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Cochrane Database of Systematic Reviews

Les soins maternels kangourou pour réduire la morbidité et la mortalité chez les nourrissons de faible poids de naissance

Información

DOI:
https://doi.org/10.1002/14651858.CD002771.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 23 agosto 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Neonatología

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Agustin Conde‐Agudelo

    Correspondencia a: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, and Department of Obstetrics and Gynecology, Wayne State University, Detroit, USA

    [email protected]

  • José L Díaz‐Rossello

    Departamento de Neonatologia del Hospital de Clínicas, Montevideo, Uruguay

Contributions of authors

The original review was carried out by Agustin Conde‐Agudelo, Jose L. Diaz‐Rossello, and Jose M. Belizán (Conde‐Agudelo 2000). The same review authors updated the review in 2003 (Conde‐Agudelo 2003) and 2011 (Conde‐Agudelo 2011). Agustin Conde‐Agudelo and Jose L. Diaz‐Rossello updated the review in 2014 (Conde‐Agudelo 2014). For this update, Dr Agustin Conde‐Agudelo conducted all statistical analyses, wrote the first draft of the review, and revised subsequent drafts in response to feedback. Dr Jose L. Diaz‐Rossello commented on the first draft of the updated review and contributed to the writing of the final draft.

Sources of support

Internal sources

  • (AC‐A) Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI, and Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.

  • (JLD‐R) Departamento de Neonatología del Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.

    Editorial support of the Cochrane Neonatal Review Group has been funded with Federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C

  • National Institute for Health Research, UK.

    Editorial support for Cochrane Neonatal has been funded with funds from a UK National Institute of Health Research Grant (NIHR) Cochrane Programme Grant (13/89/12). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health.

Declarations of interest

None.

Acknowledgements

We thank the following trial authors, who provided additional information on request: Drs Charpak, Sloan, Ludington‐Hoe, Neu, Suman, Miltersteiner, and Murki.

Version history

Published

Title

Stage

Authors

Version

2016 Aug 23

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Review

Agustin Conde‐Agudelo, José L Díaz‐Rossello

https://doi.org/10.1002/14651858.CD002771.pub4

2014 Apr 22

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Review

Agustin Conde‐Agudelo, José L Díaz‐Rossello

https://doi.org/10.1002/14651858.CD002771.pub3

2011 Mar 16

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Review

Agustin Conde‐Agudelo, José M Belizán, Jose Diaz‐Rossello

https://doi.org/10.1002/14651858.CD002771.pub2

2003 Apr 22

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

Review

Agustin Conde‐Agudelo, José M Belizán

https://doi.org/10.1002/14651858.CD002771

Differences between protocol and review

We have updated the Background and Methods sections. After the protocol was published, a new version of the Cochrane Handbook for Systematic Reviews of Interventions recommended a new approach to assess risk of bias. We changed our method of assessment to be consistent with these recommendations. We decided to group studies into continuous KMC and intermittent KMC after looking at variation in the interventions. We changed the labels for most primary and secondary outcomes and performed several new subgroup and sensitivity analyses. In the latest version of this review, we have included studies that evaluated KMC before stabilization, intermittent KMC, and early‐onset KMC.

In this updated review, we have added the method and plan for 'Summary of findings' tables and GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) recommendations; these were not included in the original protocol.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram: review update
Figuras y tablas -
Figure 1

Study flow diagram: review update

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.1 Mortality at latest follow‐up.
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.1 Mortality at latest follow‐up.

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.2 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.2 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.10 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.10 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Figure 6

Forest plot of comparison: 1 Kangaroo mother care versus conventional neonatal care, outcome: 1.34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 1 Mortality at discharge or at 40 to 41 weeks' postmenstrual age.
Figuras y tablas -
Analysis 1.1

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 1 Mortality at discharge or at 40 to 41 weeks' postmenstrual age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 2 Mortality at 6 months of age or 6 months' follow‐up.
Figuras y tablas -
Analysis 1.2

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 2 Mortality at 6 months of age or 6 months' follow‐up.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 3 Mortality at 12 months' corrected age.
Figuras y tablas -
Analysis 1.3

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 3 Mortality at 12 months' corrected age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 4 Mortality at latest follow‐up.
Figuras y tablas -
Analysis 1.4

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 4 Mortality at latest follow‐up.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 5 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.5

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 5 Severe infection/sepsis at latest follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 6 Severe illness at 6 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.6

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 6 Severe illness at 6 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 7 Nosocomial infection/sepsis at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Analysis 1.7

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 7 Nosocomial infection/sepsis at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 8 Mild/moderate infection or illness at latest follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.8

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 8 Mild/moderate infection or illness at latest follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 9 Lower respiratory tract disease at 6 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.9

