All-cause mortality and infection-related outcomes of hospital-initiated kangaroo care versus conventional neonatal care for low-birthweight infants: a systematic review and meta-analysis.

Summary

This registered, PRISMA-compliant meta-analysis of RCTs (29 studies; 17,513 infants) found that hospital-initiated kangaroo care significantly reduced all-cause mortality (pooled OR 0.77, 95% CI 0.67–0.89). Protective effects extended to sepsis and invasive infections, reinforcing kangaroo care as a core inpatient intervention for low-birthweight infants.

Key Findings

• Meta-analysis of 29 RCTs including 17,513 infants showed reduced all-cause mortality with hospital-initiated kangaroo care (pooled OR 0.77, 95% CI 0.67–0.89).
• Protective effects extended to sepsis and invasive infections, aligning with WHO recommendations.
• Most included trials were from lower-middle income countries; quality was moderate-to-high.
• Analysis was pre-registered (PROSPERO) and used random-effects models with heterogeneity assessment.

Clinical Implications

Hospitals should standardize early, hospital-initiated kangaroo care for low-birthweight infants as part of infection prevention and neonatal stabilization protocols, with staff training and monitoring for adherence.

Limitations

• Heterogeneity in settings and implementation fidelity across included trials
• Effect sizes for specific infection outcomes not uniformly reported across all studies

Future Directions

Define optimal timing, dose (hours/day), and implementation strategies of kangaroo care in diverse settings; quantify effects on specific infection syndromes and long-term neurodevelopment.