| Azevedo et al.(6666 Azevedo VM, Xavier CC, Gontijo FO. Safety of kangaroo mother care in intubated neonates under 1500 g. J Trop Pediatr. 2012;58(1):38-42.)
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Quasi-experimental study design
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n = 43, GA: > 29 weeks , Weight: not disclosed, Hemodynamically stable, intubated receiving MV
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A group evaluated longitudinally on 3 occasions: before, during and after the procedure for a duration of 90 minutes
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Procedure safety, Variables measured: HR, SpO2, FiO2, mean arterial blood pressure, and temperature
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Changes in the variables studied were not clinically significant (< 5% from baseline) although statistically significant. Skin-to-skin contact is a safe procedure for NBs receiving MV
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| Carbasse et al.(6767 Carbasse A, Kracher S, Hausser M, Langlet C, Escande B, Donato L, et al. Safety and effectiveness of skin-to-skin contact in the NICU to support neurodevelopment in vulnerable preterm infants. J Perinat Neonatal Nurs. 2013;27(3):255-62.)
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Quasi-experimental study design study
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n = 96 , GA: 24 - 33 weeks, Weight: > 500g, Vulnerable preterm infants
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Vital signs, body temperature, and oxygen requirement data were prospectively recorded by each infant's nurse before (baseline), during (3 time points), and after their first skin-to-skin contact. , 17 clinically stable NBs receiving MV, 49 with nasal CPAP and 30 spontaneously breathing room air
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Safety and physiological effectiveness of the procedure, Evaluate the impact of the respiratory support. Variables measured: HR, SpO2, FiO2, transcutaneous partial pressure of carbon dioxide (TcPCO2), and temperature
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Changes in the variables studied were statistically significant , Skin-to-skin contact is an effective and safe procedure for vulnerable preterm infants
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| Karlsson et al.(6868 Karlsson V, Heinemann AB, Sjörs G, Nykvist KH, Agren J. Early skin-to-skin care in extremely preterm infants: thermal balance and care environment. J Pediatr. 2012;161(3):422-6.)
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Quasi-experimental study design
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n = 27, GA = 22 to 26 weeks , Weight: not disclosed
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Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured during pretest (in incubator), test (during SSC), and posttest (in incubator) periods
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Assessment of the NICU's thermal balance and physical care environment during skin-to-skin, Variables studied: Relative humidity and air temperature in the incubator and skin-to-skin environment; corporal temperature; skin temperature; evaporimetry (transepidermal water loss and insensible water loss)
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Early skin-to-skin initiation allows thermoregulation to occur in even the smallest NBs receiving intensive care, including mechanical ventilation , Skin-to-skin is an important and safe care mode for extreme PTNBs, even with mechanical ventilation
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| Lorenz et al.(6969 Lorenz L, Dawson JA, Jones H, Jacobs SE, Cheong JL, Donath SM, et al. Skin-to-skin care in preterm infants receiving respiratory support does not lead to physiological instability. Arch Dis Child Fetal Neonatal Ed. 2017;102(4):F339-44.)
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Prospective observational non-inferiority study
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n = 40, GA < 33 weeks, Weight: > 800g, Receiving ventilatory support (ETT, CPAP or HFNC)
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rcO2 was measured using near-infrared spectroscopy. Ninety minutes of skin-to-skin contact, with infants in incubators acting as their own control
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Evaluate rcO2 on two occasions (skin-to-skin contact, and incubator care). Secondary outcomes included physiological parameters (SpO2, HR, FiO2, cFTOE and AT) evaluated on both occasions and divided by ventilatory support modality.
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Cerebral oxygenation and other physiological measurements in ventilated preterm infants did not differ between skin-to-skin contact, and incubator care
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| Park et al.(7070 Park H, Choi BS, Lee SJ, Son IA, Seol IJ, Lee HJ. Practical application of kangaroo mother care in preterm infants: clinical characteristics and safety of kangaroo mother care. J Perinat Med. 2014;42(2):239-45.)