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 9 Lower respiratory tract disease at 6 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 10 Diarrhea at 6 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.10

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 10 Diarrhea at 6 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 11 Hypothermia at discharge or at 40 to 41 weeks’ postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Analysis 1.11

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 11 Hypothermia at discharge or at 40 to 41 weeks’ postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 12 Hyperthermia at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Analysis 1.12

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 12 Hyperthermia at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 13 Length of hospital stay (days) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.13

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 13 Length of hospital stay (days) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 14 Re‐admission to hospital at latest follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.14

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 14 Re‐admission to hospital at latest follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 15 Weight at discharge or at 40 to 41 weeks' postmenstrual age (g) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.15

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 15 Weight at discharge or at 40 to 41 weeks' postmenstrual age (g) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 16 Weight at 6 months' corrected age (g) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.16

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 16 Weight at 6 months' corrected age (g) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 17 Weight at 12 months' corrected age (g) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.17

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 17 Weight at 12 months' corrected age (g) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 18 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.18

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 18 Weight gain at latest follow‐up (g/d) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 19 Length at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.19

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 19 Length at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 20 Length at 6 months' corrected age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.20

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 20 Length at 6 months' corrected age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 21 Length at 12 months' corrected age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.21

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 21 Length at 12 months' corrected age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 22 Length gain at latest follow‐up (cm/wk) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.22

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 22 Length gain at latest follow‐up (cm/wk) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 23 Head circumference at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.23

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 23 Head circumference at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 24 Head circumference at 6 months' corrected age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.24

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 24 Head circumference at 6 months' corrected age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 25 Head circumference at 12 months' corrected age (cm) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.25

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 25 Head circumference at 12 months' corrected age (cm) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 26 Head circumference gain at latest follow‐up (cm/wk) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.26

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 26 Head circumference gain at latest follow‐up (cm/wk) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 27 Psychomotor development (Griffith quotients) at 12 months' corrected age.
Figuras y tablas -
Analysis 1.27

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 27 Psychomotor development (Griffith quotients) at 12 months' corrected age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 28 Cerebral palsy at 12 months' corrected age.
Figuras y tablas -
Analysis 1.28

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 28 Cerebral palsy at 12 months' corrected age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 29 Deafness at 12 months' corrected age.
Figuras y tablas -
Analysis 1.29

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 29 Deafness at 12 months' corrected age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 30 Visual impairment at 12 months' corrected age.
Figuras y tablas -
Analysis 1.30

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 30 Visual impairment at 12 months' corrected age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 31 Exclusive breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Analysis 1.31

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 31 Exclusive breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 32 Exclusive breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.32

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 32 Exclusive breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 33 Exclusive breastfeeding at 6 to 12 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.33

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 33 Exclusive breastfeeding at 6 to 12 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.
Figuras y tablas -
Analysis 1.34

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 35 Any breastfeeding at 1 to 2 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.35

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 35 Any breastfeeding at 1 to 2 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 36 Any breastfeeding at 3 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.36

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 36 Any breastfeeding at 3 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 37 Any breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.37

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 37 Any breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 38 Any breastfeeding at 6 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.38

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 38 Any breastfeeding at 6 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 39 Any breastfeeding at 12 months' follow‐up ‐ stabilized infants.
Figuras y tablas -
Analysis 1.39

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 39 Any breastfeeding at 12 months' follow‐up ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 40 Onset of breastfeeding (days) ‐ stabilized infants.
Figuras y tablas -
Analysis 1.40

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 40 Onset of breastfeeding (days) ‐ stabilized infants.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 41 Parental and familial satisfaction (continuous KMC).
Figuras y tablas -
Analysis 1.41

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 41 Parental and familial satisfaction (continuous KMC).

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 42 Mother‐infant attachment: mother's feelings and perceptions according to interval between birth and start of intervention, and infant admission to NICU.
Figuras y tablas -
Analysis 1.42

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 42 Mother‐infant attachment: mother's feelings and perceptions according to interval between birth and start of intervention, and infant admission to NICU.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 43 Mother‐infant attachment: mother's responses to the infant according to interval between birth and start of intervention, and infant admission to NICU.
Figuras y tablas -
Analysis 1.43

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 43 Mother‐infant attachment: mother's responses to the infant according to interval between birth and start of intervention, and infant admission to NICU.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 44 Mother‐infant attachment: infant's responses to the mother according to interval between birth and start of intervention, and infant admission to NICU.
Figuras y tablas -
Analysis 1.44

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 44 Mother‐infant attachment: infant's responses to the mother according to interval between birth and start of intervention, and infant admission to NICU.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 45 Mother‐infant attachment at 3 months' follow‐up.
Figuras y tablas -
Analysis 1.45

