Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir...

http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi

Database of Abstracts of Reviews of Effects Issue: Volume (1), 2013, [no page #] Copyright: Copyright 2013 University of York Publication Type: [Abstracts of quality assessed systematic reviews] Accession: 00125498-100000000-24133 Keywords: Female, Humans, Male, Breast Feeding, Child Rearing, development, Infant, Newborn, Infant, Premature, growth & development, Infant Care, methods, Infant Mortality, Parent-Child Relations, Physical Stimulation, Premature Birth, Randomized Controlled Trials as Topic [Abstracts of quality assessed systematic reviews]

'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications (Structured abstract)
Centre for Reviews and Dissemination

Author Information
NHS Centre for Reviews and Dissemination. University of York, York, U.K.

Source Reference
Abstract and Commentary for:Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. 'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications. International Journal of Epidemiology. 2010;39(Supplement 1):.

CRD summary
This review investigated the effects of Kangaroo Mother Care in preventing neonatal deaths due to preterm birth complications and concluded that it substantially reduced neonatal mortality among preterm babies in hospital and was highly effective in reducing severe morbidity. Overall, the review was well conducted and the conclusion appears reliable and an accurate reflection of the evidence presented.

Authors' objectives
To update a 2003 Cochrane review to investigate the effects of Kangaroo Mother Care (KMC) in preventing neonatal deaths due to preterm birth complications.

Searching
PubMed, LILACS, African Medicus, EMRO, World Health Organisation Regional Databases and The Cochrane Library were searched for studies published in any language between 1968 and 8 September 2009. Proceedings from major conferences were searched online for unpublished literature. Search terms used were reported.

Study selection
Eligible studies needed to have a patient population of neonates (defined as babies less than 28 days old who weighed less than 2,000g) and the intervention had to be KMC (defined as continuous skin-to-skin contact and support for exclusive breastfeeding or other appropriate feeding and early recognition and response to complication). KMC had to be commenced within one week of birth. The comparator (where relevant) had to be conventional care such as incubator care or more limited care. Eligible studies needed to report neonatal mortality due to complications of preterm birth or serious neonatal morbidity related to prematurity (such as respiratory distress syndrome, pneumonia and septicaemia). Any study design was eligible for inclusion. Where outcomes were reported for a broader age group that included neonates, study authors were contacted for outcomes that related only to the neonate subgroup. Studies used to assess mortality outcomes : These studies all took place in hospitals. Study locations included Bangladesh, Colombia, Ecuador, Ethiopia, India, Indonesia, Mexico, Mozambique, South Africa and Zimbabwe. Definitions of low birth weight ranged from less than 1,600g to less than 2,000g. Median time of commencing KMC ranged from four hours to 12.4 days from birth. There was some variability in mortality outcome definitions (mortality was assessed from pre-discharge to 12 months). Studies used to determine morbidity outcomes: Comparable details were not provided. It appeared that more than one reviewer performed the initial and final screening for study selection.

Validity assessment

1 de 4

21/02/2013 10:03 a.m.

Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir...

http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi

Validity was assessed using a Child Health Epidemiology Reference Group (CHERG) checklist based on an adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The number of reviewers involved in this stage of the review process was not reported.

Data extraction
Two reviewers independently extracted data required to calculate risk ratios (RRs) with 95% confidence intervals (CIs) for the outcomes of morbidity and mortality on a standardised form. Where required, authors were contacted for additional data.

Methods of synthesis
The review stated that a priori the authors planned to conduct three meta-analyses producing pooled risk ratio estimates: one that compared mortality outcomes from RCTs only; a second that compared mortality outcomes from observational studies only; and a third that compared morbidity outcomes from RCTs only. I2 values were used to assess heterogeneity. Where heterogeneity was considered significant (threshold of p<0.10 in the associated Q tests), it appeared that a random-effects model was used to pool data instead of a Mantel-Haenszel fixed-effect model.

