Project Details

Effect of Kangaroo Care on Pre-adolescent Outcomes: 10-year NICU Follow-up

Nisha Fahey, DO

Summary

BACKGROUND: Fifteen to twenty percent of all births worldwide are low birth weight or premature, one quarter of which occur in India, making it the epicenter of this problem. Low birth weight and prematurity contribute to neonatal death, stunted growth, cognitive deficits, and chronic comorbidity. GAP: Kangaroo Care is a low-cost method that can mitigate consequences of low birth weight and prematurity; however, it is yet to be widely accepted and integrated in routine practice. More research is needed to understand the potential long-term benefits of Kangaroo Care among former neonates admitted to the Neonatal Intensive Care Unit (NICU), including child growth, cognitive development, and chronic morbidity. HYPOTHESIS: We hypothesize that in comparison to pre-adolescent children who did not receive Kangaroo Care during NICU hospitalization, those who received Kangaroo Care will have improved physical growth, enhanced cognitive development, and reduced morbidity and mortality. METHODS: This prospective cohort study followed a cohort of children who were hospitalized in a NICU in rural India between 2011-2014 with follow-up home visits conducted between 2021-2022. Standardized and validated methods were used to measure height, weight, reading ability, and mathematics skills in addition to survey-based data collection for demographics, family characteristics, and major morbidity history. Data were combined with hospital EMR data from their NICU hospitalization. This combined dataset was used to calculate propensity scores for receiving Kangaroo Care and a frailty index to adjust for possible confounding by indication in the NICU setting. Multivariable regression models were used to estimate treatment effects at the time of follow-up. RESULTS: In total, 475 of the 708 children or their families were recontacted in the follow-up period. Among the 305 living children at the time of follow-up, those who received Kangaroo Care were older and more likely to be male (p < 0.001). Receiving Kangaroo Care was associated with decreased odds of mortality, anthropometric failure, or cognitive delay. Adjustments for baseline frailty or their propensity to receive Kangaroo Care did not considerably change these associations. IMPACT: This represents the first longitudinal study of Kangaroo Care among children in India and found that not only was Kangaroo Care associated with reduced mortality among high-risk neonates, those that survived to early childhood also had a lower likelihood of having physical or cognitive deficits.