A comprehensive review published in the World Journal of Pediatrics provides strong evidence that immediate kangaroo mother care (iKMC) — skin-to-skin contact initiated as soon as possible after birth and ideally within the first 24 hours — can significantly improve survival and health outcomes for premature and low-birth-weight infants. The review, which analyzed five randomized controlled trials across low- and high-resource settings, found that iKMC was associated with lower 28-day neonatal mortality, reduced incidence of hypothermia, fewer suspected sepsis cases, higher rates of exclusive breastfeeding, and better weight-related growth outcomes compared with delayed kangaroo mother care.
Preterm birth and low birth weight remain leading causes of neonatal death and long-term developmental challenges worldwide. Kangaroo mother care (KMC), originally developed as an alternative to insufficient incubator care, combines skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support. While earlier guidelines recommended KMC only after clinical stabilization, newer evidence has shifted attention toward starting care immediately after birth. However, implementation varies widely across hospitals due to differences in timing, duration, monitoring, staffing, privacy, and family support. This review, conducted by researchers from the Faculty of Medicine, Universitas Indonesia; Dr. Cipto Mangunkusumo National General Hospital; and Universitas Indonesia Hospital, and published online on November 14, 2025, with DOI: 10.1007/s12519-025-00993-5, synthesizes evidence comparing immediate and delayed KMC, focusing on clinical outcomes, implementation procedures, economic value, and barriers to routine adoption.
The authors searched Medline (PubMed), Scopus, EuropePMC, and Google Scholar up to June 2024 and included five randomized controlled trials covering both low- and high-resource settings, including Ghana, India, Malawi, Nigeria, Tanzania, Madagascar, Norway, Gambia, and Uganda. Across the evidence, iKMC showed a strong survival signal. The World Health Organization (WHO) iKMC trial reported lower 28-day mortality in the immediate-care group than in the delayed-care group, while other trials showed similar favorable trends. iKMC also reduced hypothermia, a critical risk for preterm and low-birth-weight infants who struggle to regulate body temperature. In addition, early skin-to-skin contact may support protective maternal microbiota transfer, reduce hospital-acquired exposure, and encourage earlier breastfeeding, all of which can strengthen neonatal immunity. Beyond infant outcomes, the review notes potential maternal benefits, including greater satisfaction and improved postpartum recovery markers. Economic analyses also suggest that iKMC can lower provider and household costs by reducing reliance on more resource-intensive care.
The authors said the findings make a strong case for treating iKMC not as an optional add-on, but as a core part of neonatal care for eligible preterm and low-birth-weight infants. They said the approach is powerful because it combines warmth, feeding support, bonding, infection protection, and family participation in one low-cost intervention. At the same time, they emphasized that success depends on safe monitoring, trained staff, suitable facilities, and practical support for mothers and caregivers. The implications extend beyond individual hospitals. To scale iKMC safely, health systems may need mother–neonatal intensive care units (mother–NICUs), shared protocols between obstetric and neonatal departments, family-centered education, privacy solutions, and support for fathers or relatives as alternative caregivers. The review also identifies key gaps: long-term neurodevelopmental outcomes after iKMC remain unclear, evidence from high-resource settings is still limited, and implementation for extremely low-birth-weight infants requires more study. If implemented effectively, iKMC could offer a rare combination in global healthcare: a low-cost intervention capable of saving lives while reducing pressure on overstretched neonatal systems.
