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June 2004 Maternal Warmth: New Hope for Low-birth-weight Infants Every year, more than 20 million infants are born weighing less than five-and-a-half pounds. These low-birth-weight babies are at increased risk of respiratory and gastrointestinal conditions. Low birth weight accounts for nearly one-quarter of the world’s 7 million annual infant deaths. Most infant deaths (99 percent) occur in poor countries and are attributable to inadequate access to health care. Less than half the women in developing countries give birth in health facilities and few of the hospitals in the poorest countries have the capacity to provide the intensive care needed to promptly stabilize low-birth-weight and premature newborns. Kangaroo Mother Care was developed in 1979 at the Maternal and Child Institute of Bogotá, Colombia, specifically to care for low-birth-weight and premature infants in hospitals without sufficient personnel or incubators to lessen the risk of hypothermia and life-threatening respiratory conditions. In Kangaroo Mother Care the mother keeps her baby upright at her breast in constant skin-to-skin contact, helping to regulate the baby’s temperature. At the same time, skin-to-skin contact promotes breastfeeding on demand and maternal–infant bonding. Population Council researcher Nancy Sloan and others have demonstrated that Kangaroo Mother Care prevents respiratory illness in hospital- born, low-birth-weight infants. However, there is no evidence that such care reduces infant mortality, because it is applied only to stabilized infants (those free of major disease, able to suckle or tolerate tube feeding, and with stable body temperature). Most infant mortality occurs prior to stabilization. Nevertheless, Kangaroo Mother Care could prove to be the best means of stabilizing low-weight babies born outside of medical settings. For example, in such countries as Bangladesh, almost all women give birth at home and one-third of the babies are low birth weight. Sloan and a multidisciplinary team of researchers from Ecuador, Bangladesh, and the United States adapted Kangaroo Mother Care for community-based implementation. In Community-based Kangaroo Mother Care, all pregnant women are taught to provide 24- hour skin-to-skin contact immediately after delivery (even while sleeping), to breastfeed on demand, and to delay bathing their newborns. They also are told that healthy, active babies signal when they are ready to stop being held skin to skin, while others will continue to be comfortable with Kangaroo Care for a longer period. In a recently completed pilot study, funded by The William and Flora Hewlett Foundation and conducted by the Population Council, the Bangladesh Rural Advancement Committee, and Mitra and Associates, local workers taught Community-based Kangaroo Mother Care to 35 expectant or recently delivered women. At one month after delivery, over 75 percent of the mothers and 85 percent of women with low-birth-weight babies reported they had initiated skin-to-skin care. With the support of Save the Children’s Saving Newborn Lives Program and the Population Council, Sloan and her colleagues are embarking on a larger study in Bangladesh to determine whether Community-based Kangaroo Mother Care stabilizes low-birth-weight infants whose mothers give birth at home and helps prevent newborn and infant mortality. “Adaptation of Kangaroo Mother Care for community-based application,” by I. Quasem, N. L. Sloan, A. Chowdhury, S. Ahmed, B. Winikoff, and A. M. R. Chowdhury, appeared in the December 2003 Journal of Perinatology. See Also
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