TABLE 36.

KMC

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Cattaneo et al731Ethiopia, Indonesia, and Mexico; multicenter urban hospital setting; RCT149 LBW neonates were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 LBW neonates to conventional methods of care (warm room or incubator care).Overall scores on mother's sense of competence were better in the KMC than in the control group (weighted mean difference: 0.31; CI: 0.13–0.50) On the other hand, overall scores on mother's perception of social support during the infant's stay in the NICU were worse in the KMC group than in the control group (weighted mean difference −0.18; CI: −0.35 to −0.01).Lower rates of not exclusively breastfeeding were recorded at discharge (RR 0.41; CI: 0.25–0.68).
Charpak et al582*Colombia; urban hospital setting; RCTIn an urban tertiary hospital, 746 newborns were randomized to receive either KMC (n = 382) or traditional care (n = 364).Significantly lower rates of nosocomial infection (OR: 0.49; CI: 0.25–0.93) and severe illness at 6 mo follow-up were found in the KMC group. The risk of dying was similar in both groups (RR = 0.59; CI: .22–1.6), and no differences were found in growth indices. Hospital stay after eligibility was shorter in the KMC group, primarily for infants ≤1800 g.
Sloan et al732Ecuador; urban hospital setting; RCT300 newborns were randomized to KMC (n = 140) or incubator/thermal cot care (n = 160).Trial was stopped early because of a significantly lower rate of severe morbidity in the KMC group (P < .005 at 6 mo).
Charpak et al583*Colombia; urban hospital setting; RCTA group of 746 newborns were randomized when eligible for minimum care, into KMC (n = 382) and “traditional” care (n = 364). Information on vital status was available for 93% of infants at 12 mo of corrected age. KMC consisted of skin-to-skin contact on mother's chest 24 h/d, nearly exclusive breastfeeding, and early discharge, with close ambulatory monitoring. Controls remained in incubators until the usual discharge criteria were met.There was a “trend” toward lower risk of death among the KMC group, although the result was not significant (KMC: 11 [3.1%] of 339 infants died; control: 19 [5.5%] of 324 infants died; RR: 0.57; CI: 0.17–1.1). Growth index of head circumference was significantly greater in the KMC group, but the developmental indices of both groups were similar. Infants weighing ≤1500 g at birth and given KMC spent less time in the hospital then the group given standard care. There were similar numbers of infections in both groups, but infections in the KMC group were of lesser severity.
Ramanathan et al588India; urban hospital setting; RCT28 neonates with birth weights <1500 g were randomized into 2 groups, 1 receiving KMC and 1 receiving incubator care. The KMC group (n = 14) received KMC for 4 h per day in not more than 3 sittings. Infants received KMC after shifting from NICU and at home. Control infants received standard care. A Likert scale was used to assess mothers'/nurses' attitudes towards KMC.The number of mothers exclusively breastfeeding at 6-wk follow-up was double in the KMC as compared to the control group (12/14 [86%] vs 6/14 [43%], respectively; P < .05).KMC neonates demonstrated better weight gain after the first week of life (15.9 ± 4.5 g/d vs 10.6 ± 4.5 g/d in the KMC and control groups, respectively; P < .05) and earlier hospital discharge (27.2 ± 7 vs 34.6 ± 7 d in KMC and control groups, respectively, P < .05).
Kambarami et al730Zimbabwe; urban hospital setting; RCT74 infants (37 in each of 2 groups) were consecutively allocated to receive either KMC or incubator care.KMC infants gained twice as much weight per day (20.8 vs 10.2 g; P = .0001); had shorter stays in the hospital (16.6 vs 20.7 d; P = .0457); and had a better survival rate (0% vs 9% deaths; sample size too small for significance).
Lincetto et al731*Mozambique; urban hospital setting; PCS2 cohorts of LBW (<2000 g) infants (n = 246) were enrolled. The first cohort (n = 149) was selected during the cold season and a second cohort (n = 122) was enrolled in the hot season. The intervention encouraged KMC at home. In 64%, routine follow-up exams after discharge were performed until infants reached a weight of 2500 g.No seasonal differences in weight gain or the risk of complications were found in infants treated with KMC in the hospital. Risk of serious complications, including death (RR: 1.96; P = .02) and readmission (RR: 2.77; P = .04), was higher after discharge in the colder season because of mother's incomplete compliance with KMC and exposure to low temperatures.
Bergman585Zimbabwe; mission hospital setting; PCSKMC was introduced as the exclusive means of treating LBW infants (n = 126), without incubators and standard equipment for care of LBW neonates. Survival with KMC were compared to hospital survival data prior to the intervention, from 1983 to 1987.The survival of babies born <1500 g improved from 10% to 50%, whereas that of infants 1500–1999 g improved from 70% to 90%. Overall survival rate was 63%.
Christensson et al475Zambia; urban university hospital NICU; RCT80 consecutive low-risk hypothermic infants with admission weight of >1500 g admitted in the NICU were randomly assigned treatment with skin-to-skin (STS) care by the mother (n = 41) or in an incubator (n = 39).At 240 min, 90% of babies in STS group reached normal temperature (37.1–37.2°C), compared with 60% in the incubator group (P < .0001).
Lincetto et al586*Mozambique; provincial hospital setting; PCSKMC for LBW infants (n = 32) was introduced with limited resources and without an intensive care unit. Care included post-discharge follow-up visits to all infants <1800 g. Mothers of infants in the intervention group (n = 22) were taught skin-to-skin care and asked to observe other mothers to facilitate compliance. Control infants (n = 10) were given standard non-KMC care in the maternity ward.Out of 32 LBW infants (<1800 g) admitted in 3 mo, survival was 73% in KMC and 20% in non-KMC infants (P < .01).
Charpak et al584Colombia; 2 tertiary care hospitals, 1 offering traditional care and the other KMC; PCS332 newborns weighing <2000 g and eligible for care in the minimal care unit were enrolled in either of 2 groups: 1 receiving KMC (n = 162), and 1 control group (n = 170). KMC infants eligible for MCU were discharged regardless of gestational age or weight, were kept 24 h/d in an upright position, attached to the mother's chest and receiving skin-to-skin contact until KMC was not tolerated anymore. Control babies from another facility were kept in incubators until they were discharged. Both groups were followed periodically up to the age of 1 y.RR of death was found to be higher in KMC infants (RR: 1.9), though the reverse was found after adjusting for weight at birth and gestational age (RR: 0.5). There were no significant differences in overall mortality rates among the 2 groups. KMC infants grew less in first 3 mo and had a higher proportion of developmental delay at 1 y.
  • * Data are from the same trial.