Skip to main content
Download PDF

The effect of post discharge Kangaroo mother care with and without telephone advice on anthropometric indexes of preterm newborns: a randomized clinical trial

BMC Pediatrics volume 25, Article number: 221 (2025) Cite this article

Abstract

Background

Kangaroo mother care (KMC) is recommended as a beneficial intervention to promote the wellbeing of preterm infants. This study evaluated the effect of KMC on anthropometric indexes in preterm newborns, with and without telephone advice (TA).

Methods

At a tertiary center, in a single-blinded, randomized controlled trial (RCT), one hundred and five discharged preterm infants from the neonatal intensive care unit (NICU) were randomly allocated into two experimental groups: KMC, KMC with telephone advice (KMC-TA), and conventional care (CC) (35 birthing parent-infant pairs in each group). In two experimental groups, a research assistant trained participants on how to do KMC at home for a maximum of three times, at least 3–4 h daily, during a one-month period. In the KMC-TA group, participants were counseled on KMC by phone, twice a week. In CC group, routine care was provided. Prior to, and at the end of the intervention, anthropometric indexes including the weight, height, head and chest circumferences of neonates were measured in the three groups. The ANOVA, Kruskal–Wallis, Chi-square, Fisher’s exact test, and Bonferroni was used to analyse the data.

Results

After one month, the mean weight of neonates was significantly greater in the two experimental groups when compared to those the CC group (p = 0.006). No significant differences were observed in other anthropometric indexes.

Conclusions

Short–term implementation of KMC has a positive effect on preterm infant weight gain. Optimal implementation strategies for KMC are required, and future research may usefully inform these.

Trial registration

This trial was registered in the Iranian Registry of Clinical Trials with code IRCT201306082324N11 on 28/4/2014. URL of registry https://irct.behdasht.gov.ir/trial/1966.

Highlights

Kangaroo mother care is currently considered one of the most cost-effective interventions promoting the wellbeing of preterm infants.

Short–term implementation of KMC has a positive effect on preterm infant weight gain.

It did not affect other anthropometric measurements.

Peer Review reports

Background

Kangaroo mother care (KMC) is currently considered one of the most cost-effective interventions promoting the wellbeing of preterm infants [1]. Preterm infants experience a higher mortality rate [2], with an increased risk of low birth weight and poor health outcomes, such as poor growth and development [3]. Weight gain is one of the principal factors which predict the future of preterm infant health [4, 5]. The provision of KMC can reduce neonatal mortality [6], and improve weight gain [7,8,9,10,11] alongside other anthropometric indexes in preterm infants [12,13,14,15,16]. Contrary findings have been reported with regards to the effect of KMC on the anthropometric indexes of LBW [17,18,19,20,21]. For example, one meta-analysis of 124 studies in which KMC was compared to routine care, positive head circumference growth was reported in the KMC intervention group, and yet no positive effects were reported in relation to neonates’ length and weight [19], however, a systematic review and meta-analysis reported the positive effect of KMC on length gain in LBW infants [21]. This leaves the opportunity for research to explore how KMC and other interventions may support the wellbeing of preterm neonates most effectively.

Preterm birth is still a global health challenge. Approximately 15 million preterm babies are born worldwide every year [22]. The majority of them are born in low and middle-income countries [23]. Despite World Health Organization (WHO) recommendations, KMC coverage for infants born with LBW has been remained low for more than a decade [24, 25]. KMC is recommended as routine care for all preterm or LBW infants. It can be initiated in facilities or at home and should be given for 8–24 h per day (as many hours as possible) [26]. However, implementing continuous KMC is difficult [27], and parents tend to limit its use [28]. Studies on the effectiveness of KMC following the discharge of neonates are limited [14], and many parents are unaware of the positive effects of KMC and so may not initiate or continue to provide it [29]. This is concerning when KMC is evidenced to improve and accelerate preterm neonatal growth [30].

Essentially, although KMC is recognized as an evidence-based tool for reducing infant mortality, the implementation of KMC is still low [31]. As such the need to identify intervention which will be enhance the implementation of KMC, are urgently required. Telephone advice (TA) as a communication method between patients and health care providers may be effective in increasing access relevant information [32], and thus increase rates of KMC implementation. Nevertheless, more evidence is required to support this hypothesis.

