Did you know the benefits of skin-to-skin holding are greater when babies are held longer?

In NICUs, Kangaroo Mother Care (KMC) has been used since 1978 in order to promote a neutral thermal environment, breastfeeding, neurodevelopment and growth, but what is the duration and frequency of KMC that shows the most benefit?

Charpak et al performed a Cochrane review of randomized controlled trials (RCT) published up unto 2017, of premature and low birth weight infants that compared the growth of KMC with conventional NICU care.  13 RCTs met all inclusion criteria for the meta-analysis, and included a total of 1461 infants.  Growth in weight, head circumference, and length were analyzed.  Weights were further analyzed in grams per day and grams per kilogram per day.  Systematic reviews showed consistency in the short-term benefits of skin to skin such as stable vital signs, increased milk production, increased breastfeeding, improved sleep, and decreased stress, despite duration.  But for growth, 3 intervals were more closely examined, less than 2 hours a day, 2-6 hours a day, and greater than 6 hours a day.

Results showed that infants who received KMC for at least 6 hours per day gained more weight than conventional care with a mean difference of 8.99 grams per day.  There was also a positive difference seen in infants who received KMC for 2-6 hours a day, although it was less at a mean gain of 3.67 grams per day.  There was no statistical difference in weight gain in those infants who received KMC for less than 2 hours per day.  Researchers further examined weight gain in several groups of infants by birth weight.  Infants weighing 1000-1500 grams and 1500-1750 grams at birth showed a statistically significant weight gain, but infants <1500 grams at birth showed no significant weight gain even with KMC care >8 hours per day.  When examining length gain, researchers found that babies who received KMC >6 hours per day gained more length than babies receiving conventional care, but no difference with babies who received <6 hours per day of KMC.  This was also found to be true for head circumference.  Greater than 6 hours was the magic number for head growth as well.

All of these findings show that the effects of KMC on growth are directly related to frequency and duration, likely from the thermoregulation and an increase in breastmilk production.  This study does not negate the short-term benefits of skin to skin, and families should be encouraged to perform skin to skin holding as much as possible to promote bonding, attachment, decrease depression and anxiety, promote parental confidence, and for mothers, increase milk production.  Babies benefit from skin to skin with the neutral thermal environment, more stable vital signs, improved digestion, improved sleep, decreased stress, and improved development.  Skin to skin holding in any amount has value, but skin to skin holding as soon as possible, as often as possible and for as long as possible shows the most benefit in promoting growth.

Clarke, P., Allen, E., Atouna, S., Cawley, P. (2020). Delivery Room Cuddles for Extremely Preterm Babies and Parents: Concept, Practice, Safety, Parental Feedback. Acta Paediatrica. Doi 10.1111/apa.15716.