Immediate Skin-to-Skin Care Significantly Improves Survival for Preterm Infants, Review Finds
A new review in the World Journal of Pediatrics shows that immediate kangaroo mother care, started within 24 hours of birth, reduces mortality and improves health outcomes for premature and low-birth-weight newborns.
A comprehensive review published in the World Journal of Pediatrics has found that immediate kangaroo mother care (iKMC), 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 study, which analyzed data from five randomized controlled trials across low- and high-resource settings, suggests that early skin-to-skin contact is not merely comforting but a critical, low-cost intervention that can save lives.
Preterm birth and low birth weight remain leading causes of neonatal death and long-term developmental challenges. Kangaroo mother care, which combines skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support, was originally introduced as an alternative to incubator care. While earlier guidelines recommended starting KMC after clinical stabilization, newer evidence has shifted toward immediate initiation. However, implementation varies widely among hospitals due to differences in timing, duration, staffing, 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, in the World Journal of Pediatrics with the DOI: 10.1007/s12519-025-00993-5. The researchers 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.
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 compared with delayed care, and other trials showed similar favorable trends. iKMC also reduced hypothermia, a critical risk for preterm infants who struggle to regulate body temperature. Additionally, early skin-to-skin contact may support protective maternal microbiota transfer, reduce hospital-acquired infections, and encourage earlier breastfeeding, all of which strengthen neonatal immunity. Beyond infant outcomes, the review notes potential maternal benefits, including greater satisfaction and improved postpartum recovery. Economic analyses suggest iKMC can lower provider and household costs by reducing reliance on more resource-intensive care.
The authors argue that iKMC should be treated as a core component of neonatal care for eligible preterm and low-birth-weight infants, not as an optional add-on. The approach is powerful because it combines warmth, feeding support, bonding, infection protection, and family participation in one low-cost intervention. However, 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 further 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.
World Journal of Pediatrics is a monthly, peer-reviewed academic journal publishing original research, reviews, and special reports on all aspects of pediatrics. More information can be found at the journal's website via the related link: Chuanlink Innovations.