Following scoping searches of the available literature, we concluded few studies have documented the effectiveness of KMC following discharge from the NICU in low-income settings. Considering the above, the aim of this study was to investigate whether providing TA would provide additional benefit. The hypothesis is that KMC with TA encourages the implementation of care and has a greater effect on the anthropometric indexes compared to KMC without TA in preterm neonates following discharge from the NICU.

Methods

Study design

A single-blind, randomized, clinical trial was undertaken with three parallel groups. The study sample included pairs, birthing parents and their premature infants which discharged from the NICU of the Akbar Abadi hospital, affiliated with Iran University of Medical Sciences (IUMS) in Tehran, Iran.

Participants

Participant recruitment commenced once ethical approval was granted by the Research Ethics Committee of the Tehran University of Medical Sciences (TUMS), Tehran, Iran (ethics code: 594/130/92). On the day of their discharge from the NICU, preterm neonates who met the inclusion criteria were identified via medical records. Following explanation of the study’s aims, those who met the inclusion criteria were invited to participate and offer their informed written consent to participate via signature. The three groups included in this trial were demarcated as follows: (1) a KMC only group, (2) a KMC group who also received telephone advice (KMC-TA), and 3), a group providing conventional care (CC) only. Infants with gestational age between 32 and 37 weeks were eligible to participate in the study if they were absent of any anomaly, perinatal asphyxia, intra-ventricular hemorrhage (IVH), intrauterine growth restriction (IUGR), necrotizing enterocolitis (NEC), apnea and sepsis. Birthing parents were eligible to participate if they were aged over 18 years and had no history of illicit drug use during pregnancy. Participants were excluded from the study if they verbally expressed an unwillingness to continue. Non-exclusive breastfeeding, hospitalization, and infant death were also criteria for exclusion.

Sample size

Our sample size (n = 90) was calculated and based upon previous studies [15]. This enabled 30 participants per group to examine differences between the three groups. A power of 90% at a 5% significance level was also calculated for this sample. The effect size was assumed to be 1. We recruited 35 participants allocated to each group to avoid follow-up losses. One hundred five neonates with a gestational age of between 32 and 37 weeks were allocated into KMC, KMC-TA, and CC group (35 pairs in each group).

Randomization and blinding

The allocation of neonates to each group was randomly assigned using six-block size. The selection of blocks was done by an academic separate to the research team who was blind to the group assignment orders (see CONSORT flow diagram, Fig. 1). Neonates were randomly allocated into one of the three groups until sampling was complete. All neonatal anthropometric indexes were measured by a research assistant who was not aware of the aims of this study or the sample’s allocation.

Intervention and outcomes

All participants completed a socio-demographic data questionnaire. Those in the two experimental groups (KMC and KMC-TA) received fabric covers for implementing KMC. In a face-to-face training session delivered by the research team, they were also familiarized as to how to perform KMC at home and its advantages. They were instructed to carry their babies using the KMC method for a maximum of three times daily (3–4 h daily overall) for a period of one month. Neonates in the two experimental groups were placed between the breasts in direct skin contact. The infant’s trunk and extremities were covered using fabric. The neonatal head was covered with a cap/hat. In the KMC-TA group, participants were contacted by phone twice per week and advised as to how to continue caring for their babies using the KMC method correctly and regularly. The first author who had extensive expertise in this field offered participants TA and answered all of their questions regarding the implementation of KMC during this time. The benefits of KMC were emphasized in particular, and the flexibility of undertaking KMC even during daily activities and working at home were highlighted. Those using the KMC method only did not receive any further advice. Participants in the CC group did not receive unique covers or instruction in relation to KMC. They implemented care as usual. All neonates were exclusively breast fed. Prior to discharge and one hour after feeding, a research assistant blinded to group assignment measured neonatal participant’s weight, height, head and chest circumference in the three groups. Neonates were weighed naked on an electronic weighing scale (accuracy of ± 10 gr). The head circumference (occipitofrontal circumference - the head’s widest) and chest circumference were measured using a non-stretchable tape. Height was measured in a supine position using an infant metre. Those in the two experimental groups were given a daily registration checklist to record the duration of KMC. We collected them after the study period. Neonates in the CC group received routine care. Participants in all three groups were instructed to return one month after the baby’s discharge, when they came back to the hospital for a retinopathy examination of the neonate, to re-measure neonates’ anthropometrics indexes. After the intervention period ended, we provided care instructions to the control group to ensure ethical compliance and advised them to perform the KMC.

