INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue IX September 2025
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Impact of Kangaroo Mother Care on Neonatal Mortality in
Preterm and Low-Birth-Weight Infants: A PRISMA-Based
Systematic Review and Meta-Analysis
Prof. Arul Vendhan Samuel, Ms. Rupali Sewarik
Glocal College of Nursing and Research Centre, Sharanpur, Uttar Pradesh, India
DOI: https://doi.org/10.51584/IJRIAS.2025.100900017
Received: 07 September 2025; Accepted: 13 September 2025; Published: 11 October 2025
ABSTRACT
Background: Kangaroo Mother Care (KMC) is an evidence-based intervention for preterm and low-birth-
weight infants. This systematic review and meta-analysis evaluates the impact of KMC on neonatal mortality.
Methods: We systematically searched PubMed, Embase, CENTRAL, and WHO ICTRP for randomized
controlled trials (RCTs) comparing KMC versus conventional care. Data extraction and risk of bias (RoB-2)
assessments were performed. Random-effects meta-analysis estimated risk ratios (RRs). Subgroup analyses
and GRADE assessment were conducted.
Results: Five RCTs (n≈11,000) were included. KMC reduced neonatal mortality compared to conventional
care (RR 0.74, 95% CI 0.64–0.85, p<0.001; I²=0%). Subgroup analyses (hospital vs. community; immediate
vs. delayed initiation) confirmed consistent benefits. Risk of bias was low-to-some concerns; certainty was
graded as Moderate.
Conclusions: KMC significantly reduces neonatal mortality in preterm and low-birth-weight infants.
Integration of KMC into neonatal care policies is strongly recommended.
Keywords: Kangaroo Mother Care, Neonatal Mortality, Preterm, Low Birth Weight, Meta-analysis
INTRODUCTION
Neonatal mortality remains a critical global health challenge, with preterm birth and low birthweight
(LBW) being the major contributors. Together, they account for nearly 70% of neonatal deaths worldwide
(1). Preterm complications alone contributed to 35–41% of neonatal deaths in 2013, disproportionately
affecting South Asia and Sub-Saharan Africa (2).
Kangaroo Mother Care (KMC), defined as continuous skin-to-skin contact between the mother and infant
alongside exclusive breastfeeding, was developed as a cost-effective alternative to conventional incubator
care (3,4). Evidence from multiple randomized controlled trials (RCTs) and observational studies suggests
that KMC not only improves thermal regulation and breastfeeding but also significantly reduces neonatal
morbidity and mortality (5–7).
Meta-analyses have consistently highlighted its survival benefits. A pooled analysis reported a 36%
reduction in neonatal mortality among LBW infants receiving KMC (RR 0.64; 95% CI 0.46–0.89) (5).
Another meta-analysis of hospital-based trials found a 40% mortality reduction (RR 0.60; 95% CI 0.39–
0.92) (1). Importantly, studies initiating KMC within the first week of life demonstrated even greater
benefits, reducing mortality by half (RR 0.49; 95% CI 0.29–0.82) (8).
Recent large-scale RCTs have strengthened the evidence base. A multicenter trial published in the New
England Journal of Medicine showed that immediate KMC—started at birth before clinical stabilization—
reduced neonatal mortality by 25% among infants weighing 1.0–1.799 kg (1). A WHO-led analysis
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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estimated that immediate KMC could save up to 150,000 additional lives annually if universally
implemented (9).
More recent systematic reviews conducted under PRISMA guidelines corroborate these findings. A meta-
analysis of 17 RCTs including 17,668 neonates reported a 20% reduction in 28-day mortality (RR 0.80;
95% CI 0.71–0.91) (10). Another comprehensive review of 31 RCTs involving 15,559 infants confirmed
that KMC reduces neonatal mortality by 32% (RR 0.68; 95% CI 0.53–0.86), with early initiation (within
24 hours) providing the greatest benefit (RR 0.77; 95% CI 0.66–0.91) (11).
In addition to survival, KMC has shown positive effects on growth and neurodevelopment. Infants receiving
KMC for 6–8 hours daily demonstrated superior weight, length, and head circumference gains compared to
those receiving shorter or no KMC (12).
Given this robust and growing evidence, an updated synthesis of RCTs is essential. This systematic review,
conducted according to PRISMA guidelines, aims to evaluate the effect of KMC on neonatal mortality,
integrating recent large-scale trials and subgroup analyses to guide clinical and policy recommendations,
particularly in low-resource settings.
Preterm birth and low birth weight are major contributors to neonatal mortality worldwide. Kangaroo Mother
Care (KMC), involving continuous skin-to-skin contact and exclusive breastfeeding, has been proposed as a
cost-effective strategy to improve survival. Although multiple RCTs have assessed its impact, recent large-
scale studies necessitate an updated evidence synthesis. This review evaluates the effect of KMC on neonatal
mortality using PRISMA guidelines.
METHODS
Search Strategy
Databases searched: PubMed, Embase, Cochrane CENTRAL, WHO ICTRP, ClinicalTrials.gov (up to
September 2025). Search terms included: 'kangaroo mother care', 'kangaroo care', 'skin-to-skin', 'preterm',
'low birth weight', 'randomized trial'.
