Transforming neonatal nursing: a randomized controlled trial comparing kangaroo care and standard protocols for survival in preterm infants with respiratory distress syndrome.
Summary
In a multicenter RCT of 240 preterm infants with RDS, nurse-implemented kangaroo care improved 28-day survival (adjusted HR 0.42), reduced nosocomial infections (RR 0.45), shortened CPAP duration by 2.2 days, and increased exclusive breastfeeding at discharge. Findings support scaling nurse-led KMC for high-risk infants in resource-limited NICUs.
Key Findings
- 28-day survival improved with KMC (adjusted HR 0.42, 95% CI 0.28–0.63, p<0.001).
- Nosocomial infections reduced by 55% with KMC (RR 0.45, 95% CI 0.27–0.75, p<0.001).
- CPAP duration shortened by 2.2 days (p<0.001) and exclusive breastfeeding at discharge increased (74.2% vs 48.3%, p<0.001).
Clinical Implications
NICUs, especially in resource-limited settings, should consider standardizing nurse-led KMC for preterm infants requiring respiratory support, with protocols for ≥6 h/day skin-to-skin contact alongside breastfeeding support.
Why It Matters
This pragmatic RCT provides high-level evidence that a scalable, non-pharmacologic, nurse-led intervention improves survival and key clinical outcomes in preterm infants with respiratory distress.
Limitations
- Blinding not feasible; potential performance bias
- Generalizability may be limited to similar resource-limited NICU settings
Future Directions
Evaluate implementation at scale across diverse health systems, cost-effectiveness, and effects in extremely low birth weight and varying respiratory support modalities.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Multicenter randomized controlled trial showing survival benefit
- Study Design
- OTHER