How ‘kangaroo care’ can benefit premature babies, with discernible results even 20 years later
A new study claims that kangaroo care – also known as skin-to-skin care – can bring immediate and longer-term benefits to babies compared to those who received traditional incubator care alone
A newborn is held against one’s chest, skin-to-skin, as soon as possible after birth and for a prolonged period of time. Though it’s a simple act, new research shows this technique, known as kangaroo care, not only improves survival of premature babies but also helps them thrive – even 20 years later.
The study, published last month in the journal Paediatrics, found that kangaroo care children two decades later are better behaved and have larger brains, higher pay cheques and more protective and nurturing families, compared to premature and low birthweight contemporaries who received “traditional” inpatient incubator care.
“This study indicates that kangaroo mother care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” says lead researcher Dr Nathalie Charpak of the Kangaroo Foundation in Bogota, Colombia.
Supported by the government of Canada through the “Saving Brains” programme of Grand Challenges Canada, as well as Colombia’s Administrative Department of Science, Technology and Innovation, the study compared 18- to 20-year-olds who were enrolled in 1993-96 as premature and low birthweight infants. They were randomly assigned at birth to receive either kangaroo mother care or traditional incubator care until they could maintain their own body temperature.
Researchers documented the short and medium-term benefits of kangaroo care training on the infants’ survival, brain development, breastfeeding and the quality of mother-infant bonding. Then, 20 years later, in 2012-14, 264 of the original participants who weighed less than 1,800 grammes at birth (61 per cent of the infants) were re-enrolled.
Looking at mortality, the research found that kangaroo care offered significant protection against early death. Participants in the control group were more than twice as likely to die as the kangaroo care group (7.7 per cent vs 3.5 per cent mortality rate).
“A premature infant is born somewhere in the world every two seconds,” says Dr Peter Singer, chief executive officer of Grand Challenges Canada. “This study shows that kangaroo mother care gives premature and low birthweight babies a better chance of thriving. Kangaroo mother care saves brains and makes premature and low birthweight babies healthier and wealthier.”
When Marc Lee’s son, Joshua, was born premature in April 2014 at 32 weeks, the first-time father practised kangaroo care along with his wife while their newborn was in the neonatal intensive care unit.
Lee would hold Joshua against his bare chest, singing and reading aloud, for as long as two hours each time. “I wanted to do my part to help my baby. He protested at first, probably because my hairy chest is different from mummy’s, but he got used to it,” says Lee, who had researched kangaroo care extensively.
“The other dads realised it was something they could do, too, when they saw me holding him. We saw how it helped Joshua become stronger and gain weight faster than another baby who came to the [-neonatal intensive care unit] around the same time, but was not held as often.”
Joshua is now a healthy two-year-old and a few months ago became a big brother.
Kangaroo care was the brainchild of Dr Edgar Rey Sanabria, professor of neonatology at the Mother and Child Institute in Bogota, who came up with the method in 1978 in response to overcrowding and lack of resources in his hospital. His idea was inspired by nature: the joey stays in its kangaroo mother’s pouch for about the first eight months of life. feeding and growing, forming a powerful bond between mother and baby.
Sanabria thought this physical closeness and skin-to-skin contact seen in kangaroo mother and baby pairs could help a premature newborn and his or her mother, especially where there’s a lack of modern newborn services and resources such as incubators. Sanabria received the World Health Organisation’s Sasakawa Health Prize in 1991 for his idea and work in kangaroo care.
Research suggests kangaroo care works for various reasons. First, continuous skin-to-skin contact maintains the premature baby’s core temperature. Second, the closeness encourages exclusive breastfeeding, which comes with myriad benefits of lactation. Third, touch is critical for vital cellular and molecular mechanisms leading to improved medical and psychological health in the vulnerable newborn.
About 15 million premature infants are born each year, according to the WHO. Preterm birth complications are the leading cause of death among children under five, responsible for nearly 1 million deaths in 2015; many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
In kangaroo care, a trained parent or caregiver becomes a child’s incubator and his or her main source of food and stimulation. After the mother and child return home from the hospital, there is rigorous monitoring of baby and mother until the infant reaches one year of corrected age (the baby’s age based on due date). Family solidarity around the frail child is a key element in the success of the kangaroo care technique.
The Kangaroo Foundation research study found several benefits of kangaroo care, and these could be seen even 20 years later:
School: the kangaroo care group spent 23 per cent more time in preschool and had less than half the rate of school absenteeism compared to the control group.
Work: as young workers, their average hourly wages were almost 53 per cent higher.
Family: a higher percentage of kangaroo care children (almost 22 per cent) grew up living with both parents. The families of kangaroo care children were found to be more stimulating, protective and dedicated to their children compared to the families in the control group.
Behaviour: scores for aggressiveness and hyperactivity were 16 per cent lower in the kangaroo care group, particularly among less educated mothers. Scores for externalisation (the ability to express feelings, especially negative feelings), a trait associated with risk of juvenile delinquency, academic failure and inadequate social adjustment, were 20 per cent lower in the kangaroo care group on average. The parents of kangaroo care children also reported that their children exhibited less antisocial behaviour compared to the reports of the parents of the counterparts in the control group.
Cerebral development: compared with those in the control group, kangaroo care participants had larger brains – significantly larger volumes of total grey matter, cerebral cortex, and left caudate nucleus, which plays a vital role in how the brain learns, specifically related to the storing and processing of memories.
Overall IQ: tests after 20 years show a small but significant (3.6 per cent) advantage in overall IQ for the most fragile kangaroo care babies (those with an abnormal or transient neurological exam at six months) compared to similar infants in the control group.
Charpak says that this new knowledge must be used to extend kangaroo care coverage to the 18 million premature and low birthweight infants born each year who are candidates for the technique.
She says: “We firmly believe that this is a powerful, efficient, scientifically based health care intervention that can be used in all settings, from those with very restricted to unrestricted access to health care.”