# Immediate kangaroo mother care Intervention · id `maternal:immediate-kmc` · Maternal & Newborn Atlas · release `15708f235d73cd42` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, life stage: Newborn ## In plain language Starting skin-to-skin care within hours of birth, even before a small baby is fully stable, with the mother staying in the newborn unit. ## Technical summary KMC started as soon as possible after birth, before clinical stabilization. WHO's evidence review counts KMC started within 24 hours of birth as early. In the iKMC trial it was delivered in a Mother-NICU. ## Claims, with the population each applies to ## Context: Liveborn infants weighing 1.0 to under 1.8 kg at birth in five tertiary hospitals in sub-Saharan Africa and India (iKMC trial) Recipient: Newborn; Population: Liveborn infants with a birth weight of 1.0 to under 1.8 kg (abstract: "between 1.0 and 1.799 kg"), of any gestational age, singleton or twin, by any mode of delivery, enrolled with their mothers within 2 hours of birth. About 20% of infants in this weight band born in the study hospitals were not enrolled because mother or newborn was too sick.; Care setting: Tertiary hospitals. Intervention infants: a Mother-NICU (a neonatal intensive care unit with beds for mothers), then a KMC ward. Control infants: the NICU without the mother, then a KMC ward after stabilization.; Geography: Ghana (Kumasi), India (New Delhi), Malawi (Blantyre), Nigeria (Ile-Ife) and Tanzania (Dar es Salaam); cities per ANZCTR. The ICTRP mirror of the CTRI record does not name the fifth country; it lists it only as other.; Life stage: Neonatal period; Gestational age: Any, not restricted; Postnatal age: 0 days to 0 days; Follow-up: From enrolment to 28 days of age, with a home visit on day 29. The second primary outcome window was enrolment to 72 hours. ### In the iKMC trial, babies weighing 1.0 to under 1.8 kg at birth who started continuous skin-to-skin care with their mother within hours of birth were less likely to die in their first 28 days than babies who started it only after they were stable. 191 of 1596 babies died in the immediate group and 249 of 1587 in the control group (adjusted risk ratio 0.75, 95% CI 0.64 to 0.89). - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Newborn; Population: Liveborn infants with a birth weight of 1.0 to under 1.8 kg (abstract: "between 1.0 and 1.799 kg"), of any gestational age, singleton or twin, by any mode of delivery, enrolled with their mothers within 2 hours of birth. About 20% of infants in this weight band born in the study hospitals were not enrolled because mother or newborn was too sick.; Care setting: Tertiary hospitals. Intervention infants: a Mother-NICU (a neonatal intensive care unit with beds for mothers), then a KMC ward. Control infants: the NICU without the mother, then a KMC ward after stabilization.; Geography: Ghana (Kumasi), India (New Delhi), Malawi (Blantyre), Nigeria (Ile-Ife) and Tanzania (Dar es Salaam); cities per ANZCTR. The ICTRP mirror of the CTRI record does not name the fifth country; it lists it only as other.; Life stage: Neonatal period; Gestational age: Any, not restricted; Postnatal age: 0 days to 0 days; Follow-up: From enrolment to 28 days of age, with a home visit on day 29. The second primary outcome window was enrolment to 72 hours. - Limitations: One trial in five tertiary hospitals in low- and middle-income countries, with an open-label design. It stopped early for benefit before reaching its target of 4200 infants. About 20% of infants in the eligible weight band were not enrolled because mother or baby was too sick. The authors say the effect of starting early cannot be separated from the mother's continuous presence (author manuscript, Discussion para 5), and that applicability to low-mortality, high-resource settings is untested (author manuscript, Discussion para 3). The per-arm denominators (1596 and 1587) are smaller than the numbers randomized (1609 and 1602). They come from the author manuscript's Table 3 only, its text does not state their basis, and they were not checked against the version of record. - Last checked: Not recorded - Sources: 1. Supports: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Abstract, RESULTS, sentence 3: "relative risk of death, 0.75; 95% confidence interval \[CI\], 0.64 to 0.89; P = 0.001". Retrieved 2026-10-09T15:56:27Z. Source state: Current. Snapshot hash: 5dde5eaa4d684f398f7f3cfab05816eb73207b8adbaac5c4163e7e480567ecf6. How it applies: Abstract of the primary report, for the same infants and time window as this context. 2. Supports: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, row "Death between enrolment and 28 days of age": "191/1596 (12.0%)" and "249/1587 (15.7%)". