Premature babies who were breastfed exclusively and kept warm through continuous skin-to-skin contact have become young adults with larger brains, higher salaries and less stressful lives than babies who received conventional incubator care, according to a study published this week.
The research, in the journal Pediatrics, compared 18- to 20-year-olds who, as premature and low birth-weight infants, were randomised at birth in Colombia to receive either traditional incubator care or kangaroo mother care.
That’s a technique where parents or caregivers become a baby’s incubator and its main source of food and stimulation until they can maintain their own body temperature.
It involves the baby nestling in a “kangaroo” position on the caregiver’s chest as soon as possible after birth, accompanied by exclusive breastfeeding.
Parent and child leave the hospital together as soon as possible after birth. Baby and mother are rigorously monitored for one year after the infant’s original due date (rather than the actual birth date).
Researchers investigated 264 kangaroo care participants who weighed less than 1.8kg at birth, and found the technique offered significant protection against early death.
The mortality rate among incubator-treated babies was 7.7%, more than double those in the kangaroo group (3.5%).
Almost every other area investigated revealed further advantages: the kangaroo group’s average hourly wages were nearly 53% higher; cerebral development was significantly higher; family life was more nurturing and protective; children spent more time in school and were less aggressive, hyperactive and stressed.
“This study indicates that kangaroo mother care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” said lead researcher Dr Nathalie Charpak of the Kangaroo Foundation in Bogotá.
“We firmly believe that this is a powerful, efficient, scientifically based healthcare intervention that can be used in all settings, from those with very restricted to unrestricted access to healthcare.”
According to the World Health Organisation, nearly one in 10 babies worldwide is born pre-term (before 37 completed weeks of gestation). Resulting birth complications are the leading cause of death among children under 5.
Pre-term birth rates are rising globally every year. More premature babies are born in low-income countries (9%) – where they face a greater risk of complications – than high-income countries (12%). In Malawi, 18 in every 100 births are pre-term.
Many survivors face a lifetime of disability, including learning disabilities, visual and hearing problems, and require extra care to avoid illness and death from secondary, preventable complications including hypothermia.
In developing countries, where incubators are often scarce and unreliable, kangaroo mother care could save lives, said Dr Peter Singer, chief executive officer of Grand Challenges Canada, which supported the research.
The study’s positive findings are impossible to attribute to one reason alone, said Charpak. Rather, they result from a multidisciplinary approach involving regular skin-to-skin contact, breastfeeding, education of the mother and family, and support over a 12-month follow-up period.
“One of our hypotheses is that, by placing the infant in the mother, father or caregiver’s chest, the infant’s brain is in a less stressful environment,” said Charpak.
Kangaroo care “also creates a climate in which the parents become progressively more aware of the child and more prone to sensitive caring.”
A pre-term baby born at 30 weeks could spend seven weeks in an incubator, separated from its mother and facing a steady stream of light and noise.
“It is easy to understand why this may not be the place for the baby’s immature brain to grow correctly,” she added.
Although a review of 21 randomised control trilals concluded kangaroo care significantly reduces mortality among pre-term babies and is a safe and effective alternative to conventional care, global use of the technique remains low.