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 45 Mother‐infant attachment at 3 months' follow‐up.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 46 Mother‐infant attachment: stress in NICU.
Figuras y tablas -
Analysis 1.46

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 46 Mother‐infant attachment: stress in NICU.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 47 Mother‐infant attachment: parenting skills.
Figuras y tablas -
Analysis 1.47

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 47 Mother‐infant attachment: parenting skills.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 48 Mother‐infant interaction at 6 months' follow‐up.
Figuras y tablas -
Analysis 1.48

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 48 Mother‐infant interaction at 6 months' follow‐up.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 49 Infant behavior at 40 to 44 weeks’ postmenstrual age.
Figuras y tablas -
Analysis 1.49

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 49 Infant behavior at 40 to 44 weeks’ postmenstrual age.

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 50 Social and home environment.
Figuras y tablas -
Analysis 1.50

Comparison 1 Kangaroo mother care versus conventional neonatal care, Outcome 50 Social and home environment.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 1 Mortality at 4 weeks of age.
Figuras y tablas -
Analysis 2.1

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 1 Mortality at 4 weeks of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 2 Morbidity at 4 weeks of age.
Figuras y tablas -
Analysis 2.2

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 2 Morbidity at 4 weeks of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 3 Severe infection at 4 weeks of age.
Figuras y tablas -
Analysis 2.3

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 3 Severe infection at 4 weeks of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 4 Re‐admission to hospital at 4 weeks of age.
Figuras y tablas -
Analysis 2.4

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 4 Re‐admission to hospital at 4 weeks of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 5 Hypothermia.
Figuras y tablas -
Analysis 2.5

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 5 Hypothermia.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 6 Hyperthermia.
Figuras y tablas -
Analysis 2.6

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 6 Hyperthermia.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 7 Weight gain (grams).
Figuras y tablas -
Analysis 2.7

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 7 Weight gain (grams).

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 8 Exclusive breastfeeding.
Figuras y tablas -
Analysis 2.8

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 8 Exclusive breastfeeding.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 9 Length of hospital stay (days).
Figuras y tablas -
Analysis 2.9

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 9 Length of hospital stay (days).

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 10 Mortality at 6 months of age.
Figuras y tablas -
Analysis 2.10

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 10 Mortality at 6 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 11 Re‐admission to hospital at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.11

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 11 Re‐admission to hospital at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 12 Stunting at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.12

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 12 Stunting at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 13 Severe stunting at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.13

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 13 Severe stunting at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 14 Wasting at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.14

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 14 Wasting at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 15 Severe wasting at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.15

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 15 Severe wasting at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 16 Underweight at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.16

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 16 Underweight at 6 to 12 months of age.

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 17 Severe underweight at 6 to 12 months of age.
Figuras y tablas -
Analysis 2.17

Comparison 2 Early versus late kangaroo mother care in relatively stable LBW infants, Outcome 17 Severe underweight at 6 to 12 months of age.

Summary of findings for the main comparison. Kangaroo mother care versus conventional neonatal care for reducing morbidity and mortality in low birthweight infants

Kangaroo mother care versus conventional neonatal care for reducing morbidity and mortality in low birthweight infants

Patient or population: infants with low birthweight
Settings: neonatal intensive care unit/newborn nursery/home
Intervention: kangaroo mother care
Comparison: conventional neonatal care

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Conventional neonatal care

Kangaroo mother care

Mortality at latest follow‐up

Study population

RR 0.67
(0.48 to 0.95)

2293
(12 studies)

⊕⊕⊕⊝
moderatea

60 per 1000

40 per 1000
(29 to 57)

Moderate

30 per 1000

20 per 1000
(14 to 28)

Severe infection/sepsis at latest follow‐up ‐ stabilized infants

Study population

RR 0.5
(0.36 to 0.69)

1463
(8 studies)

⊕⊕⊕⊝
moderatea

131 per 1000

65 per 1000
(47 to 90)

Moderate

162 per 1000

81 per 1000
(58 to 112)

Hypothermia at discharge or at 40 to 41 weeks’ postmenstrual age ‐ stabilized infants

Study population

RR 0.28
(0.16 to 0.49)

989
(9 studies)

⊕⊕⊕⊝
moderateb

271 per 1000

76 per 1000
(43 to 133)

Moderate

333 per 1000

93 per 1000
(53 to 163)

Weight gain at latest follow‐up (g/d) ‐ stabilized infants

Mean weight gain at latest follow‐up (g/d) ‐ stabilized infants in the intervention groups ‐ was
4.08 higher
(2.3 to 5.86 higher)

1198
(11 studies)

⊕⊕⊕⊝
moderatec

Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants

Study population

RR 1.2
(1.07 to 1.34)

1696
(10 studies)

⊕⊕⊕⊝
moderated

762 per 1000

914 per 1000
(815 to 1000)

