Early kangaroo care in preterm ≤32 weeks and very low birth weight infants: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Statistically significant (CI excludes 1.0)

• Effect Size: 19% relative risk reduction in mortality

• Primary Outcome: Mortality reduction with early kangaroo care

• Nnt Or Sensitivity: Number needed to treat would depend on baseline mortality risk in population

• Confidence Interval: RR=0.81 (95% CI: 0.67-0.98)

Clinical Application

Requires trained staff, appropriate facilities, and family engagement; implementation varies by unit capacity Aligns with NHMRC guidelines supporting family-centred care; implementation supported by most tertiary NICUs across Australia Very preterm infants ≤32 weeks and VLBW infants <1500g in NICU settings

Abstract

OBJECTIVES: Kangaroo care (KC), involving skin-to-skin contact, early breastfeeding and early discharge, demonstrated benefits in improving outcomes for preterm and low birth weight infants. This systematic review and meta-analysis aimed to evaluate the effectiveness of early KC (initiated within the first 24 h) vs. conventional neonatal care in very preterm infants (≤32 weeks) and/or very low birth weight (VLBW) infants (<1,500 g). METHODS: A comprehensive search of MEDLINE, SCOPUS, Web of Science, and CENTRAL databases was conducted. Randomized controlled trials (RCTs) comparing early KC to conventional care in very preterm and/or VLBW infants were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted using R, with relative risks (RR) and 95 % confidence intervals (CI) calculated. RESULTS: Four RCTs, encompassing 1,679 newborns, were included. Meta-analysis revealed a significant reduction in mortality risk (RR=0.81, 95 % CI: 0.67-0.98) with early KC. The pooled RR for infection risk was 0.89 (95 % CI: 0.77-1.02). The impact on hypothermia was mixed, with moderate heterogeneity observed. CONCLUSIONS: Early KC may reduce mortality and morbidity in very preterm and VLBW infants although its effects on hypothermia vary by severity. Further studies are required to assess its effects on infants weighing <1,000 g or born before 28 weeks of gestation.

References

1. 1.Martins, J. A., Ferreira-da-Silva, R., Assunção, A., Clemente, F., Azevedo, I., & Costa, S. (2026). Early kangaroo care in preterm ≤32 weeks and very low birth weight infants: a systematic review and meta-analysis. Journal of Perinatal Medicine. https://doi.org/10.1186/s13052-016-0274-3