Results of the review

Fifteen studies were included in the review: nine RCTs and six observational studies. The authors stated that most of the RCTs had minor limitations. None of the five RCTs that assessed mortality were blinded. Mortality outcomes (RCTs): Three studies were included (n=988). There was a statistically significant reduction in mortality risk with KMC compared to standard care (RR 0.49, 95% CI 0.29 to 0.82 using a fixed-effect model, I2=0%). Mortality outcomes (observational studies): Three studies were included (n=8,257). Mortality risk was statistically significantly reduced compared with standard incubator care (RR 0.68, 95% CI 0.58 to 0.79 model used not reported, I2=54.4%). Morbidity outcomes (RCTs): Five studies were included (n=1,520). The risk was statistically significantly lower in the KMC group compared with the standard care group (RR 0.34, 95% CI 0.17 to 0.65 using a random-effects model, I2=69.7%). Sensitivity analyses for mortality outcomes: Including studies with later initiation of KMC brought the RR closer to one, but the difference was still statistically significant (RR 0.64, 95% CI 0.42 to 0.96, model details not specified). Including a study with incomplete population details did not affect the results. Using a random-effects model changed the results from statistically significant to statistically insignificant (RR 0.68, 95% CI 0.38 to 1.22).

Cost information
This review addressed a clear review question using appropriate and clearly stated study selection criteria. The search strategy was clearly reported and appeared comprehensive and clearly reported; a large number of databases were searched without date or language restrictions and search terms were reported. It appeared that study selection and other stages of the review process such as data extraction were conducted in duplicate to reduce risks of reviewer error and bias. Reporting of primary study characteristics appeared appropriate. Validity was assessed, but results were not fully reported in the paper (the review stated that supplementary tables were available online but these could not be obtained on 29/9/2010). The method of synthesis appeared appropriate and comprehensive, although the authors appeared to suggest that randomeffects Mantel-Haenszel meta-analyses were possible when they were not. The results were comprehensively and clearly reported. One of the sensitivity analyses explored the effect of using a random-effects rather than fixed-effect model and indicated that the statistical significance of some results may have been sensitive to modelling assumptions. Overall the authors' conclusion appears reliable and to accurately reflect the evidence presented.

Authors' conclusions

2 de 4

21/02/2013 10:03 a.m.

Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir...

http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi

Kangaroo Mother Care substantially reduced neonatal mortality among preterm babies in hospital and was highly effective in reducing severe morbidity.

CRD commentary
This review addressed a clear review question using appropriate and clearly stated study selection criteria. The search strategy was clearly reported and appeared comprehensive and clearly reported; a large number of databases were searched without date or language restrictions and search terms were reported. It appeared that study selection and other stages of the review process such as data extraction were conducted in duplicate to reduce risks of reviewer error and bias. Reporting of primary study characteristics appeared appropriate. Validity was assessed, but results were not fully reported in the paper (the review stated that supplementary tables were available online but these could not be obtained on 29/9/2010). The method of synthesis appeared appropriate and comprehensive, although the authors appeared to suggest that randomeffects Mantel-Haenszel meta-analyses were possible when they were not. The results were comprehensively and clearly reported. One of the sensitivity analyses explored the effect of using a random-effects rather than fixed-effect model and indicated that the statistical significance of some results may have been sensitive to modelling assumptions. Overall the authors' conclusion appears reliable and to accurately reflect the evidence presented.

Implications of the review for practice and research

Practice: The authors stated that KMC should be used routinely in facilities for all stable babies less than 2,000g at birth. Research: The authors stated that there was need for further assessment of KMC in settings with no medical care for all except the smallest babies and a need for analysis of potential cost savings on nursing time and length of in-patient stay.

Funding
Bill and Melinda Gates Foundation (Grant 43386, Grant 50124); UNICEF; Save the Children USA; Global Alliance for Prevention of Prematurity and Stillbirths.

URL for original research

http://ije.oxfordjournals.org/content/39/suppl_1/i144.abstract

Other publications of related interest

Cande-Agudelo A, az-Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003; 2: CD002771

Record status
This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD database number

DARE-12010003310

3 de 4

21/02/2013 10:03 a.m.

Ovid: 'Kangaroo mother care' to prevent neonatal deaths due to preterm bir...

http://ovidsp.tx.ovid.com/sp-3.8.0b/ovidweb.cgi

Index terms
Medical Subject Headings (MeSH)
[Subject indexing assigned by CRD]

Female; Humans; Male; Breast Feeding; Child Rearing; development; Infant, Newborn; Infant, Premature/growth & development; Infant Care/methods; Infant Mortality; Parent-Child Relations; Physical Stimulation; Premature Birth; Randomized Controlled Trials as Topic

Copyright (c) 2000-2012 Ovid Technologies, Inc.

Terms of Use

Support & Training

About Us

Contact Us

Version: OvidSP_UI03.08.00.103, SourceID 57329

4 de 4

21/02/2013 10:03 a.m.