Moderate

743 per 1000

892 per 1000
(795 to 996)

Any breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants

Study population

RR 1.17
(1.05 to 1.31)

1394
(9 studies)

⊕⊕⊝⊝
lowa,e

711 per 1000

832 per 1000
(747 to 932)

Moderate

622 per 1000

728 per 1000
(653 to 815)

Griffith quotient for psychomotor development (all subscales) at 12 months' corrected age (copy)

Mean Griffith quotient for psychomotor development (all subscales) at 12 months' corrected age (copy) in the intervention groups was
1.05 higher
(0.75 lower to 2.85 higher)

579
(1 study)

⊕⊕⊝⊝
lowf,g

*The basis for the assumed risk (eg, median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI = confidence interval; RR = risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aMost of the pooled effect provided by studies with moderate or high risk of bias
bSubstantial heterogeneity (I2 = 52%)
cSubstantial heterogeneity (I2 = 86%)
dSubstantial heterogeneity (I2 = 80%)
eSubstantial heterogeneity (I2 = 62%)
fEffect provided by 1 study with moderate risk of bias
gWide 95% CI

Figuras y tablas -
Summary of findings for the main comparison. Kangaroo mother care versus conventional neonatal care for reducing morbidity and mortality in low birthweight infants
Comparison 1. Kangaroo mother care versus conventional neonatal care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality at discharge or at 40 to 41 weeks' postmenstrual age Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 All studies

8

1736

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.39, 0.92]

1.2 Intermittent KMC

5

619

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.19, 1.81]

1.3 Continuous KMC

3

1117

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.38, 0.96]

1.4 Duration of KMC < 2 hours/d

2

188

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.22, 7.73]

1.5 Duration of KMC between 6 and 15 hours/d

3

431

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.07, 1.64]

1.6 Duration of KMC ≥ 20 hours/d

3

1117

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.38, 0.96]

1.7 Infant age ≤ 10 days at initiation of KMC

5

1412

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.36, 0.88]

1.8 Infant age > 10 days at initiation of KMC

3

324

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.22, 7.73]

1.9 Low/middle‐income countries

7

1676

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.37, 0.89]

1.10 High‐income countries

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [0.16, 17.09]

1.11 infant entered into trial before stabilization

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.33, 1.00]

1.12 infant entered into trial after stabilization

7

1613

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.32, 1.23]

2 Mortality at 6 months of age or 6 months' follow‐up Show forest plot

2

354

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.48, 2.02]

2.1 Intermittent

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.15, 6.90]

2.2 Continuous

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.46, 2.12]

3 Mortality at 12 months' corrected age Show forest plot

1

693

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.27, 1.17]

3.1 Intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Continuous

1

693

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.27, 1.17]

4 Mortality at latest follow‐up Show forest plot

12

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 All studies

12

2293

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.48, 0.95]

4.2 Intermittent KMC

8

909

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.26, 1.77]

4.3 Continuous KMC

4

1384

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.46, 0.98]

4.4 Duration of KMC < 2 hours/d

3

259

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.32, 4.30]

4.5 Duration of KMC between 6 and 15 hours/d

5

650

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.07, 1.64]

4.6 Duration of KMC ≥ 20 hours/d

4

1384

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.46, 0.98]

4.7 Infant age ≤ 10 days at initiation of KMC

6

1489

Risk Ratio (M‐H, Fixed, 95% CI)

0.56 [0.37, 0.85]

4.8 Infant age > 10 days at initiation of KMC

5

678

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.53, 2.00]

4.9 Low/middle‐income countries

10

2162

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.45, 0.93]

4.10 High‐income countries

2

131

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.29, 5.42]

4.11 Infant entered into trial before stabilization

1

123

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.33, 1.00]

4.12 Infant entered into trial after stabilization

11

2170

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.47, 1.13]

5 Severe infection/sepsis at latest follow‐up ‐ stabilized infants Show forest plot

8

1463

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.36, 0.69]

5.1 Intermittent

7

800

Risk Ratio (M‐H, Fixed, 95% CI)

0.38 [0.24, 0.60]

5.2 Continuous

1

663

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.43, 1.12]

6 Severe illness at 6 months' follow‐up ‐ stabilized infants Show forest plot

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.14, 0.67]

6.1 intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Continuous

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.14, 0.67]

7 Nosocomial infection/sepsis at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants Show forest plot

5

1239

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.22, 0.54]

7.1 Intermittent

4

576

Risk Ratio (M‐H, Fixed, 95% CI)

0.27 [0.15, 0.50]

7.2 Continuous

1

663

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.25, 0.93]

8 Mild/moderate infection or illness at latest follow‐up ‐ stabilized infants Show forest plot

4

1266

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.87, 1.88]

