A review published in the World Journal of Pediatrics suggests that immediate skin-to-skin contact, known as kangaroo mother care (KMC), can significantly improve survival and health outcomes for premature and low-birth-weight infants when started as soon as possible after birth, ideally within the first 24 hours. The study, which synthesized evidence from five randomized controlled trials across nine countries, found that immediate KMC (iKMC) was associated with lower 28-day neonatal mortality, reduced hypothermia, fewer suspected sepsis cases, improved exclusive breastfeeding, and better weight-related growth outcomes compared with delayed KMC.
Preterm birth and low birth weight remain leading causes of neonatal death and long-term developmental challenges worldwide. Kangaroo mother care, which combines skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support, was first introduced as an alternative to incubator care in low-resource settings. Earlier guidelines recommended starting KMC only after clinical stabilization, but newer evidence has shifted focus toward immediate initiation. However, implementation varies widely across hospitals due to differences in timing, duration, monitoring, staffing, privacy, and family support.
The review, conducted by researchers from the Faculty of Medicine, Universitas Indonesia; Dr. Cipto Mangunkusumo National General Hospital; and Universitas Indonesia Hospital, was published online on November 14, 2025, with the DOI 10.1007/s12519-025-00993-5. The authors searched Medline (PubMed), Scopus, EuropePMC, and Google Scholar up to June 2024 and included trials from Ghana, India, Malawi, Nigeria, Tanzania, Madagascar, Norway, Gambia, and Uganda. These studies covered both low- and high-resource settings.
The World Health Organization iKMC trial reported lower 28-day mortality in the immediate-care group, and other trials showed similar favorable trends. iKMC also reduced hypothermia, a critical risk for preterm infants who struggle to regulate body temperature. 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 suggest that iKMC can lower provider and household costs by reducing reliance on more resource-intensive care.
The authors argue that the findings make a strong case for treating iKMC as a core part of neonatal care for eligible preterm and low-birth-weight infants, not an optional add-on. They emphasize that success depends on safe monitoring, trained staff, suitable facilities, and practical support for mothers and caregivers. 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.
