A new study reveals that skin-to-skin are brings both immediate and longterm benefits for preemies compared to those who receive traditional incubator care alone.
With Kangaroo Care, a premature baby is held against parents’ chest, skin-to-skin, as soon as possible after birth and for a prolonged period of time. This is extremely beneficial for newborns as well. 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 checks 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 behavioral protective effects 20 years after the intervention,” says lead researcher Dr Nathalie Charpak of the Kangaroo Foundation in Bogota, Colombia.
The study, supported by the government of Canada through the “Saving Brains” program, as well as Colombia’s Administrative Department of Science, Technology and Innovation, 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 Care or traditional incubator care until they could maintain their own body temperature.
Researchers documented the benefits of Kangaroo Care on the infants’ survival, brain development, breastfeeding and the quality of mother-infant bonding. Then, 20 years later, in 2012-14, 264 (61% of the infants) of the original participants 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.
“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 Care gives premature and low birthweight babies a better chance of thriving. Kangaroo 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 practiced Kangaroo Care along with his wife while their newborn was in the Neonatal Intensive Care Unit.
Lee held 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 realized 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 NICU around the same time, but was not held as often.”
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 Organization’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 the 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. Babies who receive Kangaroo Care are said to enjoy benefits even 20 years later.
According to the WHO, about 15 million premature infants are born each year. 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.
With 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.
—Behavior: scores for aggressiveness and hyperactivity were 16 per cent lower in the Kangaroo Care group, particularly among less educated mothers. Scores for externalization (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 behavior 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 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.”