8.1 Intermittent

2

320

Risk Ratio (M‐H, Random, 95% CI)

1.52 [0.43, 5.38]

8.2 Continuous

2

946

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.53, 3.79]

9 Lower respiratory tract disease at 6 months' follow‐up ‐ stabilized infants Show forest plot

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.15, 0.89]

9.1 Intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 Continuous

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.15, 0.89]

10 Diarrhea at 6 months' follow‐up ‐ stabilized infants Show forest plot

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.35, 1.20]

10.1 Intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10.2 Continuous

1

283

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.35, 1.20]

11 Hypothermia at discharge or at 40 to 41 weeks’ postmenstrual age ‐ stabilized infants Show forest plot

9

989

Risk Ratio (M‐H, Random, 95% CI)

0.28 [0.16, 0.49]

11.1 Intermittent

9

989

Risk Ratio (M‐H, Random, 95% CI)

0.28 [0.16, 0.49]

11.2 Continuous

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

12 Hyperthermia at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants Show forest plot

4

448

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.59, 1.05]

12.1 Intermittent

4

448

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.59, 1.05]

12.2 Continuous

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Length of hospital stay (days) ‐ stabilized infants Show forest plot

11

1057

Mean Difference (IV, Random, 95% CI)

‐1.61 [‐3.41, 0.18]

13.1 Intermittent

11

1057

Mean Difference (IV, Random, 95% CI)

‐1.61 [‐3.41, 0.18]

13.2 Continuous

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Re‐admission to hospital at latest follow‐up ‐ stabilized infants Show forest plot

2

946

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.34, 1.06]

14.1 Intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14.2 Continuous

2

946

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.34, 1.06]

15 Weight at discharge or at 40 to 41 weeks' postmenstrual age (g) ‐ stabilized infants Show forest plot

5

1233

Mean Difference (IV, Fixed, 95% CI)

16.07 [‐20.54, 52.68]

15.1 Intermittent

3

285

Mean Difference (IV, Fixed, 95% CI)

41.84 [‐19.19, 102.87]

15.2 Continuous

2

948

Mean Difference (IV, Fixed, 95% CI)

1.59 [‐44.16, 47.34]

16 Weight at 6 months' corrected age (g) ‐ stabilized infants Show forest plot

1

591

Mean Difference (IV, Fixed, 95% CI)

78.19 [‐52.26, 208.64]

16.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16.2 Continuous

1

591

Mean Difference (IV, Fixed, 95% CI)

78.19 [‐52.26, 208.64]

17 Weight at 12 months' corrected age (g) ‐ stabilized infants Show forest plot

1

596

Mean Difference (IV, Fixed, 95% CI)

31.46 [‐135.08, 198.00]

17.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 Continuous

1

596

Mean Difference (IV, Fixed, 95% CI)

31.46 [‐135.08, 198.00]

18 Weight gain at latest follow‐up (g/d) ‐ stabilized infants Show forest plot

11

1198

Mean Difference (IV, Random, 95% CI)

4.08 [2.30, 5.86]

18.1 Intermittent

10

913

Mean Difference (IV, Random, 95% CI)

4.13 [2.19, 6.07]

18.2 Continuous

1

285

Mean Difference (IV, Random, 95% CI)

3.60 [0.78, 6.42]

19 Length at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants Show forest plot

3

856

Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.69, 0.48]

19.1 Intermittent

2

193

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐1.51, 1.04]

19.2 Continuous

1

663

Mean Difference (IV, Random, 95% CI)

0.0 [‐0.36, 0.36]

20 Length at 6 months' corrected age (cm) ‐ stabilized infants Show forest plot

1

590

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.18, 0.64]

20.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

20.2 Continuous

1

590

Mean Difference (IV, Fixed, 95% CI)

0.23 [‐0.18, 0.64]

21 Length at 12 months' corrected age (cm) ‐ stabilized infants Show forest plot

1

586

Mean Difference (IV, Fixed, 95% CI)

0.31 [‐0.17, 0.79]

21.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

21.2 Continuous

1

586

Mean Difference (IV, Fixed, 95% CI)

0.31 [‐0.17, 0.79]

22 Length gain at latest follow‐up (cm/wk) ‐ stabilized infants Show forest plot

3

377

Mean Difference (IV, Random, 95% CI)

0.21 [0.03, 0.38]

22.1 Intermittent

3

377

Mean Difference (IV, Random, 95% CI)

0.21 [0.03, 0.38]

22.2 Continuous

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

23 Head circumference at discharge or at 40 to 41 weeks' postmenstrual age (cm) ‐ stabilized infants Show forest plot

3

856

Mean Difference (IV, Random, 95% CI)

0.17 [‐0.33, 0.66]