Statistical analysis

SPSS (version 16) was used to analyse the data. Descriptive and bivariate analyses were performed to explore the data. The Kolmogorov-Smirnov test was also used to assess the normality of data. Chi-square and Fisher’s exact test was used to compare qualitative variables. One-way analysis of variance (ANOVA) was performed for normally distributed data, and the Kruskal–Wallis test was performed for non-normally distributed data to compare data among three groups. For tracking and comparing between groups in weight gaining of neonates, Bonferroni, as a post hoc test was used.

Fig. 1
figure 1

CONSORT 2010 flow diagram

Full size image

Results

During the study, 105 neonates fulfilled the criteria for enrollment. In total, seven subjects were excluded from the research for the following reasons: two neonates required hospitalization, two were unable to commit to performing KMC continuously, and three neonates were not exclusively breast fed. Accordingly, a total of 98 neonates were assigned to receive either KMC (n = 33), KMC-TA (n = 33), or CC (n = 32) (Fig. 1). There were no significant differences in participants’ demographic characteristics, nor all anthropometric indexes between the three groups at baseline (Table 1). There was no difference in the average duration of daily KMC implementation in the KMC and KMC-TA groups (3.41 ± 0.88 h vs. 3.42 ± 0.89 h, respectively). After the one-month intervention period concluded, there was a significant difference identified in mean weight between the three groups (p = 0.006), but not in the mean value of other anthropometric indexes (Table 2; Fig. 2). Furthermore, there was no significant difference in all anthropometric indexes between the two experimental groups.

Fig. 2
figure 2

Weight gain in the three groups during one month intervention

Full size image
Table 1 Socio-demographic data in the three groups
Full size table
Table 2 Anthropometric indexes before and after the intervention in the three groups
Full size table

Discussion

After one-month intervention, the mean weight of neonates was significantly greater in the two experimental groups compared to the CC group. No significant differences were observed in other anthropometric indexes. It is noteworthy that KMC implementation immediately after delivery is one of the guidelines set by the Ministry of Health, in Iran, but it is not being implemented properly. Additionally, the implementation of care in setting during our study was not routine and was not recommended after discharge. However, the continuation of skin-to-skin contact after leaving the hospital has been neglected, so there are no available statistics on the implementation of this care at home. Our study focused on the period following discharge.

The effect of KMC on weight gain [7,8,9,10,11] and other anthropometric indexes [12,13,14,15,16] has been reported in studies. Yet whilst implementation of KMC at home for longer durations has been found to have a significant impact on the weight gain of the preterm infants [14], in other studies with limited intervention duration in NICU, it has not [33, 34]. The benefits of KMC are clear, yet evidently contextual [18]. Other evidence is contrasting. For example, in a longitudinal study including 202 LBW neonates, after four weeks of KMC at home, neonates gained 23.7 gr (95% CI: 22.6 gr to 24.7 gr) per day [11]. However, one meta-analysis reported no essential differences in growth measured at discharge or at 40 to 41 weeks’ postmenstrual age [19]. In our sample, performing KMC at home significantly increased weight gain in preterm infants but did not affect other anthropometric indexes. Furthermore, providing TA alongside KMC did not lead to better outcomes in preterm infants when compared to KMC alone.

