In this form of care, first tested in Colombia, the "mother of a preemie puts the baby on her exposed chest, dressed only in a diaper and sometimes a cap, in an upright or semi-upright position. The baby is strapped in by a scarf or other cloth sling supporting its bottom, and all but its head is covered by mom’s shirt. The mother keeps the baby like that, skin-to-skin, as much as possible, even sleeping in a reclining chair. Fathers and other relatives or friends can wear the baby as well to give the mother a break. Even very premature infants can go home with their families (with regular follow-up visits) once they are stable and their mothers are given training.
"The babies stay warm, their own temperature regulated by the sympathetic biological responses that occur when mother and infant are in close physical contact. The mother’s breasts, in fact, heat up or cool down depending on what the baby needs. The upright position helps prevent reflux and apnea. Feeling the mother’s breathing and heartbeat helps the babies to stabilize their own heart and respiratory rates. They sleep more. They can breastfeed at will, and the constant contact encourages the mother to produce more milk. Babies breastfeed earlier and gain more weight."
The process facilitates bonding between mother and child, and it is reported "leads to lower rates of abandonment of premature infants."
"A trial in a Bogota hospital of 746 low birth weight babies randomly assigned to either kangaroo or conventional incubator care found that the kangaroo babies had shorter hospital stays, better growth of head circumference and fewer severe infections. They had slightly better rates of survival, but the difference was not statistically significant. Other studies have found fewer differences between kangaroo and conventional methods. A conservative summary of the evidence to date is that kangaroo care is at least as good as conventional treatment — and perhaps better."
The method was tested in "(t)he Manama Mission Hospital in southwest Zimbabwe (which) had available only antibiotics and piped oxygen in its neonatal unit. Survival rates for babies born under 1500 grams (3.3 lbs.) improved from 10 percent to 50 percent when kangaroo care was started in the 1980s. In 2003, the World Health Organization put kangaroo care on its list of endorsed practices."
When I worked in Cali, Colombia in the early 1970s, people there were already experimenting with alternative forms of medical care, showing in some cases that simple, affordable approaches not only saved money but had better outcomes for the patients.
There were a couple of things I liked about this story, in addition to the obvious fact that kangaroo care is going to save a lot of lives in the coming years. First, note that a randomized case-control study using objective measures was done to test the utility of kangaroo care. The data on the efficacy of the treatment were judged to be sufficiently trustworthy that kangaroo care is being adopted for some infants in the United States, even where expensive incubators and medical staff are available.
Second, data are also being collected on the effectiveness of the approach when it is applied in large scale in another country. Not all technology works everywhere, and intuition is not always reliable in judging whether a technique will transfer.
Third, I like the fact that kangaroo care is simply a technique for patient (and family) care. It does not involve either drugs or machines. On the other hand, it is not a "simple" technique, in the sense that it has a lot of medical insight and objective epidemiological evidence behind it. It is nice to see people thinking about better ways to do things, finding a candidate approach, and then using effective methods to verify its utility.
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