23.1 Intermittent

2

193

Mean Difference (IV, Random, 95% CI)

0.24 [‐0.84, 1.31]

23.2 Continuous

1

663

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.14, 0.34]

24 Head circumference at 6 months' corrected age (cm) ‐ stabilized infants Show forest plot

1

592

Mean Difference (IV, Fixed, 95% CI)

0.34 [0.11, 0.57]

24.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

24.2 Continuous

1

592

Mean Difference (IV, Fixed, 95% CI)

0.34 [0.11, 0.57]

25 Head circumference at 12 months' corrected age (cm) ‐ stabilized infants Show forest plot

1

597

Mean Difference (IV, Fixed, 95% CI)

0.39 [‐0.00, 0.78]

25.1 Intermittent

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

25.2 Continuous

1

597

Mean Difference (IV, Fixed, 95% CI)

0.39 [‐0.00, 0.78]

26 Head circumference gain at latest follow‐up (cm/wk) ‐ stabilized infants Show forest plot

4

495

Mean Difference (IV, Random, 95% CI)

0.14 [0.06, 0.22]

26.1 Intermittent

4

495

Mean Difference (IV, Random, 95% CI)

0.14 [0.06, 0.22]

26.2 Continuous

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

27 Psychomotor development (Griffith quotients) at 12 months' corrected age Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

27.1 Locomotion

1

579

Mean Difference (IV, Fixed, 95% CI)

2.25 [‐0.45, 4.95]

27.2 Personal, social

1

579

Mean Difference (IV, Fixed, 95% CI)

0.97 [‐1.27, 3.21]

27.3 Hand‐eye coordination

1

579

Mean Difference (IV, Fixed, 95% CI)

0.57 [‐1.25, 2.39]

27.4 Audition, language

1

579

Mean Difference (IV, Fixed, 95% CI)

1.29 [‐0.98, 3.56]

27.5 Execution

1

579

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐1.50, 2.10]

27.6 All criteria

1

579

Mean Difference (IV, Fixed, 95% CI)

1.05 [‐0.75, 2.85]

28 Cerebral palsy at 12 months' corrected age Show forest plot

1

588

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.21, 2.02]

29 Deafness at 12 months' corrected age Show forest plot

1

588

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.03, 2.90]

30 Visual impairment at 12 months' corrected age Show forest plot

1

588

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.53, 1.56]

31 Exclusive breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants Show forest plot

6

1453

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [1.07, 1.25]

31.1 Intermittent

4

511

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [1.11, 1.35]

31.2 Continuous

2

942

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [1.00, 1.24]

32 Exclusive breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants Show forest plot

5

600

Risk Ratio (M‐H, Random, 95% CI)

1.20 [1.01, 1.43]

32.1 Intermittent

3

221

Risk Ratio (M‐H, Random, 95% CI)

1.36 [1.12, 1.65]

32.2 Continuous

2

379

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.96, 1.10]

33 Exclusive breastfeeding at 6 to 12 months' follow‐up ‐ stabilized infants Show forest plot

3

810

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.95, 1.76]

33.1 Intermittent

1

75

Risk Ratio (M‐H, Fixed, 95% CI)

1.52 [1.10, 2.10]

33.2 Continuous

2

735

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.66, 1.86]

34 Any breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age ‐ stabilized infants Show forest plot

10

1696

Risk Ratio (M‐H, Random, 95% CI)

1.20 [1.07, 1.34]

34.1 Intermittent

8

754

Risk Ratio (M‐H, Random, 95% CI)

1.23 [1.07, 1.41]

34.2 Continuous

2

942

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.93, 1.40]

35 Any breastfeeding at 1 to 2 months' follow‐up ‐ stabilized infants Show forest plot

6

538

Risk Ratio (M‐H, Random, 95% CI)

1.33 [1.00, 1.78]

35.1 Intermittent

4

159

Risk Ratio (M‐H, Random, 95% CI)

1.89 [1.30, 2.75]

35.2 Continuous

2

379

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.96, 1.10]

36 Any breastfeeding at 3 months' follow‐up ‐ stabilized infants Show forest plot

5

924

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [1.06, 1.23]

36.1 Intermittent

4

261

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [1.15, 1.59]

36.2 Continuous

1

663

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [1.00, 1.17]

37 Any breastfeeding at 1 to 3 months' follow‐up ‐ stabilized infants Show forest plot

9

1394

Risk Ratio (M‐H, Random, 95% CI)

1.17 [1.05, 1.31]

37.1 Intermittent

6

352

Risk Ratio (M‐H, Random, 95% CI)

1.39 [1.18, 1.64]

37.2 Continuous

3

1042

Risk Ratio (M‐H, Random, 95% CI)

1.05 [1.00, 1.11]