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: Author accepted manuscript (CC BY 4.0); not checked against the version of record. 3. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, column header: "Adjusted RR (95%CI)". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: The ratios are adjusted, not crude; see the Table 3 footnote. 4. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Discussion, para 5: "20% of infants 1.0 to <1.8 kg born in study hospitals were not enrolled because mother or newborn was too sick". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: Limits who the result describes. ### In the first 72 hours, 74 of 1606 babies died with immediate skin-to-skin care and 92 of 1599 with the control approach (adjusted risk ratio 0.77, 95% CI 0.58 to 1.04). The interval includes no difference, so the trial did not show a clear effect in this window. - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Newborn; Population: Liveborn infants with a birth weight of 1.0 to under 1.8 kg (abstract: "between 1.0 and 1.799 kg"), of any gestational age, singleton or twin, by any mode of delivery, enrolled with their mothers within 2 hours of birth. About 20% of infants in this weight band born in the study hospitals were not enrolled because mother or newborn was too sick.; Care setting: Tertiary hospitals. Intervention infants: a Mother-NICU (a neonatal intensive care unit with beds for mothers), then a KMC ward. Control infants: the NICU without the mother, then a KMC ward after stabilization.; Geography: Ghana (Kumasi), India (New Delhi), Malawi (Blantyre), Nigeria (Ile-Ife) and Tanzania (Dar es Salaam); cities per ANZCTR. The ICTRP mirror of the CTRI record does not name the fifth country; it lists it only as other.; Life stage: Neonatal period; Gestational age: Any, not restricted; Postnatal age: 0 days to 0 days; Follow-up: From enrolment to 28 days of age, with a home visit on day 29. The second primary outcome window was enrolment to 72 hours. - Limitations: One trial in five tertiary hospitals in low- and middle-income countries, with an open-label design. It stopped early for benefit before reaching its target of 4200 infants. About 20% of infants in the eligible weight band were not enrolled because mother or baby was too sick. The authors say the effect of starting early cannot be separated from the mother's continuous presence (author manuscript, Discussion para 5), and that applicability to low-mortality, high-resource settings is untested (author manuscript, Discussion para 3). Fewer deaths in this window make the estimate less precise. The per-arm denominators (1606 and 1599) come from the author manuscript's Table 3 only, its text does not state their basis, and they were not checked against the version of record. - Last checked: Not recorded - Sources: 1. Supports: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Abstract, RESULTS, sentence 3: "relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P = 0.09". Retrieved 2026-10-09T15:56:27Z. Source state: Current. Snapshot hash: 5dde5eaa4d684f398f7f3cfab05816eb73207b8adbaac5c4163e7e480567ecf6. How it applies: Abstract of the primary report, for the same infants and time window as this context. 2. Supports: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, row 2 (death between enrolment and 72 hours of age): 74/1606 (4.6%) and 92/1599 (5.8%). Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: Author accepted manuscript (CC BY 4.0); not checked against the version of record. 3. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, column header: "Adjusted RR (95%CI)". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: The ratios are adjusted, not crude; see the Table 3 footnote. 4. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Discussion, para 5: "20% of infants 1.0 to <1.8 kg born in study hospitals were not enrolled because mother or newborn was too sick". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: Limits who the result describes. ### Fewer babies in the immediate skin-to-skin group had a recorded low temperature (under 36 °C at the armpit) during their hospital stay: 90 of 1609 versus 133 of 1602 (adjusted risk ratio 0.65, 95% CI 0.51 to 0.83). - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Newborn; Population: Liveborn infants with a birth weight of 1.0 to under 1.8 kg (abstract: "between 1.0 and 1.799 kg"), of any gestational age, singleton or twin, by any mode of delivery, enrolled with their mothers within 2 hours of birth. About 20% of infants in this weight band born in the study hospitals were not enrolled because mother or newborn was too sick.; Care setting: Tertiary hospitals. Intervention infants: a Mother-NICU (a neonatal