Why skin contact is critical to survival of premature babies

Stephanie lost her child two years ago, a week after she was born. The child was born prematurely, which led to the baby developing complications that could not be addressed or resolved by the doctors.

Her baby, Caroline, was among the over 193,000 children born prematurely (before 37 weeks) in Kenya each year.

Among them, about 13,000 often die out of complications linked to preterm births such as breathing difficulties, feeding problems, liver complications and brain damage.

Most of these children usually require to be put in incubators until their bodies mature to a level where they can be discharged without the risk of developing complications.

But this medical equipment is mostly unavailable or insufficient in most public health facilities across the country. This is a major contributor to the high number of deaths among premature babies.

A low-cost approach known as kangaroo mother care, which is recommended by the World Health Organisation (WHO) can help address this challenge and hasten the recovery process of affected babies.

This is a method of holding a newborn baby, which requires skin-to-skin contact. The baby, who is typically naked except for a diaper and hat, is placed in an upright position against a parent’s bare chest for up to a few hours. A blanket, shirt, hospital gown or robe can be wrapped around the parent and over the baby’s back for warmth.

This greatly helps to improve the survival of premature babies by stabilising their breathing rates and oxygen levels, regulating body temperatures effectively (giving required warmth) and conserving body calories hence promoting weight gain in infants.

Most premature babies are usually underweight (weighing less than 2.5 kilogrammes). And this further increases their risk of developing fatal health complications.

For these premature and underweight babies, the current WHO guidelines recommend that Kangaroo Mother Care should begin after birth once doctors ascertain that they are in a stable condition and devoid of major complications.

However, findings of a new study published in The New England Journal of Medicine indicate that the continuous skin-to-skin contact should begin much earlier — immediately after delivery, even before the baby has been stabilised — for Kangaroo Mother Care to be more effective.

According to the researchers of the study who were based at the Karolinska Institutet, Sweden, about 75 per cent of deaths among premature babies usually occur before the infant is declared stable by healthcare practitioners.

Consequently, they note that the recommendation of delivering Kangaroo Mother Care much earlier to affected babies can contribute immensely to the reduction in deaths among affected infants.

“The idea of giving skin-to-skin contact immediately after delivery to very small, unstable babies has encountered quite strong resistance, yet most deaths occur before the infant has been judged sufficiently stable,” says Nils Bergman, one of the lead authors of the study who is also a medical doctor and researcher at the Karolinska Institutet in Sweden.

The new study, which was financed by the Bill and Melinda Gates Foundation and coordinated by the WHO, examined whether immediate kangaroo mother care after delivery leads to even better survival rates for infants with a birth weight (of between 1 to 1.8 kilogrammes) in low- and middle-income countries.

The study was conducted at five university hospitals in Ghana, India, Malawi, Nigeria and Tanzania. In these nations, the death rates for these premature babies before the study, varied between 20 and 30 per cent.

Based on the results of the study, the preterm deaths reduced by 25 percent among infants that received immediate kangaroo mother care, compared to those that did not.

Blood poisoning

There were also significantly fewer babies with low body temperature or bacterial blood poisoning among those that got immediate skin-to-skin contact.

“The main message is that low weight newborns should receive skin-to-skin contact immediately after birth and subsequently at a mother-infant care unit, where mothers and babies are looked after together without having to be separated,” says Björn Westrup, another lead author of the study and researcher at the Department of Women’s and Children’s Health in the Karolinska Institutet.

“Our results suggest that this care model, which in itself isn’t resource-demanding, could have significant health effects.”

The researchers estimate that delivering immediate kangaroo mother care to premature babies has the potential to save the lives of an additional 150,000 small newborns each year.

“Keeping the mother and baby together right from birth, with zero separation, will revolutionise the way neonatal intensive care is practised for babies born early or small,” says Dr Rajiv Bahl, the WHO Head of Maternal and Newborn Health Research and Development, who was also the coordinator of the study.

He states: “This study illustrates that kangaroo mother care has the potential to save many more lives if it is started immediately after birth. This is a finding with relevance for countries of all income levels.”

The WHO is currently in the process of reviewing its current recommendations on kangaroo mother care, published in 2015, in light of new evidence.