Evidence from across the globe in this field of research is building. In a meta-analysis study of 11 studies in Asian societies (India, Bangladesh, Philippines, and Nepal), implementation of KMC was evidenced to improve length gain in LBW infants (p < 0.001) [21]. In an alternate systematic and meta-analysis study, at least 2–6 h per day of KMC implementation was evidenced to increase weight gain, length and head circumference in neonates [35]. Yet elsewhere, no differences have been identified in the daily weight gain of infants where less time has been spent undertaking KMC (21.75 vs. 21.30 gr) [36]. Yet it is important to remember that exclusive breastfeeding also assists in neonatal weight gain, and that invasive procedures may inhibit neonatal growth [34]. Skin-to-skin contact with her preterm infant provides multisensory stimulation, and also promotes beneficial physiological conditions in preterm infants such as a calmer sleep state and more stable thermoregulation, heart rate, respiratory rate and oxygen saturation. KMC reduces the effort required for metabolism and thermoregulation so that most of the energy goes into the infant’s growth [10]. As such, it will be important to document feeding methods and consider external compounding factors in all future studies.

In our study, the implementation of KMC in preterm infants over a one-month period did not significantly affect head circumference. Yet a systematic review and meta-analysis of 124 studies reported that among LBW newborns, KMC implementation resulted in increased head circumference growth when compared to conventional care [19]. This difference in findings could be attributed to the difference between birth weight and the gestational age of neonates included in the various studies reviewed in meta-analysis.

KMC has also been reported to vary in duration [37, 38]. Skin-to-skin contact for more than 20 h a day in infants with a stable medical condition constitutes continuous KMC, and is the preferred method for the care of preterm neonates [39]. Nevertheless, prolonged KMC is not always practical [40]. Some studies report significant weight gain in neonates experiencing KMC of various duration [35, 41]. At least 6 h of KMC both in hospital and after discharge (maximum four times daily) is considered optimal [14]. Longer durations of daily KMC in low birth weight neonates has also been shown to lead to significant improvement in weight, length, and head [15]. The average duration of daily KMC implementation in the KMC (3.41 ± 0.88 h) and KMC-TA (3.42 ± 0.89 h) groups was similar. Future research may usefully consider the optimal duration of KMC, and balance this with practicality in parenting.

In the current study, one-month of KMC significantly affected the mean of the neonate’s weight, but not on other anthropometric indexes. In quasi-randomized research, significant advances have been reported in weight, length, and head circumference [13]. The variables such as length, chest, and head circumference require a more extended intervention period than that of weight gain. Indeed, the length of the intervention was an essential factor affecting the anthropometric indexes in the current study. Seemingly, longer implementation of KMC is necessary to investigate the impact of KMC implementation on all anthropometric indexes on preterm infants. Overall, KMC is a successful and low-cost method of caring for low-birth-weight infants, especially preterm neonates. It is also recommended for those affected by the COVID-19 (Coronavirus disease 2019) pandemic along with breast feeding [42]. Future studies are needed to compare various implementation durations on the growth of premature and LBW infants. A comparison of parental satisfaction in the performance of KMC in this context should also be considered.

A key limitation of this study was the lack of follow-on access to participants > 1 month following the discharge of their infants from hospital when they attend retinopathy screening. Future studies may benefit from longer follow-up periods. Moreover, the generalizability of our outcomes is limited as this study was conducted at a single center. Future multicenter studies are required to provide greater insights in this area.

A key strength of the current study is that it included the novel design and testing of an intervention which used both TA and KMC. Due to the impossibility of using social networks, telephone counseling was used to communicate with participants in the KMC-TA group. We were also unable to measure human milk consumed by the neonates in this study due to the nature of naturalized human milk feeding. We also acknowledge that differences in neonatal growth are inherent. After discharge from the hospital, we hypothesized that TA alongside KMC would improve outcomes. However, in current study there was no significant difference in the study results between the two experimental groups. In both experimental groups, the duration of care was not statistically different. Those in both groups were determined to implement this care, even in the group that did not receive TA. This may be due to the comprehensive education that participants in both intervention groups had received at the time of discharge. In which case, future research could usefully test the effectiveness of this as an intervention in itself. Indeed, education from healthcare providers may increase KMC for the benefit of all [43, 44].