intensive care unit with beds for mothers), then a KMC ward. Control infants: the NICU without the mother, then a KMC ward after stabilization.; Geography: Ghana (Kumasi), India (New Delhi), Malawi (Blantyre), Nigeria (Ile-Ife) and Tanzania (Dar es Salaam); cities per ANZCTR. The ICTRP mirror of the CTRI record does not name the fifth country; it lists it only as other.; Life stage: Neonatal period; Gestational age: Any, not restricted; Postnatal age: 0 days to 0 days; Follow-up: From enrolment to 28 days of age, with a home visit on day 29. The second primary outcome window was enrolment to 72 hours. - Limitations: Secondary outcome. Its confidence interval is not adjusted for multiplicity, and the authors say such intervals should not be used to infer definitive effects. Temperatures were measured in an open-label trial. The trial's hypothermia definition differs from other studies. One trial in five tertiary hospitals in low- and middle-income countries, with an open-label design. It stopped early for benefit before reaching its target of 4200 infants. About 20% of infants in the eligible weight band were not enrolled because mother or baby was too sick. The authors say the effect of starting early cannot be separated from the mother's continuous presence (author manuscript, Discussion para 5), and that applicability to low-mortality, high-resource settings is untested (author manuscript, Discussion para 3). - Last checked: Not recorded - Sources: 1. Supports: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, hypothermia row: "90/1609 (5.6%) 133/1602 (8.3%) 0.65 (0.51–0.83)". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: Author accepted manuscript (CC BY 4.0); not checked against the version of record. 2. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, footnote 1: "Any instance of axillary temperature <36ºC at any time from 2 hours after randomization until discharge from hospital.". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: The trial's own hypothermia definition. 3. Background: Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485.) Locator: Table 3, footnote dagger: "The 95% confidence intervals for secondary outcomes are not adjusted for multiplicity and should not be used to infer definitive intervention effects.". Retrieved 2026-10-09T15:57:07Z. Source state: Current. Snapshot hash: 0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac. How it applies: The authors' own caution on this secondary outcome. ## Context: Preterm or low-birth-weight infants (WHO 2022 guideline population) Recipient: Newborn; Population: Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.; Care setting: Health-care facility or home. The A.1b remarks give separate conditions for each.; Geography: Global (WHO guideline; the setting text says "any country or setting"); Life stage: Newborn, from birth; Gestational age: Not reported; Postnatal age: at least 0 days; Follow-up: Not applicable (recommendation context) ### WHO recommends starting kangaroo mother care as soon as possible after birth for babies who are born early or small (preterm or low-birth-weight infants). WHO rates this a strong recommendation based on high-certainty evidence. - Category: Recommendation - Evidence stage: Guidance - Certainty: High certainty (method: GRADE, as stated by WHO in the 2022 guideline for recommendation A.1b) - Applies to: Recipient: Newborn; Population: Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.; Care setting: Health-care facility or home. The A.1b remarks give separate conditions for each.; Geography: Global (WHO guideline; the setting text says "any country or setting"); Life stage: Newborn, from birth; Gestational age: Not reported; Postnatal age: at least 0 days; Follow-up: Not applicable (recommendation context) - Limitations: The population, all preterm or low-birth-weight infants, is broader than any single trial. In facilities, the remarks exclude infants who cannot breathe spontaneously after resuscitation, are in shock or need mechanical ventilation. The PDF prints the strength parenthetical twice in succession. The GRADE evidence tables are in a web supplement that was not fetched. - Last checked: Not recorded - Sources: 1. Supports: WHO recommendations for care of the preterm or low-birth-weight infant (Guideline, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.) Locator: Recommendation A.1b, PDF p. 25 (printed p. 12): "Kangaroo mother care (KMC) for preterm or low-birth-weight infants should be started as soon as possible after birth.". Retrieved 2026-10-09T15:58:39Z. Source state: Current. Snapshot hash: 650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532. How it applies: WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution. 