Nathalie Charpak, Rejean Tessier, Juan G. Ruiz, Jose Tiberio
Hernandez, Felipe Uriza, Julieta Villegas, Line Nadeau, Catherine Mercier,
Francoise Maheu, Jorge Marin, Darwin Cortes, Juan Miguel Gallego, Dario Maldonado. Twenty-year Follow-up of Kangaroo Mother Care
Versus Traditional Care. Pediatrics. In press.
Abstract
BACKGROUND AND OBJECTIVES: Kangaroo mother care (KMC) is a
multifaceted intervention for preterm and low birth weight infants and their
parents. Short- and mid-term benefits of KMC on survival, neurodevelopment,
breastfeeding, and the quality of mother–infant bonding were documented in a
randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The
aim of the present study was to evaluate the persistence of these results in
young adulthood.
METHODS: From 2012 to 2014, a total of 494 (69%) of the 716
participants of the original RCT known to be alive were identified; 441 (62% of
the participants in the original RCT) were re-enrolled, and results for the 264
participants weighing ≤1800 g at birth were analyzed. The KMC and control
groups were compared for health status and neurologic, cognitive, and social
functioning with the use of neuroimaging, neurophysiological, and behavioral
tests.
RESULTS: The effects of KMC at 1 year on IQ and home
environment were still present 20 years later in the most fragile individuals,
and KMC parents were more protective and nurturing, reflected by reduced school
absenteeism and reduced hyperactivity, aggressiveness, externalization, and
socio-deviant conduct of young adults. Neuroimaging showed larger volume of the
left caudate nucleus in the KMC group.
CONCLUSIONS: This study indicates that KMC had significant,
long-lasting social and behavioral protective effects 20 years after the
intervention. Coverage with this efficient and scientifically based health care
intervention should be extended to the 18 million infants born each year who
are candidates for the method.
Charpak N, Ruiz JG, Zupan J, Cattaneo A, Figueroa Z, Tessier
R, Cristo M,
Anderson G, Ludington S, Mendoza S, Mokhachane M, Worku B.
Kangaroo Mother Care:
25 years after. Acta Paediatr. 2005 May;94(5):514-22.
Abstract
The components of the Kangaroo Mother Care (KMC)
intervention, their rational bases, and their current uses in low-, middle-,
and high-income countries are described. KMC was started in 1978 in Bogotá
(Colombia) in response to overcrowding and insufficient resources in neonatal
intensive care units associated with high morbidity and mortality among
low-birthweight infants. The intervention consists of continuous skin-to-skin
contact between the mother and the infant, exclusive breastfeeding, and early
home discharge in the kangaroo position. In studies of the physiological
effects of KMC, the results for most variables were within clinically
acceptable ranges or the same as those for premature infants under other forms
of care. Body temperature and weight gain are significantly increased, and a
meta-analysis showed that the kangaroo position increases the uptake and duration
of breastfeeding. Investigations of the behavioral effects of KMC show rapid
quiescence. The psychosocial effects of KMC include reduced stress, enhancement
of mother-infant bonding, and positive effects on the family environment and
the infant's cognitive development.
CONCLUSION:
Past and current research has clarified some of the rational
bases of KMC and has provided evidence for its effectiveness and safety,
although more research is needed to clearly define the effectiveness of the
various components of the intervention in different settings and for different
therapeutic goals.
______________________________________________________________________________
From the above article
Data from Bogotá suggest that infants allocated to
continuous kangaroo position at 1 y had higher IQs than those given traditional
care (KMC 101.1, control 97.4; p<0.02). At 12 mo of corrected age, a
significantly higher Griffiths score was documented in preterm infants exposed
to KMC (12.9 points higher) who had required intensive care and had been
diagnosed as doubtful or overtly abnormal neurological development at 6 mo.
This may be explained in part by the fact that KMC families (particularly mothers)
are more sensitive to infant needs, and provide a more stimulating home
environment. They are more active in seeking healthcare, which might have a
positive effect in infants with transient or definitive neurodevelopmental
conditions.
The main effect of the kangaroo position was on the
development of personal relations and on planning functions related to brain
developmental stage at birth. A similar trend was observed by Feldman et al.
The explanations are based on three characteristics of the intervention. The
first is the timing of the intervention, which is started early in hospital, as
soon as the infant's physiological state is stabilized. This early start gives
the infant qualitative compensation for lost intrauterine experience and avoids
input overload. Developmental care during the last weeks of (extrauterine)
gestation positively influences neurodevelopmental functioning and appears to prevent frontal lobe and
attentional difficulties in the neonatal period. The second explanatory
characteristic is the kangaroo position itself, which induces combinations of
sensory modalities: auditory stimulation through the mother's voice, olfactive
stimulation from the proximity of the mother's body, vestibular–kinesthetic
stimulation from the infant's location on the adult's chest, tactile
stimulation from the permanent skin-to-skin contact, and visual stimulation, as
the infant is placed in an upright position (60°), which allows him or her to
see the mother's face and body and contextual elements as she moves around.
Because multimodal sensory stimulation programs have been reported as having
short-term impact on physical and mental maturation, we suggest that this KMC
component may be positively related to mental development. The third
explanation is related to breastfeeding, which will be discussed later.
Holding the infant in the kangaroo position has been
associated with a positive effect on temperament; KMC infants being better
organized and calmer and crying less. KMC also has a positive effect on the
infant's capacity to emit cues and to respond to the mother's requests. KMC
intervention is most effective when started within the first 3 d of life and
when used for high-risk infants.
Breastfeeding as an integral component of KMC might
contribute to significant gains in neurological development and IQ. KMC induces
mothers to breastfeed their infants 42, and mother's milk has been associated
with gains in IQ. A recent meta-analysis 44 clearly identified the short- and
long-term (between 6 mo and 16 y of age) benefits of breastfeeding on cognitive
development. On the basis of this and many previous papers, we believe that
breastfeeding as a component of KMC could contribute to the enhancement of
infants’ mental development.
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