Early Continuous Kangaroo Mother Care and Physiological Stabilisation of Preterm Infants: A Randomised Controlled Trial in a Tertiary Care Neonatal Unit

Abstract

Background: Complications of preterm birth are the leading cause of under-five mortality, and much of this burden follows physiological instability in the first days of life. The study evaluated whether early, continuous kangaroo mother care (KMC) improved physiological stabilisation of preterm infants compared with conventional care. Methods: In this single-centre, open-label randomised controlled trial, 180 preterm infants (30+0 to 33+6 weeks; 1200 to 1799 g) received either continuous KMC initiated within 2 hours of birth (target at least 16 hours per day) or incubator or radiant warmer care with KMC deferred until stabilisation. Vital parameters were recorded serially over 72 hours. The primary outcome was hypothermia within 72 hours. Results: Overall, 176 infants (88 per group) were analysed. Median daily skin-to-skin duration was 17.5 versus 2.0 hours. Hypothermia occurred in 20.5% of the KMC group and 51.1% of controls (relative risk 0.40, 95% CI 0.25 to 0.63; p < 0.001). The 6-hour stabilisation (SCRIP) score was higher with KMC (5.57 ± 0.34 versus 5.18 ± 0.57; p < 0.001) and median time to stabilisation shorter (8.8 versus 13.2 hours; p < 0.001). Group-by-time interactions were significant for temperature, heart rate, respiratory rate and oxygen saturation (p ≤ 0.008). KMC reduced hypoglycaemia, apnoea, escalation of respiratory support and sepsis, and shortened hospital stay by 4.1 days (p < 0.001). Mortality at 28 days did not differ significantly (2.3% versus 5.7%; p = 0.44). Conclusion: Early continuous KMC achieved faster and more sustained thermal and cardiorespiratory stabilisation of preterm infants than conventional care and should be the default mode of care from birth.

Keywords: Kangaroo mother care; skin-to-skin contact; preterm infant; physiological stability; hypothermia; neonatal intensive care