Definition: Care method for preterm/LBW infants involving continuous Skin-to-Skin (STS) contact with mother/caregiver to ensure optimum growth and development.
Status: Standard of care for LBW infants in all settings (WHO).
Goal: Promote thermal control, breastfeeding, and bonding while reducing mortality.
2. COMPONENTS OF KMC
Kangaroo Position (Skin-to-Skin Contact):
Vertical Position: Infant placed between mother’s breasts under clothes.
Posture: Hips flexed and abducted (“frog position”); head turned to one side/extended for airway patency.
Maternal Position: Semi-reclining to prevent gastric reflux in the infant.
Exclusive Breastfeeding:
Direct suckling or expression of milk while in position.
Promotes higher rates and longer duration of lactation.
Early Discharge:
Safe discharge from facility once stable and mother is confident.
Continued Follow-up:
Regular monitoring of growth (weight/neurodevelopment) after discharge.
3. TYPES OF KMC
Based on Duration:
Intermittent: For unstable babies or initial adaptation (short sessions).
minimum session should be one hour
Continuous: Ideally >20 hours/day (minimum 8 hours/day for benefit). Interrupted only for diapers.
Based on Timing:
Late/Conventional: Initiated after hemodynamic stability (off respiratory support).
Immediate (iKMC): Initiated within 24 hours of birth, even if on non-invasive ventilation (CPAP/HFNC).
Based on Setting:
Facility-based: Initiated in NICU/Postnatal ward.
Home-based: Continued care in the community post-discharge.
4. PREREQUISITES (ELIGIBILITY)
A. Neonatal Eligibility
Indication: All preterm and LBW neonates.
Stability: Hemodynamically stable (no shock/vasopressors).
Permitted Support: Can be done with IV fluids, Orogastric tube, or Non-invasive ventilation (CPAP).
Apnea: Not a contraindication (KMC reduces apnea episodes).
Contraindications: Hemodynamic instability (shock), invasive ventilation (some protocols allow), active seizures, severe jaundice requiring intense phototherapy.
B. Maternal/Caregiver Prerequisites
Willingness: Mother must be counseled and motivated.
Health: Free from serious illness or active infections.
Hygiene: Daily bath, clean clothes, short fingernails.
Support: Family members (father/grandparents) needed to relieve mother for breaks.
C. Facility Requirements
Infrastructure: Reclining chairs, open visitation policy, “Mother-NICU” beds.
Staff: Trained to support positioning and breastfeeding.
5. BENEFITS OF KMC
A. Mortality and Survival
Mortality Reduction: Reduces neonatal mortality by ~40% (22% even with immediate initiation).
Survival: Significant survival benefit irrespective of birth weight or setting.
B. Morbidity Reduction
Hypothermia: Reduces risk by ~68% (Mother acts as a heat source).
Sepsis: Significant reduction in severe infections/nosocomial sepsis.
Apnea: Reduces episodes by 60% due to sensory stimulation and upright posture.
Stability: Improved heart rate and oxygen saturation stability.
C. Growth and Development
Physical Growth: Better daily weight gain (15-20 g/kg/day), length, and head circumference.
Breastfeeding: Higher rates of exclusive breastfeeding at discharge.
Neurodevelopment: Reduced school absenteeism and behavioral problems (hyperactivity/aggression) at 20 years of age.
Analgesia: Reduces pain scores during minor procedures (e.g., heel prick).
Reduced stress - reduced cortisol levels
6. DISCHARGE CRITERIA
Weight Gain: 15–20 g/kg/day for 3 consecutive days.
Thermoregulation: Maintains temperature at room temperature for 3 consecutive days.
Feeding: Accepting breast milk well (direct/spoon/paladai).
Confidence: Mother confident in handling the baby.