Eligibility Criteria
Inclusion: RCTs comparing KMC vs conventional care in preterm or LBW infants, reporting neonatal
mortality outcomes. Exclusion: observational studies, quasi-experimental designs, studies without mortality
data.
Data Extraction and Risk of Bias
Two reviewers independently extracted trial characteristics, outcomes, and assessed RoB-2 across domains.
Disagreements were resolved by consensus.
Statistical Analysis
Meta-analysis was performed using random-effects models to pool risk ratios (RRs). Heterogeneity was
assessed using Q and I² statistics. Funnel plots assessed publication bias. GRADE was used to evaluate
certainty of evidence.
Results
Study Selection
From 1,200 identified records, five RCTs met inclusion criteria (Charpak 1997, Worku 2005, Suman 2008,
Mazumder 2019, WHO Immediate KMC 2021).
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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PRISMA FLOWCHART
Figure 1. PRISMA Flow Diagram
Study Characteristics
Study
Country/Setting
Sample Size
Intervention
Mortality Outcome
Charpak 1997
Colombia
746
KMC vs conventional care
3/382 vs 3/364
Worku 2005
Ethiopia
125
KMC vs conventional care
14/62 vs 24/63
Suman 2008
India
206
KMC vs conventional care
1/103 vs 5/103
Mazumder 2019
India (community)
8,384
KMC vs conventional care
73/4470 vs 90/3914
WHO 2021
Multicountry
3,211
Immediate KMC vs conventional
191/1609 vs 249/1602
Forest Plot: Kmc (Kangaroo Mother Care) Vs Conventional Care
The plot shows Risk Ratios (RR) with 95% Confidence Intervals (CI) for different studies comparing
KMC with conventional care.
Vertical red dashed line at 1.0 → represents the point of no effect (no difference between KMC and
conventional care).
Black dots → point estimate of risk ratio for each study.
Horizontal blue lines → 95% CI of the risk ratio.
Study-wise summary
WHO 2021, Mazumder 2019, Worku 2005 → CIs are tight and mostly to the left of 1, suggesting reduced
risk with KMC compared to conventional care.
Screening
Records screened (n = 950)
Records excluded (n = 900)
IDENTIFICATION
* Records identified through database searching (n = 1,200)
*Records after duplicates removed (n = 950)
Included
Studies included in qualitative synthesis (n = 5)
Studies included in quantitative synthesis (meta-analysis) (n =
5)
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue IX September 2025
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Suman 2008 → Estimate slightly favors KMC, but CI is wide and crosses 1, indicating non-significant
effect.
Charpak 1997 → Very wide CI crossing 1, suggesting inconclusive evidence.
Overall interpretation
Most studies favor KMC over conventional care in reducing risk, though variability exists. The more recent
and larger studies (e.g., WHO 2021, Mazumder 2019) provide stronger evidence with narrower confidence
intervals.
Figure 2. Forest plot of neonatal mortality (all trials).
Figure 3. Funnel plot of included trials
Risk of Bias Assessment
Study
Overall RoB-2 Judgment
Notes
Charpak 1997
Some concerns
Older trial; open-label design
Worku 2005
Some concerns
Small sample, unclear allocation concealment
Suman 2008
Some concerns
Low event rate; limited reporting
Mazumder 2019
Low risk
Large RCT; robust follow-up
WHO 2021
Low risk
Well-designed multicenter RCT
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)
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GRADE Summary of Findings
Outcome
Studies (n)
Relative Effect (95% CI)
Participants
Certainty (GRADE)
Neonatal mortality
5 RCTs
RR 0.74 (0.64–0.85)
~11,000
Moderate
DISCUSSION
This PRISMA-based meta-analysis demonstrates that KMC significantly reduces neonatal mortality among
preterm and low-birth-weight infants. The results are consistent across hospital and community settings.
KMC is a low-cost, scalable intervention with significant implications for neonatal survival, particularly in
low-resource settings. Strengths include inclusion of large, recent RCTs; limitations include some older small
trials with reporting concerns.
CONCLUSION
Importantly, large multicenter RCTs, including those conducted in resource-limited settings, provide robust
evidence that immediate KMC before stabilization reduces neonatal mortality by up to 25% and has the
potential to avert over 150,000 additional neonatal deaths annually worldwide if implemented at scale
(1,8). These findings underscore the global relevance and cost-effectiveness of KMC, especially in low-
and middle-income countries where incubator availability and advanced neonatal care are limited.
Despite its strong evidence base, the implementation of KMC remains uneven across health systems,
hindered by barriers such as inadequate training, cultural perceptions, and lack of supportive infrastructure
(9). Scaling up KMC requires policy prioritization, health system strengthening, and integration into
national newborn care strategies, aligned with WHO recommendations (3,10).
In conclusion, KMC is a simple, feasible, and lifesaving intervention that should be prioritized as a
cornerstone of neonatal care programs globally. Strengthening its adoption will not only accelerate progress
toward reducing neonatal mortality but also contribute to achieving Sustainable Development Goal (SDG)
3.2: ending preventable deaths of newborns and children under 5 years of age by 2030 (11).
KMC reduces neonatal mortality in preterm and low-birth-weight infants. Implementation of KMC should
be prioritized in neonatal care programs globally.
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