Maternal & Newborn Atlas
About
Menu

Immediate kangaroo mother care

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.

  • Intervention
  • In this atlas

Overview

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.

About this intervention

Type
Service
Mechanism
Not reported

Claims and evidence

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.
Eligibility: 4 inclusion criteria; 8 exclusion criteria
Included
  • Liveborn infant
  • Birth weight 1.0 kg to under 1.8 kg
  • Any gestational age, mode of delivery, or singleton or twin status
  • Enrolled with the mother within 2 hours of birth
Excluded
  • Mother younger than 15 years
  • Mother, or the guardian of a minor mother aged 15 to 17, unable or unwilling to consent
  • Triplets or higher-order multiples
  • Mother unlikely to provide KMC within the first 3 days (registry examples: eclampsia, shock, major surgery)
  • Cannot be enrolled within 2 hours of birth
  • Residence outside the study area
  • Infant unable to breathe spontaneously by 1 hour of age
  • Major congenital malformation (registry: one that interferes with, or is interfered with by, the intervention)

  • Effect Interventional Certainty not assessed

    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).

    Applies to Newborn
    • 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.
    • 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.
    • 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.
    • 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.
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (4)

    1. Supports Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Abstract, RESULTS, sentence 3: "relative risk of death, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P = 0.001"
      How it applies
      Abstract of the primary report, for the same infants and time window as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5dde5eaa4d684f398f7f3cfab05816eb73207b8adbaac5c4163e7e480567ecf6
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    2. Supports Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, row "Death between enrolment and 28 days of age": "191/1596 (12.0%)" and "249/1587 (15.7%)"
      How it applies
      Author accepted manuscript (CC BY 4.0); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    3. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, column header: "Adjusted RR (95%CI)"
      How it applies
      The ratios are adjusted, not crude; see the Table 3 footnote.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    4. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      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"
      How it applies
      Limits who the result describes.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

  • Effect Interventional Certainty not assessed

    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.

    Applies to Newborn
    • 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.
    • 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.
    • 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.
    • 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.
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (4)

    1. Supports Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Abstract, RESULTS, sentence 3: "relative risk of death, 0.77; 95% CI, 0.58 to 1.04; P = 0.09"
      How it applies
      Abstract of the primary report, for the same infants and time window as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      5dde5eaa4d684f398f7f3cfab05816eb73207b8adbaac5c4163e7e480567ecf6
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    2. Supports Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, row 2 (death between enrolment and 72 hours of age): 74/1606 (4.6%) and 92/1599 (5.8%)
      How it applies
      Author accepted manuscript (CC BY 4.0); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    3. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, column header: "Adjusted RR (95%CI)"
      How it applies
      The ratios are adjusted, not crude; see the Table 3 footnote.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    4. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      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"
      How it applies
      Limits who the result describes.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

  • Effect Interventional Certainty not assessed

    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).

    Applies to Newborn
    • 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.
    • 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.
    • 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.
    • 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.
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, hypothermia row: "90/1609 (5.6%) 133/1602 (8.3%) 0.65 (0.51–0.83)"
      How it applies
      Author accepted manuscript (CC BY 4.0); not checked against the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    2. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      Locator
      Table 3, footnote 1: "Any instance of axillary temperature <36ºC at any time from 2 hours after randomization until discharge from hospital."
      How it applies
      The trial's own hypothermia definition.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

    3. Background Immediate "Kangaroo Mother Care" and Survival of Infants with Low Birth Weight

      Publication · Massachusetts Medical Society (N Engl J Med 384(21):2028-2038) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed. Full-text facts come from the PMC author accepted manuscript PMC8108485. · Published 2021-05-27 · doi: 10.1056/NEJMoa2026486

      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."
      How it applies
      The authors' own caution on this secondary outcome.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0945a417a4ffacfded839e4e8df7cf03c99c581e34fbca8ddd6daa7229b79bac
      Reuse basis
      Bibliographic metadata and short factual extraction. The PMC author accepted manuscript is licensed CC BY 4.0 and is committed at research/snapshots/pmc-PMC8108485.xml. Attribution: WHO Immediate KMC Study Group, N Engl J Med 2021;384:2028-2038, doi:10.1056/NEJMoa2026486, author accepted manuscript via PMC (PMC8108485). The version of record is not redistributed.