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Prospective clinical trial,
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n = 31, GA: 25 - 32 weeks, Weight: 760g - 1,740g
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Two groups submitted to skin-to-skin contact: 25 - 28 weeks (n = 11) and 29 - 32 weeks (n = 20)
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Determine the clinical characteristics and safety of skin-to-skin contact according to GA, Physiological parameters were evaluated longitudinally for 60 minutes (15 minutes before, 30 minutes during and 15 minutes after the procedure). , Variables studied: HR, RR, SpO2, blood pressure, temperature
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Changes in the variables studied were not clinically significant (< 5% from baseline) although some were statistically significant. , At the same post-menstrual age, the lower GA group showed greater thermoregulation maturation compared to the higher GA group, Skin-to-skin contact is a safe procedure for PTNBs even while receiving ventilatory support
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| Okan et al.(7171 Okan F, Ozdil A, Bulbul A, Yapici Z, Nuhoglu A. Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. Ann Trop Paediatr. 2010;30(2):119-28.)
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Randomized controlled clinical trial, ,
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n = 107, GA: > 37 weeks, Age between 24 and 48 hours of life, Weight: not disclosed, Healthy NB,
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Three groups:, Skin-to-skin contact group (N = 35) with maternal breast feeding;, n = 36 skin-to-skin contact, n = 36 placed in the crib, evaluated before, during and after the painful stimulus,
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Evaluate the effectiveness of skin-to-skin contact for pain reduction during heel puncture in FTNBs, Assess whether the combination of skin-to-skin contact with breastfeeding provides greater analgesia than skin-to-skin contact alone, Variables studied: Crying time after painful stimulus. Secondary outcomes: HR, SpO2
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HR, SpO2, and crying duration was significantly lower in the groups skin-to-skin and skin-to-skin contact with breastfeeding, compared to NBs in the crib who underwent the painful procedure, Skin-to-skin contact before, during, and after a painful stimulus promotes a reduction in physiological and behavioral responses to pain in healthy FTNBs, The combination of skin-to-skin contact with breastfeeding promotes an analgesic effect similar to skin-to-skin contact only
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| Saeidi et al.(7272 Saeidi R, Asnaashari Z, Amirnejad M, Esmaeili H, Robatsangi MG. Use of "kangaroo care" to alleviate the intensity of vaccination pain in newborns. Iran J Pediatr. 2011;21(1):99-102.)
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Randomized controlled clinical trial
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n = 60, GA: healthy full-term NBs, Weight: not disclosed
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Two groups: skin-to-skin contact for 30 minutes (n = 30) and control (wrapped in blanket and placed next to mother, n = 30)
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Evaluate the effect of skin-to-skin contact on pain intensity using the NIPS scale in healthy NBs undergoing a painful procedure (vaccination), Secondary outcomes: HR, SpO2 and crying duration
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Mean pain intensity during the procedure, and 3 minutes after, was significantly lower in the skin-to-skin contact group, Kangaroo care may be used to decrease pain intensity in newborns undergoing painful procedures
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| Cong et al.(7373 Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. J Pain. 2012;13(7):636-45.)
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Randomized crossover clinical trial
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n = 28, GA: 28 - 32 weeks, Weight: not disclosed, < 14 days of life in heated incubator
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Three groups randomized into different procedure sequences, evaluated on 6 occasions: skin-to-skin for 30 minutes, skin-to-skin for 15 minutes, and standard care
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Skin-to-skin effect (duration of 30 and 15 minutes) on the autonomic pain response of PTNBs subjected to heel puncture compared to standard care. , Variables studied: HR variability, behavioral state
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Both skin-to-skin contact durations, before and during heel puncture, promote prolonged restful sleep after puncture. , Kangaroo care has a significant effect on reducing autonomic pain responses in preterm infants. The findings support that KC is a safe and effective pain intervention, in the neonatal intensive care unit
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| Nimbalkar et al.(7474 Nimbalkar SM, Patel VK, Patel DV, Nimbalkar AS, Sethi A, Phatak A. Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. J Perinatol. 2014;34(5):364-8.)
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Randomized controlled clinical trial
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n = 100 term and late preterm, Weight: > 1,800g
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Two groups:, Intervention Group: SSC at 30 minutes to 1 hour after delivery and continue for as long as possible in the first 24 hours with each session lasting for minimum 60 minutes, Control Group, after providing routine care under radiant warmer, NBs were kept clothed (including head cap) and covered with blanket with their mother (bedding in) for first 48 hours
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Temperature and heart rate
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The incidence of hypothermia in conventional care was significantly higher as compared with the SSC
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| Chidambaram et al.(7575 Chidambaram AG, Manjula S, Adhisivam B, Bhat BV. Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial. J Matern Neonatal Med. 2014;27(5):488-90.)
