Immediate kangaroo mother care increases survival of premature babies

Premature birth and low birth weight remain major contributors to neonatal mortality and long-term developmental challenges. Kangaroo mother care, first introduced as an alternative to inadequate incubator care, includes skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support. Earlier guidelines recommended kangaroo mother care (KMC) after clinical stabilization, but new evidence has drawn attention toward starting care soon after birth. Yet implementation varies widely across hospitals, with differences in timing, duration, monitoring, staffing, confidentiality, and family support. These challenges have heightened the need for clear evidence on how immediate KMC can be delivered safely and effectively in routine clinical practice.

The review was conducted by researchers from the Faculty of Medicine, Universitas Indonesia; Dr. Sipto Mangunkusumo National General Hospital; and Universitas Indonesia Hospital, published online November 14, 2025 (DOI: 10.1007/s12519-025-00993-5) World Journal of Pediatrics. The article synthesizes the evidence comparing immediate and delayed KMC in premature or low birth weight infants, focusing on clinical outcomes, implementation processes, 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 compared to the delayed care group, while other trials showed similar favorable trends. iKMC also reduced hypothermia, a serious risk for premature and low-birth-weight infants, who struggle to regulate body temperature. Furthermore, early skin-to-skin contact may support protective maternal microbiota transfer, reduce hospital-acquired exposure, and encourage earlier breastfeeding, all of which may strengthen the newborn’s immunity. Beyond infant outcomes, the review focused on potential maternal benefits, including greater satisfaction and improved postpartum recovery markers. Economic analyzes also suggest that iKMC may reduce provider and household costs by reducing reliance on more resource-intensive care.

The authors said the findings make a strong case for considering IKMC not as an optional add-on, but as a core part of neonatal care for eligible premature and low-birth weight infants. He said this approach is powerful because it combines warmth, food support, connection, protection from infection and family involvement in one low-cost intervention. At the same time, they stressed that success depends on safe monitoring, trained staff, appropriate facilities and practical support for mothers and caregivers.

Its impact extends beyond individual hospitals. To safely scale up IKMC, health systems may need maternal-newborn intensive care units (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 major shortcomings: 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 health care: a low-cost intervention capable of saving lives while reducing pressure on overwhelmed neonatal systems.