Immediate kangaroo mother care boosts survival for premature infants

Preterm birth and low birth weight remain major contributors to neonatal death and long-term developmental challenges. Kangaroo mother care, first introduced as an alternative to insufficient incubator care, combines skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support. Earlier guidelines recommended kangaroo mother care (KMC) after clinical stabilization, but newer evidence has shifted attention toward starting care immediately after birth. Yet implementation varies widely across hospitals, with differences in timing, duration, monitoring, staffing, privacy, and family support. These challenges have intensified the need for clearer evidence on how immediate KMC can be delivered safely and effectively in routine clinical practice.

The review, conducted by researchers from the Faculty of Medicine, Universitas Indonesia; Dr. Cipto Mangunkusumo National General Hospital; and Universitas Indonesia Hospital, was published (DOI: 10.1007/s12519-025-00993-5) online on November 14, 2025, in World Journal of Pediatrics. The article synthesizes evidence comparing immediate and delayed KMC in premature or low-birth-weight infants, focusing on clinical outcomes, implementation procedures, economic value, and barriers to routine adoption.

The authors searched Medline (PubMed), Scopus, EuropePMC, and Google Scholar up to June 2024 and included five randomized controlled trials (RCTs) comparing immediate and delayed KMC. These studies covered both low- and high-resource settings, including Ghana, India, Malawi, Nigeria, Tanzania, Madagascar, Norway, Gambia, and Uganda. Across the evidence, immediate kangaroo mother care (iKMC) showed a strong survival signal. The World Health Organization (WHO) iKMC trial reported lower 28-day mortality in the immediate-care group than in the delayed-care group, while other trials showed similar favorable trends. iKMC also reduced hypothermia, a critical risk for preterm and low-birth-weight infants who struggle to regulate body temperature. In addition, early skin-to-skin contact may support protective maternal microbiota transfer, reduce hospital-acquired exposure, and encourage earlier breastfeeding, all of which can strengthen neonatal immunity. Beyond infant outcomes, the review notes potential maternal benefits, including greater satisfaction and improved postpartum recovery markers. Economic analyses also suggest that iKMC can lower provider and household costs by reducing reliance on more resource-intensive care.

The authors said the findings make a strong case for treating iKMC not as an optional add-on, but as a core part of neonatal care for eligible preterm and low-birth-weight infants. They said the approach is powerful because it combines warmth, feeding support, bonding, infection protection, and family participation in one low-cost intervention. At the same time, they emphasized that success depends on safe monitoring, trained staff, suitable facilities, and practical support for mothers and caregivers.

The implications extend beyond individual hospitals. To scale iKMC safely, health systems may need mother-neonatal intensive care units (mother-NICUs), shared protocols between obstetric and neonatal departments, family-centered education, privacy solutions, and support for fathers or relatives as alternative caregivers. The review also identifies key gaps: long-term neurodevelopmental outcomes after iKMC remain unclear, evidence from high-resource settings is still limited, and implementation for extremely low-birth-weight infants requires more study. If implemented effectively, iKMC could offer a rare combination in global healthcare: a low-cost intervention capable of saving lives while reducing pressure on overstretched neonatal systems.