaroo care before newborns had been clinically stabilised.
“Fourteen per cent effect on mortality is a lot if you apply it to millions of vulnerable newborns around the world. This is an opportunity to really change the trajectory of neonatal survival, which is one of the most off-track global goals. But to get these gains, country governments and partners are going to have to invest.”
But how can something as simple as skin-to-skin contact be a better investment than a top of the range incubator?
“It’s not magic, it’s science,” said Prof Lawn, who said that the technique of kangaroo care is now used all over the world to improve the life chances and development of all newborns.
“This rightly places the family at the centre of care for their baby,” she said.
Even in the most sophisticated birthing facilities in Scandinavia tiny pre-term babies are better on their mothers’ chests than in incubators, albeit with all sorts of breathing and nutrition devices also attached.
The benefits, she said, came from several pathways. “Being skin-to-skin provides warmth, but also better supports breastmilk feeding, and protects the babies from infections, so they often go home earlier.”
The Ugandan trial combined kangaroo care with feasible neonatal care interventions – such as respiratory support when pre-term babies are struggling to breathe, and antibiotics to manage infections.
This trial found no significant mortality gains in the early days – which was a surprise – but a pooled 14 per cent uplift in neonatal survival rates over 28 days with kangaroo care.
The finding could be hugely important, especially for lower income countries which have limited highly intensive specialist equipment that adorn neonatal units in many western hospitals.
“This trial shows that there are actions we can take now to cut neonatal deaths, but kangaroo care is not a magic bullet. We still need more neo-natal nurses, more space and the basic devices, but together more focus on these interventions could start to change national survival progress in many countries, especially across Africa” said Prof Lawn, who herself almost died at birth in Northern Uganda.
“Wherever you are in the world, if you are born very pre-term, it’s actually better to be skin-to-skin with your mother”.
Despite the improving child and maternal mortality rates around the world, there is slower progress for neonatal survival and marked disparities between low and high-income countries.
Over 90 per cent of extreme pre-term babies (born before 28 weeks) will survive in high-income settings, compared to less than 10 per cent in low-income nations, according to WHO’s Born Too Soon Report, co-led by Prof Lawn.
Kangaroo care was cheaper than current standard care but harnessing its full benefits in lower income countries would still investment, said Prof Lawn.
It was found to be especially important to invest in infrastructure such as showers that would make mothers comfortable as caring for a baby on your chest for weeks, sometimes months on end was an intensive ask, she said.
A major and recurring issue was the mental and physical toll that the small and sparsely equipped hospital rooms without proper facilities had on women, and also on nurses and doctors.
Mothers in the study were discharged from hospital often within days with their vulnerable newborn but ensuring they were supported at home was equally important.
“The mother is not an intervention on her own,” said Prof Lawn. “The mother needs respect. She needs a room with beds, you can’t expect her to do 12 to 18 hours of kangaroo care without showers. The carer also needs care.”
Dr Oyella’s son is now a healthy five-year-old boy.
“In the beginning it was quite hard, but by the time I was leaving, I actually requested discharge. We all became confident at that point. The father came in and he was there to help me provide kangaroo care,” she said.
“I felt confident enough to look after my baby at home in terms of feeding, providing warmth and picking any danger signs earlier now.”
Having benefited from Kangaroo care personally, Dr Oyella now recommends it for all pre-term newborns she cares for. “Moving forward we need physical space for small and sick newborns in all the [maternity] facilities that actually handle deliveries,” she said.
“Many times you find there is not even one kangaroo care bed.”
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