38 Any breastfeeding at 6 months' follow‐up ‐ stabilized infants Show forest plot

5

952

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.98, 1.29]

38.1 Intermittent

3

143

Risk Ratio (M‐H, Fixed, 95% CI)

1.50 [1.08, 2.08]

38.2 Continuous

2

809

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.92, 1.24]

39 Any breastfeeding at 12 months' follow‐up ‐ stabilized infants Show forest plot

1

589

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.65, 1.21]

39.1 Intermittent

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

39.2 Continuous

1

589

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.65, 1.21]

40 Onset of breastfeeding (days) ‐ stabilized infants Show forest plot

2

295

Mean Difference (IV, Random, 95% CI)

0.03 [‐1.64, 1.70]

40.1 Intermittent

2

295

Mean Difference (IV, Random, 95% CI)

0.03 [‐1.64, 1.70]

40.2 Continuous

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

41 Parental and familial satisfaction (continuous KMC) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

41.1 Mother satisfied with method

1

269

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [1.05, 1.30]

41.2 Father satisfied with method

1

269

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.91, 1.14]

41.3 Family satisfied with method

1

269

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.83, 1.13]

42 Mother‐infant attachment: mother's feelings and perceptions according to interval between birth and start of intervention, and infant admission to NICU Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

42.1 Sense of competence ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.41 [0.14, 0.68]

42.2 Sense of competence ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.08, 0.58]

42.3 Sense of competence ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.21 [‐0.17, 0.59]

42.4 Sense of competence ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

0.54 [0.07, 1.01]

42.5 Sense of competence ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.24 [0.05, 0.43]

42.6 Worry and stress ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.31 [0.04, 0.58]

42.7 Worry and stress ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

0.09 [‐0.20, 0.38]

42.8 Worry and stress ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.70, 0.12]

42.9 Worry and stress ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.1 [‐0.60, 0.40]

42.10 Worry and stress ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.12 [‐0.06, 0.30]

42.11 Social support ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.35, 0.23]

42.12 Social support ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.34, 0.22]

42.13 Social support ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐0.84, ‐0.10]

42.14 Social support ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.52, 0.42]

42.15 Social support ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

‐0.2 [‐0.39, ‐0.01]

43 Mother‐infant attachment: mother's responses to the infant according to interval between birth and start of intervention, and infant admission to NICU Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

43.1 Mother's sensitivity ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.02, 0.06]

43.2 Mother's sensitivity ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.05, 0.03]

43.3 Mother's sensitivity ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.06 [0.01, 0.11]

43.4 Mother's sensitivity ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.04, 0.08]

43.5 Mother's sensitivity ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.00, 0.04]

43.6 Mother's response to child's distress ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.08, 0.02]

43.7 Mother's response to child's distress ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.03, 0.05]

43.8 Mother's response to child's distress ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.04, 0.06]

43.9 Mother's response to child's distress ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.01, 0.11]

43.10 Mother's response to child's distress ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.05, 0.01]

43.11 Mother's response to child's socioemotional growth fostering ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.04, 0.06]

43.12 Mother's response to child's socioemotional growth fostering ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.06, 0.02]

43.13 Mother's response to child's socioemotional growth fostering ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.05 [‐0.00, 0.10]

43.14 Mother's response to child's socioemotional growth fostering ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.12, 0.02]

43.15 Mother's response to child's socioemotional growth fostering ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.01, 0.05]

43.16 Mother's response to child's cognitive growth fostering ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.04, 0.08]

43.17 Mother's response to child's cognitive growth fostering ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.10, 0.02]

43.18 Mother's response to child's cognitive growth fostering ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.07 [0.00, 0.14]

43.19 Mother's response to child's cognitive growth fostering ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.17, 0.03]

43.20 Mother's response to child's cognitive growth fostering ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.01, 0.07]

44 Mother‐infant attachment: infant's responses to the mother according to interval between birth and start of intervention, and infant admission to NICU Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

44.1 Clarity of cues ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.04, 0.06]

44.2 Clarity of cues ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.03, 0.07]

44.3 Clarity of cues ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.05, 0.05]

44.4 Clarity of cues ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.07, 0.05]

44.5 Clarity of cues ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.01, 0.05]

44.6 Responsiveness ‐ interval of 1 to 2 days

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.06, 0.02]

44.7 Responsiveness ‐ interval of 3 to 14 days

1

177

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.02, 0.06]

44.8 Responsiveness ‐ interval > 14 days

1

141

Mean Difference (IV, Fixed, 95% CI)

0.05 [0.01, 0.09]

44.9 Responsiveness ‐ infant admitted to NICU

1

82

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.07, 0.05]

44.10 Responsiveness ‐ infant not admitted to NICU

1

406

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.01, 0.05]