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)
Eligibility: 1 inclusion criterion; 2 exclusion criteria
Included
  • Preterm or low-birth-weight infant
Excluded
  • In a facility: an infant who cannot breathe spontaneously after resuscitation, is in shock or needs mechanical ventilation. Otherwise immediate KMC can start before the infant is clinically stable.
  • At home: an infant with danger signs, since home KMC is for infants without danger signs

  • Recommendation Guidance High certainty

    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.

    Applies to Newborn
    • Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.
    • Health-care facility or home. The A.1b remarks give separate conditions for each.
    • Global (WHO guideline; the setting text says "any country or setting")
    • Newborn, from birth
    • Gestational age Not reported
    • Postnatal age at least 0 days
    Follow-up Not applicable (recommendation context)
    Certainty method
    GRADE, as stated by WHO in the 2022 guideline for recommendation A.1b
    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
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports WHO recommendations for care of the preterm or low-birth-weight infant

      Guideline · World Health Organization · 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. · Published 2022-11-15 · isbn: 978-92-4-005826-2

      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."
      How it applies
      WHO 2022 guideline, CC BY-NC-SA 3.0 IGO; short quotation with attribution.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532
      Reuse basis
      Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and the PDF is not committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.

    2. Supports WHO recommendations for care of the preterm or low-birth-weight infant

      Guideline · World Health Organization · 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. · Published 2022-11-15 · isbn: 978-92-4-005826-2

      Locator
      Recommendation A.1b, PDF p. 25, printed twice in succession: "(Strong recommendation, high-certainty evidence)"
      How it applies
      The strength and certainty as WHO states them.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532
      Reuse basis
      Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and the PDF is not committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.

    3. Background WHO recommendations for care of the preterm or low-birth-weight infant

      Guideline · World Health Organization · 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. · Published 2022-11-15 · isbn: 978-92-4-005826-2

      Locator
      A.1 Remarks, Immediate KMC, PDF p. 25: "immediate KMC can be initiated before the infant is clinically stable"
      How it applies
      Applies in facilities.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532
      Reuse basis
      Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and the PDF is not committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.

    4. Background WHO recommendations for care of the preterm or low-birth-weight infant

      Guideline · World Health Organization · 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. · Published 2022-11-15 · isbn: 978-92-4-005826-2

      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"
      How it applies
      Facility exceptions.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532
      Reuse basis
      Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and the PDF is not committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.

    5. Background WHO recommendations for care of the preterm or low-birth-weight infant

      Guideline · World Health Organization · 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. · Published 2022-11-15 · isbn: 978-92-4-005826-2

      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"
      How it applies
      Defines WHO's strength labels for this guideline.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      650354ec6f6cfdc81bd9b542ef488eb32de0d2675cdc574fd26a529c2275d532
      Reuse basis
      Licensed CC BY-NC-SA 3.0 IGO, as stated in the PDF. Only short quotations with attribution are used, and the PDF is not committed. The non-commercial and share-alike terms need a licensing decision before any text is adapted.

Guidance

Recommended: Immediate kangaroo mother care

Applies to Newborn
  • Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.
  • Health-care facility or home. The A.1b remarks give separate conditions for each.
  • Global (WHO guideline; the setting text says "any country or setting")
  • Newborn, from birth
  • Gestational age Not reported
  • Postnatal age at least 0 days
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global (WHO guidance intended to inform national and subnational policy, per the WHO publication page)
Supersession
Not checked
Basis
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.

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.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

  • Claim, not a settled fact Evaluated in iKMC for death by 28 days, in infants of 1.0 to under 1.8 kg: Low birth weight (Evaluated for)

    Applies to Newborn
    • 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.
    • 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.
    • 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.
    • 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).

    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.

  • Claim, not a settled fact WHO 2022 A.1b: strong recommendation, high-certainty evidence: Low birth weight (Recommended for)

    Applies to Newborn
    • Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.
    • Health-care facility or home. The A.1b remarks give separate conditions for each.
    • Global (WHO guideline; the setting text says "any country or setting")
    • 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.

    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.

  • Claim, not a settled fact WHO 2022 A.1b: strong recommendation, high-certainty evidence: Preterm birth (Recommended for)

    Applies to Newborn
    • Preterm or low-birth-weight infants. This is broader than the iKMC trial's 1.0 to under 1.8 kg band.
    • Health-care facility or home. The A.1b remarks give separate conditions for each.
    • Global (WHO guideline; the setting text says "any country or setting")
    • 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.

    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.

Record details

Record id
maternal:immediate-kmc
Content hash
bd3026b5ef2a9268df90b50e0f99c1703bfa7a40809c1fa898888aa403bf0df5