Conclusions

Despite increasingly robust evidence supporting the benefits of KMC, it is not universally implemented. In the current study, KMC improved the weight gain of premature neonates in two experimental groups when compared to the CC group subjects. It did not affect other anthropometric measurements. This may be due to the intervention’s short duration period. Therefore, further studies using KMC with extended follow-up are recommended. Future research is also required to determine the optimal implementation of KMC after discharge, particularly in low-income countries.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ANOVA:

One-way analysis of variance

CC:

Conventional care

COVID-19:

Coronavirus disease 2019

IVH:

Intra-ventricular hemorrhage

IUGR:

Intrauterine growth restriction

KMC:

Kangaroo mother care

KMC-TA:

Kangaroo mother care with telephone advice

LBW:

Low birth weight

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

SGA:

Small-for-gestational age

TA:

Telephone advice

WHO:

World Health Organization

References

  1. Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, et al. Caregiving can be costly: a qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth. 2019;19:1–12.

    Article  Google Scholar 

  2. Ray JG, Park AL, Fell DB. Mortality in infants affected by preterm birth and severe small-for-gestational age birth weight. Pediatrics. 2017;140.

  3. Ndembo VP, Naburi H, Kisenge R, Leyna GH, Moshiro C. Poor weight gain and its predictors among preterm neonates admitted at Muhimbili National Hospital in Dar-es-salaam, Tanzania: a prospective cohort study. BMC Pediatr. 2021;21:493.

    Article  PubMed  PubMed Central  Google Scholar 

  4. de Castro ECM, Leite ÁJM, Guinsburg R. Mortality in the first 24 h of very low birth weight preterm infants in the Northeast of Brazil. Revista Paulista De Pediatria. 2016;34:106–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chibwesha CJ, Zanolini A, Smid M, Vwalika B, Kasaro MP, Mwanahamuntu M, et al. Predictors and outcomes of low birth weight in Lusaka, Zambia. Int J Gynecol Obstet. 2016;134:309–14.

    Article  Google Scholar 

  6. Narciso LM, Beleza LO, Imoto AM. The effectiveness of Kangaroo Mother Care in hospitalization period of preterm and low birth weight infants: systematic review and meta-analysis. J Pediatr (Rio J). 2022;98:117–25.

    Article  PubMed  Google Scholar 

  7. Ahmed MS, Ahmed S, Biswas BK, Al Mamun MA. Kangaroo mother care as compared to standard care for the management of preterm low birth weight babies.International Journal of Scientific and Research Publications. 2019;9(4):708-14.

  8. Kashaninia Z, Dehghan M. The effect of kangaroo care on weight gain of premature neonates in hospitalized in neonatal intensive care units. Biosci Biotechnol Res Asia. 2015;12:1405–10.

    Article  Google Scholar 

  9. Sathyakala M. Effectiveness of Kangaroo Care on temperature and weight gain in Low Birth Weight Babies of Post Natal Mothers at selected hospitals in Madurai, Tamil Nadu. Int J Nurs Educ Res. 2015;3:260–2.

    Article  Google Scholar 

  10. Samra NM, El Taweel A, Cadwell K. Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain. J Perinat Educ. 2013;22:194–200.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nguah SB, Wobil PNL, Obeng R, Yakubu A, Kerber KJ, Lawn JE, et al. Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: a longitudinal study. BMC Pregnancy Childbirth. 2011;11:1–8.

    Article  Google Scholar 

  12. Jahan N, Hoque MM, Chowdhury MAKA. Effects of intermittent Kangaroo Mother Care in Preterm Low Birth Weight babies: a Randomized Controlled Trial. Dhaka Shishu (children). Hosp J. 2020;36:107–13.

    Google Scholar 

  13. Swarnkar K, Vagha J. Effect of kangaroo mother care on growth and morbidity pattern in low birth weight infants. J Krishna Inst Med Sci Univ. 2016;5:91–9.

    Google Scholar 

  14. Gathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Trop Doct. 2010;40:199–202.

    Article  PubMed  Google Scholar 

  15. Suman Rao PN, Udani R, Nanavati R. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Indian Pediatr. 2008;45:17.

    CAS  PubMed  Google Scholar 

  16. Kumbhojkar S, Mokase Y, Sarawade S. Kangaroo mother care (KMC): an alternative to conventional method of care for low birth weight babies. Int J Health Sci Res. 2016;6:36–42.

