The effect of early intermittent Kangaroo mother care on neonatal mortality, morbidity and weight gain in stable low birth weight infants

Abstract

Kangaroo Mother Care (KMC) is a safe and effective alternative to conventional neonatal care of Low Birth Weight (LBW) infants. Continuous KMC can reduce neonatal morbidity and mortality in LBW infants as well as improve neonatal growth. The typical practice of KMC involves intermittent Skin to Skin Contact (SSC). There is limited data on the effectiveness of intermittent KMC in reducing neonatal mortality and morbidity and increasing weight gain in LBW infants. The aim of the study was to assess the effect of early intermittent KMC in improving the health status of stable LBW infants in terms of reduced morbidity and mortality and improved neonatal weight gain. A clustered quasi-experimental study was done with Pumwani Maternity Hospital as the intervention site and both Thika and Machakos Level 5 Hospitals as the control sites. The study composed of 171 KMC infants and 172 control infants weighing ≤2000 grams. The KMC infants received early (within 72 hours after birth) intermittent KMC for a cumulative period of eight hours a day. When not on KMC, they were placed in incubators for warmth. The infants in the control sites received the conventional neonatal care. Data was collected through baseline and exit questionnaires and by abstraction from patient files between July 2016 and June 2017. The mean birth weight among infants in the intervention group was 1555.4 (SE=20.8) grams while the mean birth weight among infants in the control group was 1430.1 (SE=20.2) grams. There were more female, 205 (59.8%) than male infants. The study outcome measures were neonatal mortality, morbidity, weight changes and duration of hospital stay. There were few neonatal deaths in the intervention group but this reduction was not statistically significant (p>0.05).The intervention reduced the risk of neonatal morbidity among stable LBW infants by 33% (RR=0.67, p<0.0001) and significantly shortened the duration of hospital stay (t (304) 14.5009, p<0.0001). It had a significantly higher mean weight gain during the neonatal period (t (302) 7.2, p<0.0001). Several factors that could be associated with neonatal mortality and morbidity were identified and controlled for through multiple logistic regression. There was a significant association between incidence of neonatal mortality with Non-Communicable Diseases (NCD) (aOR=4.7, p=0.048), birth weight (aOR=0.997, p=0.043), gestational age (aOR=0.72, p=0.005), multiple births (aOR=7.6, p=0.001) and household income (reference category was <6000 KES; 6000 to 15000, aOR=0.22; >15000, aOR=0.15, p=0.038).The regression analysis showed that there was a significant association between incidence of neonatal morbidity with intermittent KMC (aOR=0.26, p=0.001), infant sex (males, OR=2.6, p=0.003), birth complications (aOR=2.1, p=0.001), access to toilet (OR=0.53, p=0.037), place of delivery (reference category was study hospital; another hospital, OR=1.6; home, OR=0.3, p=0.009), birth weight (OR=0.997, p<0.0001), gestational age (OR=0.935, p=0.021) and NCD (OR=11.6, p=0.029). In conclusion, the intervention was effective in reducing neonatal morbidity and improving weight gain during the neonatal period. Recommendations were made to the Ministry of Health to prepare guidance on the implementation of early intermittent KMC for LBW infants and the County health department to implement the intervention. Further research was recommended on evaluating the effect of increased duration of SSC in reducing neonatal mortality.