Premature and low birth-weight babies should be placed in immediate contact with their caregivers’ skin after birth to improve their health outcomes and chances of survival, the World Health Organization (WHO) has said.
The guidelines mark a significant change from earlier guidance, and will apply to all infants born before 37 weeks of pregnancy or under 2.5kg (5.5lb) in weight – apart from those needing breathing support, mechanical ventilation or who are in shock.
Named after the way kangaroos hold their babies in their pouch, kangaroo mother care involves wrapping premature or tiny newborns in a sling worn by a caregiver, rather than placing them in an incubator or warmer to stabilise them first, as well as exclusive breastfeeding where possible.
While it is common practice at many NHS trusts in the UK, it is not happening at all of them. Recent research led by Giulietta Stefani at Imperial College London found that a lack of training and clear guidance were key barriers to wider adoption.
Previous WHO recommendations for preterm and low birth-weight infants also advised starting kangaroo mother care only after the baby had been stabilised in an incubator or warmer – resulting in physical separation from their caregivers for the first three to seven days on average. Because preterm babies lack body fat, many have problems regulating their own temperature and may require medical assistance with breathing.
Even so, research increasingly suggests that starting kangaroo care immediately after birth can improve feeding and reduce the risk of infections and hypothermia. A study published in the New England Journal of Medicine last year found that starting kangaroo mother care immediately after birth could save an additional 150,000 lives worldwide each year.
“The guidelines show that improving outcomes for these tiny babies is not always about providing the most hi-tech solutions,” said the WHO director-general, Dr Tedros Adhanom Ghebreyesus.
Alanna Linkhorn, a midwife for the pregnancy charity Tommy’s, described the WHO recommendations as a welcome step forward. “Often if mum or baby experience any complications immediately after birth, it can result in skin-to-skin [contact] being delayed,” she said. “It is really encouraging to see the WHO focus on the need for parents and newborns to be together immediately and intensively.
“These updated guidelines also give extra weight to campaigns for neonatal leave and pay by explaining how absolutely vital being with preterm infants is for everyone involved.”
She added that, while skin-to-skin contact could be trickier to achieve if babies were not stable, there were ways to modify how it was done, such as hand hugging, which involved placing one hand on the baby’s head and cupping the other around its bottom.
“We encourage parents to ask their healthcare teams if they don’t feel they’re getting enough skin-to-skin time,” Linkhorn said. “It is not only a very special part of the experience of getting to know your new baby, but is also a calming and relaxing experience for both mother and baby – and helps regulate the baby’s temperature and breathing, which preterm babies in particular often require support with.
“In addition to this, skin-to-skin contact stimulates the release of hormones to support the early initiation of breastmilk production, especially important for premature babies due to their immature gut systems to help reduce rates of infection.”
Lia Brigante, quality and standards adviser at the Royal College of Midwives (RCM), said: “The benefits it [kangaroo care] can bring for women and babies is strong and growing, and its use in the UK is also growing – but not consistently enough.
“Midwives play a key role in supporting women with skin-to-skin contact with their baby and promoting the health benefits it brings. This is dependent, of course, on having the right staffing levels in maternity services and, sadly, we know that this is often not the case.
“We have a severe shortage of midwives, which means important initiatives like this cannot always be implemented as they should. The government has to address the maternity workforce crisis so that women and babies get the care they deserve.”