Status: Funded - Open
The impact of kangaroo mother care on mortality in clinically unstable preterm infants in Uganda
Melissa Morgan, MD, MSc
BACKGROUND: Each year, 15 million babies are born preterm and 1 million deaths occur as a result. Facility-based kangaroo mother care (KMC) for infants weighing ≤2000g is associated with a 51% reduction in mortality, 58% reduction in sepsis, and 77% reduction in hypothermia. World Health Organization guidelines state that KMC “should be initiated in healthcare facilities as soon as newborns are clinically stable;” however, the majority of deaths occur in babies who are unstable from the time of birth.
GAP: There is uncertainty in the effect of KMC in unstable babies and a need for a well-designed randomized controlled trial (RCT) that initiates KMC within 48 hours after birth to examine the effect on mortality versus conventional incubator care.
HYPOTHESIS: Unstable infants weighing ≤2000g in the KMC group will have a 25% relative reduction in mortality and a 15% relative reduction in length of stay compared to infants receiving incubator care. KMC for unstable infants will be acceptable to providers and parents at Jinja Hospital.
METHODS: This will be a parallel group RCT with the intervention arm receiving KMC and the control arm receiving incubator care per current hospital practice. Infants in both arms will receive other available interventions according to existing national guidelines. The trial will enroll infants who are born alive weighing ≥700g and ≤2000g; admitted within 48 hours; have no congenital anomalies or severe problems that preclude safe use of KMC; and clinically unstable (defined by need for ≥2 of the following: oxygen, CPAP, IV fluids, antibiotics, or anticonvulsants). Further, the mother must be able and willing to participate in KMC.
IMPACT: Should this trial demonstrate that KMC is effective in reducing mortality; this will have broad applicability for the care of preterm infants, informing policies for unstable infants in LMIC in the next 5 years.
University of California, San Francisco