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Randomized crossover clinical trial
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n = 100, GA: 32 - 36 weeks, Weight: < 2,500g, Hemodynamically stable without dependence on oxygen.
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Two groups: , Control Group (n = 50), Skin-to-Skin Contact Group (n = 50),
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PIPP pain scale assessment 15 minutes before, 15 and 30 minutes after heel puncture
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PIPP scores at 15 and 30 minutes after puncture were significantly lower in the skin-to-skin contact group compared to the control group, Skin-to-skin contact is effective in reducing pain in PTNBs subjected to heel puncture
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| Gao et al.(7676 Gao H, Xu G, Gao H, Dong R, Fu H, Wang D, et al. Effect of repeated Kangaroo Mother Care on repeated procedural pain in preterm infants: a randomized controlled trial. Int J Nurs Stud. 2015;52(7):1157-65.)
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Randomized controlled clinical trial
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n = 75, GA: < 37 weeks, Weight: 2,030g
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Two groups: , Control group (n = 37), Skin-to-Skin Group (n = 38)
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Evaluate the effectiveness of 30 minutes of skin-to-skin contact on behavioral and physiological responses of PTNBs undergoing heel punctures. During the first puncture procedure, all NBs were kept in the incubator. In the other three procedures, the NBs were randomized into skin-to-skin contact or standard incubator care; evaluators were blinded to the purpose of the study. , Variables studied: facial expression, crying, and HR in four heel puncture procedures
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HR was significantly lower, crying and grimacing duration was significantly shorter (from time of heel puncture to recovery) across repeated heel puncture procedures in the skin-to-skin group compared to the control group, The effect of repeated Kangaroo Mother Care analgesia remains stable in preterm infants over repeated painful procedures
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| Choudhary et al.(7777 Choudhary M, Dogiyal H, Sharma D, Datt Gupta B, Madabhavi I, Choudhary JS, et al. To study the effect of Kangaroo Mother Care on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates: a study from western Rajasthan. J Matern Neonatal Med. 2016;29(5):826-31.)
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Quasi-experimental crossover single-blind clinical trial
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n = 140, Weight: > 1,000g
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One group (n = 140): each NB was its own control, GA < 37 weeks , All NBs were divided into gestational age: 28 - 30 weeks (n = 80); 30 - 34 weeks (n = 60) and birth weight: 1,000g - 1,500 g (n = 88); 1,500 - 2,500g (n = 52)
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Assessment of PIPP during heel puncture, HR, SpO2, crying duration and recovery time,
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The effect of skin-to-skin contact was statistically significant in the PTNBs (30 - 34 weeks) and very low weight (1,000 - 1,500g) groups, SpO2 drop was lower (36% reduction) in the skin-to-skin contact group than in conventional care, Crying duration was shorter in the skin-to-skin contact group than in conventional care, with a statistically significant difference, PIPP scores were significantly lower with skin-to-skin contact, Implementing skin-to-skin contact is a safe method of helping physiological and behavioral stability in PTNBs
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| Kaffashi et al.(7878 Kaffashi F, Scher MS, Ludington-Hoe SM, Loparo KA. An analysis of the kangaroo care intervention using neonatal EEG complexity: a preliminary study. Clin Neurophysiol. 2013;124(2):238-46.)
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Randomized quasi-experimental crossover clinical trial
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n = 134 NBs (8 PTNBs), Received 8 weeks of skin-to-skin contact.
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Three groups: PTNBs received skin-to-skin contact for 8 weeks (16 EEG recordings during sleep, n = 8) compared to two groups (nN = 126): one group of PTNBs with corrected gestational age and another of FTNBs
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Neurophysiology maturation of the neonatal brain by quantifying temporal characteristics (regularity and predictability) of sleep EEG signals, , ,
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The group of PTNBs that received skin-to-skin contact exhibited more complex EEG signals compared to PTNBs of the same gestational age, Discriminatory analyses show that PTNBs who received skin-to-skin contact (at 40 weeks corrected age) exhibit patterns closer to FTNBs than PTNBs not submitted to this intervention, at the same gestational age.