2. Supports: WHO recommendations for care of the preterm or low-birth-weight infant (Guideline, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.) Locator: Recommendation A.1b, PDF p. 25, printed twice in succession: "(Strong recommendation, high-certainty evidence)". Retrieved 2026-10-09T15:58:39Z. Source state: Current. Snapshot hash: 650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532. How it applies: The strength and certainty as WHO states them. 3. Background: WHO recommendations for care of the preterm or low-birth-weight infant (Guideline, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.) Locator: A.1 Remarks, Immediate KMC, PDF p. 25: "immediate KMC can be initiated before the infant is clinically stable". Retrieved 2026-10-09T15:58:39Z. Source state: Current. Snapshot hash: 650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532. How it applies: Applies in facilities. 4. Background: WHO recommendations for care of the preterm or low-birth-weight infant (Guideline, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.) Locator: A.1 Remarks, Immediate KMC, PDF p. 25: "unless the infant is unable to breathe spontaneously after resuscitation, is in shock or needs mechanical ventilation". Retrieved 2026-10-09T15:58:39Z. Source state: Current. Snapshot hash: 650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532. How it applies: Facility exceptions. 5. Background: WHO recommendations for care of the preterm or low-birth-weight infant (Guideline, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.) Locator: Chapter 2, Box 2.1, PDF p. 22 (printed p. 9): "A “strong recommendation” if the intervention is applicable to all preterm or low-birth-weight infants". Retrieved 2026-10-09T15:58:39Z. Source state: Current. Snapshot hash: 650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532. How it applies: Defines WHO's strength labels for this guideline. ## Guidance, authorization and access ### Recommendation `maternal:rec-who-2022-a1b` - Intervention: Immediate kangaroo mother care (`maternal:immediate-kmc`) - Direction: Recommended - Issued by: World Health Organization (`maternal:who`) - Guideline: WHO recommendations for care of the preterm or low-birth-weight infant, edition 2022. Electronic ISBN 978-92-4-005826-2; print ISBN 978-92-4-005827-9. The who.int page shows 15 November 2022 and the WHO IRIS record 10665/363697 lists an issue date of 2022-10-21; both are kept, and the decisions use the who.int date.; snapshot `maternal:who-9789240058262-pdf-2026-10-09` - Jurisdiction: Global (WHO guidance intended to inform national and subnational policy, per the WHO publication page) - Strength: Strong recommendation (WHO guideline method with GRADE. Box 2.1 (PDF p. 22, printed p. 9) defines a strong recommendation, a conditional recommendation and a good practice statement, with certainty rated high, moderate, low or very low.) - Effective: 2022-11-15 (The who.int page date, 15 November 2022 (2022-11-15), is the effective date under the atlas rule for WHO decisions. The WHO IRIS record lists an issue date of 2022-10-21. Both dates are kept.) - Supersession: Not checked - Applies to: Recipient: Newborn; Population: Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.; Care setting: Health-care facility or home. The A.1b remarks give separate conditions for each.; Geography: Global (WHO guideline; the setting text says "any country or setting"); Life stage: Newborn, from birth; Gestational age: Not reported; Postnatal age: at least 0 days; Follow-up: Not applicable (recommendation context) - Basis: claim `maternal:claim-who-a1b-immediate-kmc` ## Connected pages - KMC started as soon as possible after birth: Kangaroo mother care (KMC) (`maternal:kangaroo-mother-care`) - Evaluated in iKMC for death by 28 days, in infants of 1.0 to under 1.8 kg: Low birth weight (`maternal:low-birth-weight`) [a claim, not a settled fact; see claim `maternal:claim-ikmc-28d-mortality` and its context] - WHO 2022 A.1b: strong recommendation, high-certainty evidence: Low birth weight (`maternal:low-birth-weight`) [a claim, not a settled fact; see claim `maternal:claim-who-a1b-immediate-kmc` and its context] - WHO 2022 A.1b: strong recommendation, high-certainty evidence: Preterm birth (`maternal:preterm-birth`) [a claim, not a settled fact; see claim `maternal:claim-who-a1b-immediate-kmc` and its context] - Related to: Immediate KMC in high-resource neonatal intensive care units (`maternal:idea-immediate-kmc-high-resource-nicu`) - Investigated in: WHO Immediate KMC Study (iKMC) (`maternal:ikmc-study`) ## Provenance Content hash: bd3026b5ef2a9268df90b50e0f99c1703bfa7a40809c1fa898888aa403bf0df5 Last substantive edit: 2026-10-09 Evidence last checked: Not recorded