Sweeping Harvard Study Finds Skin-To-Skin 'Kangaroo Care' Helps Preemies Thrive

You want to hold your baby. It's surely one of the deepest of human instincts. But if your newborn is among the nearly 10 percent who arrive prematurely in America each year, you may need to wait — until the days of tubes and high-tech monitors in the incubator have passed.

Now, a new study, apparently the most sweeping yet, offers added evidence that if a premature baby is medically stable, the age-old practice of holding the tiny child — skin to skin, heartbeat to heartbeat — might well do some good. A survey of more than 100 previous studies, it found that overall, the skin-to-skin cradling widely known as "kangaroo mother care" may cut a premature, low-birth-weight baby's risk of death by 36 percent.

The findings may rightly spur parents to advocate for holding their preemies once they're medically stable enough, says the study's senior author, Dr. Grace Chan of Boston Children's Hospital and the Harvard Chan School of Public Health.

"With this degree of evidence, it doesn't hurt to ask," she says. High-tech medical interventions "are necessary for many conditions," she says. "At the same time, for your preterm, low-birth-weight baby who's otherwise stable, this is the best thing for the baby."

Kangaroo care is considered most useful in low-income areas where high-level-care hospitals — and incubators — are few. But Dr. Chan says it seems to offer benefits across all settings. The new study, in the journal Pediatrics, quantifies those benefits, finding both the 36 percent drop in risk of death and a 47 percent drop in infection or sepsis. It looked at newborns who weighed less than 2 kilograms, or 4.4 pounds.

My own son weighed just about that when he was born two months early, back in 2004. And I remember the joy of the brief periods when we were allowed to extract him from his incubator home for a few minutes and hold him close. Judging by that Boston hospital experience, I asked Dr. Chan, kangaroo care is fairly widely accepted, right?

"Surprisingly, the acceptance of kangaroo care really varies," she says, "based on multiple factors, including leadership and policies at the institutions and the health care providers who are on service at that time."

"Some providers who strongly believe in kangaroo mother care and skin-to-skin care would highly encourage it. And when you have champions for kangaroo mother care, the adoption rate is much higher. To date, we don't have a specific policy or set of guidelines for kangaroo mother care in the U.S. or globally. If a health provider team believes keeping the baby safe in an incubator is more beneficial, then that is probably where the baby will be. There’s not a standard of care yet."

"I imagine it can be a hard clinical decision," I said.

"I think it is," Dr. Chan replies. "There hasn't been a lot of data. Some people can argue that there hasn’t been a 'gold-standard' randomized controlled clinical trial that compares tertiary-level care — with a high-risk baby either ventilated or on non-invasive ventilation in an incubator — versus on the mother, skin to skin. Most of the studies that we looked at in our meta-analysis are from settings with limited resources, perhaps just an incubator or a bassinet."

Still, she added, the World Health Organization has included kangaroo mother care in its preterm guidelines for all babies under 2 kilograms. And the practice has also been gaining ground because there are few other effective interventions for preterm newborn babies. Malawi and Ethiopia also now include kangaroo care in their national guidelines.

So will it take off still further in the United States? Barriers remain, Dr. Chan says, in a system that leans toward the high-tech, and some wonder, "Really? Could skin-to-skin really be as beneficial as a nice incubator that provides humidity and temperature regulation?"

We don't exactly know the mechanism behind the benefits of kangaroo care, Dr. Chan adds. It appears that it helps babies regulate their body temperature better. Also, mothers become likelier to breastfeed, so their babies get better at fighting infections, and parents can monitor their babies' breathing and overall well-being better.

For all the kangaroo fathers out there, my first question for Dr. Chan was whether a kangaroo caregiver had to be a mother.

That question has come up repeatedly, she says, but studies have mainly focused on mothers. There has been talk of doing research that would compare mothers with other caregivers, but for now, "we would assume the father or other caregiver would have the same attachment and relationship with the baby," Dr. Chan says. And in terms of the warmth and attention they provide, "physiologically, it's probably all the same."

Readers, have you given kangaroo care, or wanted to? How was it?