    Google Scholar 

  17. de Ocampo FS, Villanueva-Uy MET. A randomized controlled trial of intermittent Kangaroo Mother Care versus Conventional Care in increasing the rate of Weight Gain among low-birth-weight neonates. Acta Med Philipp. 2021;55.

  18. Conde-Agudelo A, Belizán JM, Diaz‐Rossello J. Cochrane Review: Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Evid Based Child Health. 2012;7:760–876.

    Article  Google Scholar 

  19. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. Pediatrics. 2016;137.

  20. Sharma D, Farahbakhsh N, Sharma S, Sharma P, Sharma A. Role of kangaroo mother care in growth and breast feeding rates in very low birth weight (VLBW) neonates: a systematic review. J Maternal-Fetal Neonatal Med. 2019;32:129–42.

    Article  Google Scholar 

  21. Wijayanti T, Yanti Y. Meta-analysis: the effect of kangaroo mother care on growth (increasing length gain) in infants with low birth weight. 2022.

  22. Jamehdar M, Nourizadeh R, Divband A, Valizadeh L, Hosseini M, Hakimi S. KMC by surrogate can have an effect equal to KMC by mother in improving the nutritional behavior and arterial oxygen saturation of the preterm infant: results of a controlled randomized clinical trial. BMC Pediatr. 2022;22:242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Salim N, Shabani J, Peven K, Rahman QS, Kc A, Shamba D, et al. Kangaroo mother care: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth. 2021;21:1–16.

    Article  Google Scholar 

  24. Mazumder S, Taneja S, Dube B, Bhatia K, Ghosh R, Shekhar M, et al. Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial. Lancet. 2019;394:1724–36.

    Article  PubMed  Google Scholar 

  25. Kapito EM, Chirwa EM, Chodzaza E, Norr KF, Patil C, Maluwa AO, et al. The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison. BMC Pediatr. 2023;23:187.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Organization WH. WHO recommendations for care of the preterm or low birth weight infant. World Health Organization; 2022.

  27. Chan G, Bergelson I, Smith ER, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health Policy Plan. 2017;32:1466–75.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cooper L, Morrill A, Russell RB, Gooding JS, Miller L, Berns SD. Close to me: enhancing kangaroo care practice for NICU staff and parents. Adv Neonatal Care. 2014;14:410–23.

    Article  PubMed  Google Scholar 

  29. Chan GJ, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bull World Health Organ. 2016;94:130.

    Article  PubMed  Google Scholar 

  30. Bear RJ, Mellor DJ. Continuing Education Module—Kangaroo Mother Care 2: potential beneficial impacts on Brain Development in premature infants. J Perinat Educ. 2017;26:177–84.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kapoor R, Verma A, Dalal P, Gathwala G, Dalal J. Enhancing kangaroo mother care uptake through implementation of an education protocol. Indian J Pediatr. 2021;88:544–9.

    Article  PubMed  Google Scholar 

  32. Tomlinson P, Heaton H, Medcalf P, Campbell J, Whiteside D. A nurse-led rheumatology telephone advice line: service redesign to improve efficiency and patient experience. Br J Nurs. 2019;28:619–27.

    Article  PubMed  Google Scholar 

  33. Boo N, Jamli FM. Short duration of skin-to‐skin contact: effects on growth and breastfeeding. J Paediatr Child Health. 2007;43:831–6.

    Article  PubMed  Google Scholar 

  34. Rojas MA, Kaplan M, Quevedo M, Sherwonit E, Foster LB, Ehrenkranz RA, et al. Somatic growth of preterm infants during skin-to-skin care versus traditional holding: a randomized, controlled trial. J Dev Behav Pediatr. 2003;24:163–8.

    Article  PubMed  Google Scholar 

  35. Charpak N, Montealegre-Pomar A, Bohorquez A. Systematic review and meta‐analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr. 2021;110:45–59.

    Article  PubMed  Google Scholar 

  36. Pavlyshyn H, Sarapuk I, Casper C, Makieieva N. Kangaroo mother care can improve the short-term outcomes of very preterm infants. J Neonatal Perinat Med. 2021;14:21–8.

