Resource Library

NEST360 is an international alliance united to end preventable newborn deaths in African hospitals. The alliance works to deliver a package of technologies and services that enable local governments to save newborn lives, improve newborn outcomes, and empower the medical workforce for the future. There are a number of resources available to support clinicians, engineers and administrators to implement an evidence-based model for sustainable, high-quality hospital-based newborn care in limited resource settings, including clinical and technical resources, technology resources, implementation resources, and COVID-19 related resources.

Summary

Implementation of KMC is central to achievement of the SDGs for the survival, health and well-being of preterm or LBW infants, both well and sick, through its successful scale-up at all levels of facility care and in the community. Based on the new evidence on successful scale-up of KMC in programmatic settings from several countries, complemented by the joint wisdom and experience of global stakeholders, this implementation strategy is intended to guide the way forward for universal coverage of KMC for all preterm or LBW infants, both well and sick. This implementation strategy is meant to inspire a renewed vision in which mothers and infants are kept and cared for together from birth, and where parents and families play a central role in the care of their infants, thus humanizing health care.

Highlights

Achieving KMC implementation at scale requires:

• A system-wide perspective and structural changes to place mothers and infants at the center of care by keeping and caring for them together after birth
• A commitment by political and program leadership to implement KMC as the foundation of small and/or sick newborn care
• A dedicated budget for implementing KMC as part of small and/or sick newborn care in national maternal, newborn and child health programs
• Developing and implementing a monitoring and evaluation framework to track progress.

How to Use

KMC has been shown to be an essential intervention superior to standard radiant warmer/incubator care in all settings. All countries, irrespective of their income setting and resource availability, should adapt this strategy to their health system contexts to realize the full impact of KMC in improving the survival, health and well-being of mothers and preterm or LBW infants alike.

Summary

The purpose of this document is to put forward the joint position and vision of an expert, global, multi-stakeholder working group on implementing KMC for all preterm or LBW infants as the foundation for small and/or sick newborn care within maternal, newborn and child health programs, and spur collaborative global action. Reversing the long-standing inequities in health care will require prolonged efforts; the scale-up of KMC as an essential service for all mothers and their preterm or LBW infants as a critical component of universal health coverage can serve as the key starting point.

Highlights

• Kangaroo mother care (KMC) is an intervention that enables the mother to take a central role in her own and her newborn’s care, thereby ensuring the power stays with the mother, and health workers support and respond to the mother’s and newborn’s needs.
• It humanizes maternal and newborn care by empowering and involving those who care most for the infant, rather than focusing predominantly on technological solutions.
• KMC can serve as a starting point for broader health-system redesign and service delivery transformation for maternal and newborn care, and a model of what can be accomplished when relevant stakeholders are empowered to play the roles naturally entrusted to them in the care of their newborns.

How to Use

Operationalizing this concept can serve as a strong foundation of highly efficient health systems that are rooted in the communities they serve and focus not only on preventing and treating illness but also on improving well-being and quality of life.

“Kangaroo mother care,” a type of newborn care involving skin-to-skin contact with the mother or other caregiver, reduces mortality in infants with low birth weight (<2.0 kg) when initiated after stabilization, but the majority of deaths occur before stabilization. The safety and efficacy of kangaroo mother care initiated soon after birth among infants with low birth weight are uncertain.

The results of this new clinical trial published in May 2021 provide evidence in support of starting KMC immediately after birth, a clear message that keeping mothers and babies together helps babies to survive and thrive.

Key Findings

• Starting KMC immediately after birth in newborns with birthweight of 1000 grams to 1799 grams has the potential to save up to 150,000 more lives each year (a further increase in survival of 25%), compared with the current recommendation of starting it only once a baby is stable.
• Mother-Newborn Intensive Care Units will be critical to support the mother, or a surrogate, in providing this immediate, ongoing skin-to-skin contact from birth.

Understanding of the lifesaving benefits of KMC for babies born early or small and its continued importance during the COVID-19 pandemic are further strengthened with this new evidence on the benefits of starting the intervention immediately after birth. Among preterm or low birthweight infants, KMC has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%.

This Kangaroo Mother Care (KMC) Implementation Guide provides pertinent guidelines primarily for national-level policymakers and managers of maternal and newborn health programs. Chapters detail key steps in the development, implementation and expansion of sustainable, facility-based KMC services in developing countries.

Personal testimonies discussing the experience of stillbirth can be found on the Healthy Newborn Network blog series on stillbirth here. These testimonies offer an important perspective of the human cost of stillbirth and support advocacy efforts.