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| Neu et al.(7979 Neu M, Hazel NA, Robinson J, Schmiege SJ, Laudenslager M. Effect of holding on co-regulation in preterm infants: a randomized controlled trial. Early Hum Dev. 2014;90(3):141-7.)
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Randomized controlled clinical trial
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n = 79, GA: 32 - 35 weeks, Weight: not disclosed
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Three groups: , Control Group (n = 24), Skin-to-Skin Contact Group (n = 29), Group Wrapped in Blanket (n = 26
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Evaluate coregulation in salivary cortisol between mother and NB; coregulation defined as progressive reduction in the absolute difference between mother and NB cortisol levels during each 60-minute session of skin-to-skin contact, Variable studied: coregulation of salivary cortisol between mother and NB
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Decreased cortisol levels in mothers and NBs suggesting that skin-to-skin contact caused a decline in stress hormone levels, There was no significant difference in coregulation between the groups, nonstressful situations, co-regulation in salivary cortisol may not differ based on holding method
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| Srivastava et al.(8080 Srivastava S, Gupta A, Bhatnagar A, Dutta S. Effect of very early skin to skin contact on success at breastfeeding and preventing early hypothermia in neonates. Indian J Public Health. 2014;58(1):22-6.)
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Randomized controlled clinical trial
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n = 240, GA: any age, Weight > 2,500g, Skin-to-skin in the first 30 minutes of life
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Two groups: , Control Group (n = 118), Skin-to-Skin Contact Group (n = 122), Variables studied: breastfeeding effectiveness, 6-week breastfeeding status, maternal satisfaction, thermoregulation, weight loss at hospital discharge and at first follow-up, and morbidity
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Evaluate the impact of early skin-to-skin initiation on breastfeeding effectiveness and maternal satisfaction in relation to perceived NB breastfeeding status at hospital discharge, Secondary outcomes: related to neonatal well-being (thermoregulation in the immediate postpartum period, NB weight parameters and morbidities during the first six weeks of life)
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Skin-to-skin contact contributed to greater breastfeeding effectiveness, more infants being exclusively breastfed at the first follow-up and at 6 weeks, greater maternal satisfaction, better immediate postpartum temperature gain, lower weight loss at hospital discharge and first follow-up, and lower morbidity when compared to the control group
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| Jayaraman et al.(8181 Jayaraman D, Mukhopadhyay K, Bhalla AK, Dhaliwal LK. Randomized controlled trial on effect of intermittent early versus late kangaroo mother care on human milk feeding in low-birth-weight neonates. J Hum Lact. 2017;33(3):533-9.)
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Randomized controlled clinical trial, ,
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n = 160, Weight: 1,000g - 1,800g,
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Two groups: early skin-to-skin contact initiated within the first 4 days of life (n = 80); late skin-to-skin contact, initiated after complete stabilization, defined as absence of respiratory support and intravenous fluids (n = 80)
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Evaluate the effects of early skin-to-skin contact initiation on exclusive breastfeeding, growth, mortality and morbidity compared to late initiation (during hospitalization and after hospital discharge) in low-weight NBs
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The early skin-to-skin contact group had higher proportion of exclusive breastfeeding, higher breastfeeding rate during hospitalization, and a higher proportion of exclusive breastfeeding up to one month after hospital discharge, The incidence of apnea and recurrent apnea requiring ventilation was significantly reduced in the early skin-to-skin contact group, There was no significant difference in mortality, morbidity, and growth during hospitalization and after hospital discharge
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| Nagai et al.(8282 Nagai S, Andrianarimanana D, Rabesandratana N, Yonemoto N, Nakayama T, Mori R. Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low-birth-weight infants: a randomized controlled trial. Acta Paediatr. 2010;99(6):827-35.)
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Randomized controlled clinical trial,
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n = 73, Weight: < 2,500g, Age: < 24 hours, Relatively stable clinical conditions
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Two groups: early skin-to-skin contact within the first 24 hours of life (n = 37)., Control: conventional care performed initially with skin contact after 48 - 72 hours of life (n = 36).