    Article  CAS  Google Scholar 

  37. Cai Q, Chen D-Q, Wang H, Zhang Y, Yang R, Xu W-L, et al. What influences the implementation of kangaroo mother care? An umbrella review. BMC Pregnancy Childbirth. 2022;22:851.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Gupta M, Jora R, Bhatia R. Kangaroo mother care (KMC) in LBW infants—a western Rajasthan experience. Indian J Pediatr. 2007;74:747–9.

    Article  PubMed  Google Scholar 

  39. Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R et al. Towards universal kangaroo mother care: recommendations and report from the first European conference and seventh international workshop on kangaroo mother care. 2010.

  40. Muddu GK, Boju SL, Chodavarapu R. Knowledge and awareness about benefits of kangaroo mother care. Indian J Pediatr. 2013;80:799–803.

    Article  PubMed  Google Scholar 

  41. Madhavi K, Kireeti AS, Shankar Reddy D, Ravikumar P. Effect of kangaroo mother care on weight gain in low birth weight babies. Int J Res Dev Health. 2015;3:1–4.

    Google Scholar 

  42. Stuebe A. Should infants be separated from mothers with COVID-19? First, do no harm. Breastfeed Med. 2020;15:351–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Coutts S, Woldring A, Pederson A, De Salaberry J, Osiovich H, Brotto LA. What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units. BMC Pregnancy Childbirth. 2021;21:1–15.

    Article  Google Scholar 

  44. Maniago JD, Almazan JU, Albougami AS. Nurses’ kangaroo mother care practice implementation and future challenges: An integrative review. Scand J Caring Sci. 2020;34:293–304.

Download references

Acknowledgements

The authors are grateful to all participants for their participation. This study was submitted as a fulfillment of the M.Sc. thesis of midwifery, which TUMS supported.

Funding

The study was supported by the TUMS.

Author information

Authors and Affiliations

  1. School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

    Shima Shirazi

  2. Reproductive Sciences and Technology Research Center; Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

    Maryam Keshavarz

  3. Centre for Healthcare Research, Coventry University, Coventry, UK

    Sally Pezaro

  4. School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

    Azam Amzajerdi

  5. School of Medicine, Public Health and Community Medicine, Tufts University, Boston, USA

    Shayesteh Jahanfar

  6. Reproductive Sciences and Technology Research Center; Department of Midwifery and Reproductive Health; School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

    Maryam Keshavarz

  7. School of Nursing & Midwifery, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran

    Maryam Keshavarz

Authors
  1. Shima Shirazi
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Maryam Keshavarz
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Sally Pezaro
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Azam Amzajerdi
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Shayesteh Jahanfar
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

S.S. and M.K. participated in the study’s design, acquisition, and analysis of the data. S.S. participated in the study’s conceptualization and sampling. M.K. wrote the original draft of the research paper. M.K. and A.A. participated in interpretation, supervision and searching for newly published articles in this field. S.P. participated in wider interpretation, supervision and reviewing and editing the manuscript. S. J. participated in critical appraisal. All authors read and approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Maryam Keshavarz.

Ethics declarations

Ethics approval and consent to participate

The study protocol was in accordance with the declaration of Helsinki and was approved by the Research Ethics Committee of the TUMS, Tehran, Iran (ethics code: 594/130/92). It was recorded in the Iranian Registry of Clinical Trials Center (201306082324N11) on 28/4/2014. The first sampling began on 1/06/2014. Informed written consent was obtained from all participants before the start of the study and they were fully informed about the study objectives and methodology. Moreover, the participants ensured the confidentiality of their information, and they were allowed to leave the study at any time. All participants’ information was kept in a personal file which was locked with limited access. The Consolidated Standards of Reporting Trials (CONSORT) guidelines have been followed in this study.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shirazi, S., Keshavarz, M., Pezaro, S. et al. The effect of post discharge Kangaroo mother care with and without telephone advice on anthropometric indexes of preterm newborns: a randomized clinical trial. BMC Pediatr 25, 221 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12887-024-05355-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12887-024-05355-0

Keywords

BMC Pediatrics

ISSN: 1471-2431

Contact us