Effectiveness of Kangaroo Mother Care in Reducing Mortality and Improving Clinical Outcomes among Preterm and Low-Birth-Weight Neonates: An Overview of Systematic Reviews and Meta-Analyses
Keywords:
Kangaroo-Mother Care Method, Infant, Premature, Infant, Low Birth Weight, Infant Mortality, Neonatal Sepsis, Hypothermia, Breast Feeding, Umbrella ReviewAbstract
Background: Preterm birth and low birth weight (LBW) remain leading causes of neonatal death worldwide. Kangaroo mother care (KMC), which combines prolonged skin-to-skin contact with exclusive or near-exclusive breast-milk feeding, is recommended by the World Health Organization for all preterm and LBW infants, yet its uptake in routine care remains uneven. Aim: To synthesise evidence from systematic reviews and meta-analyses on the effect of KMC on mortality and major clinical outcomes in preterm and LBW neonates, and to consider the implications for neonatal nursing. Design: Overview of systematic reviews (umbrella review). Methods: PubMed/MEDLINE, Embase, CINAHL, Scopus and the Cochrane Library were searched for systematic reviews with meta-analysis published between January 2016 and [July 2026]. Methodological quality was appraised with AMSTAR 2. Because the included reviews shared many primary trials, effect estimates (risk ratios [RR] or odds ratios [OR] with 95% confidence intervals [CI]) were synthesised narratively rather than re-pooled. Reporting follows the PRIOR statement. Results: Six systematic reviews were included. In the largest review (31 randomised trials; 15,559 infants), KMC reduced mortality during birth hospitalisation or by 28 days compared with conventional care (RR 0.68, 95% CI 0.53–0.86; high certainty), probably reduced severe infection (RR 0.85, 0.79–0.92) and reduced hypothermia (RR 0.32, 0.19–0.53). A 2025 review of hospital-initiated KMC (29 trials; 17,513 infants) found lower odds of death (OR 0.77, 0.67–0.89), sepsis (OR 0.55, 0.37–0.82) and invasive infection (OR 0.49, 0.33–0.74). Initiation within 24 hours of birth reduced neonatal mortality compared with later initiation (RR 0.77, 0.66–0.91) and was associated with more breastfeeding at discharge. In very preterm and very-low-birth-weight infants, early KMC reduced mortality (RR 0.81, 0.67–0.98; four trials), although data for infants below 1,000 g or 28 weeks remain sparse. The mortality benefit was greater when skin-to-skin contact lasted at least eight hours a day. Conclusion: Evidence from several independent systematic reviews consistently shows that KMC improves survival and reduces infection and hypothermia in preterm and LBW infants, with the largest benefit when it is started early and maintained for long periods each day. Nurses are central to its delivery, and neonatal units should treat KMC as standard care rather than an optional adjunct.
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