This story reports on a 20-year follow-up study of low birth weight infants in Colombia who received continuous skin-to-skin contact with a caregiver as part of a practice known as kangaroo mother care (KMC).
Researchers concluded that infants who had been randomized to receive KMC rather than staying in an incubator reaped long-lasting social and behavioral benefits such as lower mortality, lower school absenteeism and fewer behavior problems.
This coverage describes both positive and negative findings of the 20-year outcomes, which were reported in the journal Pediatrics, but it doesn’t include quantified data or tap independent sources. It also misses important limitations, such as the difficulty of measuring the precise impact of a multi-faceted intervention after 20 years have gone by.
It seems odd to label as an “intervention” something as natural as skin-to-skin contact between a mother and a baby, along with an emphasis on breastfeeding and early hospital discharge. KMC was developed in the 1970s in Bogatá, Colombia, partly in response to overtaxed neonatal care facilities. But its many demonstrated benefits — including lower mortality and infection rates, greater breastfeeding and stronger family bonding — have pushed those concepts into mainstream preemie care in countries of all income levels.
The World Health Organization includes KMC in its guidelines to improve premature birth outcomes. Some 15 million babies are born too early every year, leading to nearly 1 million deaths in 2015, according to the World Health Organization. Survivors are prone to learning disabilities and visual and hearing problems. The vast majority of these at-risk infants are in developing countries where medical resources are limited. Despite some flaws, this study offers reassurance that premature babies who spend their early days with skin-to-skin will fare at least as well as adults as those who were in an incubator. Stories should not extrapolate beyond that.
The costs of this intervention or of the control, a neonatal minimal care unit in which infants remain in an incubator while they gain weight, aren’t mentioned.
The story states that KMC babies were 39 percent more likely to live into adulthood, but doesn’t give absolute numbers to help readers judge the significance of this finding. The story also lists several other benefits without quantifying them (or even explaining what they mean in some cases), including that the babies “grew up with fewer social problems,” stayed in school longer and earned more as adults. It quotes a researcher saying they “had less aggressive drive and were less impulsive and hyperactive” compared to babies who stayed in an incubator.”
There aren’t any obvious harms from this intervention, although the story does note the finding that children given standard incubator care had higher math and language scores in school even though IQ levels were similar in both groups.
A 2012 Cochrane review of multiple studies found no negative outcomes associated with skin-to-skin contact for healthy newborns except for one study’s report of longer duration of breastfeeding in a control group.
The story acknowledges KMC “didn’t work miracles. Children with cerebral palsy were equally likely to have symptoms whether they had the kangaroo care or not, and more than half the people in the entire group needed glasses.”
But, the story should have made the point that it’s difficult to connect the dots between a single intervention and outcomes 20 years down the road. In an editorial accompanying the study, Lydia Furman, MD, of University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine in Cleveland, describes several complications with the findings. For one, she notes, KMC is a “bundled intervention” involving parental nurturing, breastfeeding, and skin-to-skin contact, making it difficult to discern which contributed to the outcomes. She writes:
Second, it is difficult to quantify and qualify parent-associated and parent-delivered interventions because all parents are different. Third, we are a full 20 years out, and “life has happened,” so numerous potentially unmeasured contributions to each individual child’s life (and outcomes) have occurred.
Furman notes that the study shows that KMC infants had some superior outcomes. “Yet the authors are pressed to explain the significantly higher math and language academic scores in the traditional care group. In other words, it is complicated.”
The story accurately states that 20 million babies are born at a low birth weight every year, according to the World Health Organization.
We did take issue with this speculative quote about the behavior of the babies in the skin-to-skin group, which was featured prominently in all caps in the NBC story:
“THEY EXHIBITED LESS ANTISOCIAL BEHAVIOR, WHICH MIGHT BE ASSOCIATED WITH SEPARATION FROM THE MOTHER AT BIRTH.”
This borders on fear-mongering. For all mothers–but especially moms who have premature babies and/or complicated births–having a newborn is very stressful. The looming threat that antisocial behavior is a risk the mother is specifically responsible for in these fragile days and hours may compound the stress.
The story lacked comment from independent sources. While there are some statements about KMC attributed to the World Health Organization, those statements don’t address the findings of this study. An independent source likely could have provided some context and important reassurances to parents who had premature babies but either weren’t offered kangaroo care or weren’t able to because of birth complications, which is a growing problem in the U.S.
The purpose of the study was to compare the KMC approach with a neonatal intensive care. There are no other viable alternatives to infant care that we know of.
The story notes that KMC requires parents to receive adequate support and follow-up. But we would have liked to see more information, such as how widely this approach is used to treat premature infants and what some of the barriers might be in high-income countries where incubator care has been the norm. For example, how many U.S. neonatal intensive care units incorporate skin-to-skin contact in their care? Which babies in intensive care don’t or can’t get this kind of care?
From what we could find, what makes this study notable is that it’s the only 20-year follow-up for this kind of intervention. In an indirect way, the story touches upon this.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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