45 Mother‐infant attachment at 3 months' follow‐up Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

6.24 [5.57, 6.91]

45.1 Total attachment score at 3 months' follow‐up

1

100

Mean Difference (IV, Fixed, 95% CI)

6.24 [5.57, 6.91]

46 Mother‐infant attachment: stress in NICU Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

46.1 Nursery environment score

1

30

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.51, 0.71]

46.2 Infant appearance score

1

30

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.62, 0.62]

46.3 Relationship with the infant score

1

30

Mean Difference (IV, Fixed, 95% CI)

1.00 [0.35, 1.65]

46.4 Staff behavior and communication score

1

30

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.95, 1.15]

47 Mother‐infant attachment: parenting skills Show forest plot

1

30

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.89, 0.09]

47.1 Total score at discharge

1

30

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.89, 0.09]

48 Mother‐infant interaction at 6 months' follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

48.1 Symmetrical co‐regulation

1

45

Mean Difference (IV, Fixed, 95% CI)

16.38 [13.61, 19.15]

48.2 Asymmetrical co‐regulation

1

45

Mean Difference (IV, Fixed, 95% CI)

‐18.31 [‐21.42, ‐15.20]

48.3 Unilateral regulation

1

45

Mean Difference (IV, Fixed, 95% CI)

2.12 [‐1.24, 5.48]

49 Infant behavior at 40 to 44 weeks’ postmenstrual age Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

49.1 Attention

1

55

Mean Difference (IV, Fixed, 95% CI)

0.29 [‐0.40, 0.98]

49.2 Autonomic organization

1

55

Mean Difference (IV, Fixed, 95% CI)

0.19 [‐0.41, 0.79]

49.3 Motor

1

55

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐0.22, 0.82]

49.4 Orientation

1

55

Mean Difference (IV, Fixed, 95% CI)

‐0.19 [‐0.72, 0.34]

49.5 Autonomic

1

55

Mean Difference (IV, Fixed, 95% CI)

0.11 [‐0.89, 1.11]

49.6 State regulation

1

55

Mean Difference (IV, Fixed, 95% CI)

‐0.31 [‐0.95, 0.33]

49.7 Robust crying

1

55

Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐0.90, 0.58]

49.8 State stability

1

55

Mean Difference (IV, Fixed, 95% CI)

0.32 [‐0.93, 1.57]

50 Social and home environment Show forest plot

1

338

Mean Difference (IV, Fixed, 95% CI)

0.79 [0.74, 0.84]

50.1 HOME environment total score at 12 months' corrected age

1

338

Mean Difference (IV, Fixed, 95% CI)

0.79 [0.74, 0.84]

Figuras y tablas -
Comparison 1. Kangaroo mother care versus conventional neonatal care
Comparison 2. Early versus late kangaroo mother care in relatively stable LBW infants

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality at 4 weeks of age Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

1.95 [0.18, 20.53]

2 Morbidity at 4 weeks of age Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.18, 1.28]

3 Severe infection at 4 weeks of age Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.42 [0.12, 1.49]

4 Re‐admission to hospital at 4 weeks of age Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

1.95 [0.18, 20.53]

5 Hypothermia Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.15, 2.27]

6 Hyperthermia Show forest plot

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.56, 1.99]

7 Weight gain (grams) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 At 24 hours post birth

1

73

Mean Difference (IV, Fixed, 95% CI)

39.16 [11.11, 67.21]

7.2 At 48 hours post birth

1

73

Mean Difference (IV, Fixed, 95% CI)

43.3 [5.49, 81.11]

7.3 At 2 weeks of age

1

73

Mean Difference (IV, Fixed, 95% CI)

12.14 [‐83.18, 107.46]

7.4 At 4 weeks of age

1

73

Mean Difference (IV, Fixed, 95% CI)

58.85 [‐116.93, 234.63]

8 Exclusive breastfeeding Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 At 24 hours of age

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.67, 1.57]

8.2 At 2 weeks of age

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.89, 1.12]

8.3 At 4 weeks of age

1

67

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.85, 1.04]

8.4 At 6 months of age

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

2.69 [0.99, 7.31]

9 Length of hospital stay (days) Show forest plot

1

73

Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐1.24, ‐0.56]

10 Mortality at 6 months of age Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.15, 6.72]

11 Re‐admission to hospital at 6 to 12 months of age Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.32, 3.16]

12 Stunting at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.46, 1.48]

13 Severe stunting at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.17, 2.73]

14 Wasting at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.1 [0.01, 1.77]

15 Severe wasting at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Underweight at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.49 [0.21, 1.14]

17 Severe underweight at 6 to 12 months of age Show forest plot

1

55

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.03, 1.88]

Figuras y tablas -
Comparison 2. Early versus late kangaroo mother care in relatively stable LBW infants