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Evaluate the effectiveness of early skin contact initiation for relatively stable low-weight NBs in a resource-constrained country
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There were no differences in the incidence of morbidity, Weight loss from birth up to 24 hours (and up to 48 hours) of life was significantly lower in the early skin-to-skin contact group compared with the control group, The occurrence of adverse effects and length of hospitalization did not differ between the groups
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| Sharma et al.(8383 Sharma D, Murki S, Pratap OT. The effect of kangaroo ward care in comparison with "intermediate intensive care" on the growth velocity in preterm infant with birth weight <1100 g: randomized control trial. Eur J Pediatr. 2016;175(10):1317-24.)
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Randomized controlled clinical trial
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n = 141, Weight: < 1,100g, Clinically stable
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Two groups: skin-to-skin contact (n = 71) and conventional care (n = 70) when NBs reached 1,150g.
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Assess weight gain (g/day) from start of randomization to full-term (40 weeks), Variables studied: weight gain (g/day), Secondary outcomes: weight, length and head circumference at 40 weeks; intra-hospital weight gain (g/day), length (cm/week) and head circumference (cm/week) following randomization; breastfeeding rates at hospital discharge and at full-term age; neonatal ICU readmissions (level III or intermediate care unit)
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Average weight gain, as well as weight, length and head circumference at term corrected age were comparable in both groups, There was a significant reduction in hospitalization time in the conventional care group and a significant increase in weight gain before discharge in the skin-to-skin contact group
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| Mitchell et al.(8484 Mitchell AJ, Yates CC, Williams DK, Chang JY, Hall RW. Does daily kangaroo care provide sustained pain and stress relief in preterm infants? J Neonatal Perinatal Med. 2013;6(1):45-52.)
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Randomized controlled clinical trial, ,
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n = 38, GA: 27 - 30 weeks , Weight: < 1,311g , Receiving ventilatory support (MV, CPAP or nasal cannula)
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Two groups: , Control Group (n = 19), Skin-to-Skin Contact Group (n = 19) ,
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Determine if stress on PTNBs (measured by salivary cortisol levels) decreases after 5 days of skin-to-skin contact compared to 5 days in standard care, Determine if skin-to-skin provides sustained pain relief following the period of contact, Salivary cortisol was collected and evaluated on the 5th and 10th day of life, PIPP pain score was measured during routine tracheal and nasal aspiration because such procedures are considered painful,
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Skin-to-skin contact did not affect basal salivary cortisol levels in PTNBs compared to standard care , Salivary cortisol levels decreased in both groups between the 5th and 10th day of life, demonstrating that the day of life variable should be considered when salivary cortisol is evaluated in PTNBs, Skin-to-skin contact did not affect PIPP scores after aspiration, as NBs were not in skin-to-skin contact during the procedure
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| Ghavane et al.(8585 Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S. Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeedingoutcomes when reaching term gestational age in very low birth weight infants. Acta Paediatr. 2012;101(12):e545-9.)
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Randomized controlled clinical trial
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n = 140, Weight: < 1,500g, Hemodynamically stable; tolerating spoon feeding of 150mL/kg /day
|
Two groups: skin-to-skin contact (n = 71) and conventional care (n = 69)
|
Evaluate the effectiveness of early NB skin-to-skin contact in the Kangaroo unit compared to conventional care in the neonatal unit, in relation to the growth and breastfeeding of very low weight NBs at 40 weeks corrected age. , Variables studied: mean weight gain (g/kg/day) from randomization to corrected term age.
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At full-term GA there were no differences between groups regarding mean weight gain (g/kg/day) after randomization and breastfeeding rate. , Skin-to-skin contact in the Kangaroo unit is as effective as conventional care at the neonatal unit with no increase in mortality or morbidity in very low weight NBs.
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| Sharma et al.(8686 Sharma D, Murki S, Oleti TP. To compare cost effectiveness of "Kangaroo Ward Care" with "Intermediate intensive care" in stable very low birth weight infants (birth weight < 1100 grams): a randomized control trial. Ital J Pediatr. 2016;42(1):64.)
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Randomized controlled clinical trial
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n = 141, GA: ≤ 32 weeks, Weight: < 1,000g, Clinically stable
|
Two groups: 71 KWC Group and 70 to Intermediate Intensive Care Group
|
Compare growth and cost-effectiveness of skin-to-skin contact with intermediate intensive care
|
Average weight gain, as well as weight, length and head circumference at term corrected age were comparable in both groups, Initiating early shifting to Kangaroo ward is cost effective intervention and have huge monetary implication in resource poor countries
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