The new era is moving more towards AI-based care, where everything is technology-driven, and the role of humans is slowly decreasing. But in NICUs, we are seeing something different. Over the past 40-45 years, which started as a spark from Colombia by Mr Bogota, the concept of humanised care through the human touch, Kangaroo Mother Care, has been evolving slowly.
Although there was a lot of resistance in the beginning, neonatologists, hospital management, and the broader healthcare system have now acknowledged that Kangaroo mother care is evidence-based and proven beyond doubt. It is causing a paradigm shift in the care that we provide to neonates admitted to NICU.
What is kangaroo mother care?
Kangaroo Mother Care (KMC) is the continuous skin-to-skin contact between a mother and her baby. This is mainly recommended for premature babies born before 37 weeks of gestation and those with a birth weight of less than 2,500 grams. When a mother and baby are in skin-to-skin contact, the pre-term baby, whose brain and body are still immature, is given a stress-free environment where there is warmth, appropriate sound, stimulation through smell and touch, much like how it is in the womb. It basically mimics the intrauterine environment, which no incubator can replicate.
Incubators, however technologically advanced they become, can’t provide the human touch a mother gives, nor can they mimic the sounds that the baby heard inside the womb – the mother’s heartbeat, the whooshing sound of her blood vessels, or her smell.
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These are important for the preterm baby because, after birth, they are exposed to bright lights, harsh environment, or loud monitor alarms – all of which have detrimental effects on the still-developing brain. So, when we provide a developmental supportive care or a healing environment, it protects the baby’s sleep, the right amount of sensory stimulation, and promotes healthy neural connections.
KMC can be provided not only by the mother but also by the father, which is now actively encouraged in modern NICUs, and in some cases by grandparents as well.
How KMC benefits the baby?
At a physiological level, skin-to-skin contact releases hormones such as oxytocin, dopamine, and endorphins in the baby's brain. This helps in better gut-brain axis formation, improves the baby's ability to assimilate milk, promotes weight gain, and reduces stress hormones. This, in turn, helps develop the immune system, particularly T-cell immunity and cell-mediated immunity.
In measurable outcomes, standard KMC, as defined by the WHO as at least 8 hours per day for stable preterm or low birth weight infants, reduces mortality by 32 - 40%. So, the longer the duration of KMC, the greater the benefit. There is also about 45% reduction in neonatal sepsis with standard KMC.
Immediate KMC involves skin-to-skin contact within the first 2 hours of life, even for babies on ventilators or invasive respiratory support, provided they are hemodynamically stable. A large multi-centric study published in the New England Journal of Medicine 2 years ago found that immediate KMC reduces neonatal sepsis by almost 60%. It also reduces hypothermia, apnea (cessation of breathing), and neonatal hypoglycemia.
KMC is also known for better long-term neural connections and sensory development, leading to improved cognition, motor development, and academic performance.
How KMC benefits the mother?
When skin-to-skin contact is initiated early, it releases oxytocin, the love hormone, in the mother, which lowers stress hormones – cortisol and epinephrine. This leads to better uterine contractions, reducing the risk of postpartum haemorrhage, postpartum depression and the separation anxiety mothers experience when their babies are admitted to the NICU.
There is also a remarkable immunological benefit known as the enteromammary axis. When the mother is present in the NICU, she is exposed to the hospital-specific pathogens in the environment. Her immune system responds by producing secretory IgA antibodies, which travel from her gut to her breast and are delivered to the baby through breast milk. This means the baby receives targeted antibodies against the very bacteria it is being exposed to in the NICU, lowering the risk of sepsis.
KMC also increases mother-infant bonding. The fear and hesitation a mother may feel when first encountering her tiny, fragile baby are gone when she is holding her child from the very beginning. KMC has advantages for the hospital as well as the community as well. It is cost-effective since no equipment is needed other than a comfortable reclining chair for the mother.
M-NICU: A possibility
In the near future, neonatal care will be reshaped by a Mother-Neonatal ICU (M-NICU) model, which will ensure zero separation between mother and baby, right from the moment of delivery to discharge from the hospital. This approach will ensure that even critically ill, very small preterm babies can experience the constant, life-saving power of a mother's touch, without interruption, and without separation.
India was part of a multi-centric study on this model, which demonstrated tremendous reductions in morbidity and significant improvements in the survival of preterm and low birth weight infants. Rather than simply placing a maternal bed next to a radiant warmer, the M-NICU model integrates the care of both mother and baby within a single shared environment, with joint clinical rounds.
This article is authored by Dr Anjali S Raj, Consultant - Neonatology, Manipal Hospital, Kanakapura Road.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
