MANUSCRIPT CITATION

Peña-Moreno A, Fernández-Monteagudo B, Gómez-Montes E, Tebar-Cuesta MI, Martín-Arriscado-Arroba C, Alba-Raya N, Moral-Pumarega MT, Pallás-Alonso CR, Piris-Borregas S. Immediate Kangaroo Mother Care Was More Feasible for Preterm Infants After Vaginal Than Caesarean Deliveries in a Spanish Neonatal Unit. Acta Paediatr. 2025 Jun 14;114(9):2397–9. doi: 10.1111/apa.70172. Epub ahead of print. PMID: 40515612; PMCID: PMC12336942.

REVIEWED BY

Le Khac Linh
College of Health Sciences, VinUniversity, Hanoi, Vietnam
Dr.linhkhac@gmail.com

Apoorva S Sachidanand
Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Apoorvaasachi@gmail.com

Phan Vinh Nghi
Department of Obstetrics and Gynecology Nam Can Tho University, Can Tho City, Vietnam
Pvnghi1994@gmail.com

Nguyen Tien Huy
Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
Nguyentienhuy4@duytan.edu.vn

TYPE OF INVESTIGATION

Quality improvement.

QUESTION

Among preterm infants born at ≥28 weeks’ gestation, is immediate Kangaroo Mother Care (KMC) feasible and safe compared to routine incubator-based stabilization, and does feasibility differ between vaginal and Caesarean deliveries?

METHODS

• Design: Single-center quality improvement study.
• Allocation: Non-randomized, based on feasibility and clinical condition.
• Blinding: Not applicable.
• Follow-up period: Immediate postnatal stabilization up to NICU transfer.
• Setting: Tertiary-level NICU, 12 de Octubre University Hospital, Madrid, Spain.
• Patients: Preterm infants born 28–36 weeks (n=96 eligible; 47 received KMC). Excluded if FiO₂ >40%, need for intubation, congenital malformations, triplets, maternal instability, or general anesthesia.
• Intervention: Immediate skin-to-skin KMC (median initiation 10 min after birth; up to 2 hrs vaginal, max 30 min Caesarean).
• Outcomes: Primary – feasibility of immediate KMC; Secondary – interruptions, safety (temperature, respiratory stability), transfer mode.
• Analysis & Sample Size: Descriptive comparison; subgroup analysis <30 weeks or <1000 g.
• Patient follow-up: 47 infants (49% of candidates) were included in analysis.

MAIN RESULTS

• Median gestation: 33+1 weeks; median birth weight: 1600 g.
• KMC initiated at median of 10 minutes after birth.
• Early interruption (<20 min): 8.5%, none due to respiratory deterioration.
• Caesarean birth significantly associated with shorter KMC duration (median 25 min vs 30 min, p=0.02).
• 66.7% transferred via KMC (mostly with father); 33.3% in incubator.
• Temperatures remained stable; colostrum collected in 15.6%.

CONCLUSION

Immediate KMC for preterm infants ≥28 weeks is feasible and safe, but more limited after Caesarean deliveries due to operating theatre logistics and maternal transfer requirements

COMMENTARY

This study conducted in a Spanish tertiary NICU aimed to evaluate the feasibility of immediate Kangaroo Mother Care (iKMC) for preterm infants born at 28 weeks’ gestation or later. The authors reported that iKMC for preterm infants ≥28 weeks is feasible and safe, but more limited after Caesarean deliveries due to operating theatre logistics and maternal transfer requirements; This pioneering effort provides important insights while also highlighting areas where further clarification and development would strengthen the evidence base.

 

First, additional detail on how parental consent was obtained would enhance transparency. Because preterm infants are very fragile and care protocols have been changed for research, clarifying the consent process would be valuable for both ethical considerations and reproducibility.

 

Second, 49 out of 96 infants (51.04%) were excluded from analysis. The high exclusion rate introduces potential selection bias and complicates the applicability of the results in other contexts, particularly in low- and middle-income nations where the newborn care system may be significantly different in structure and staffing.

 

Third, the authors reported that iKMC was more practicable following vaginal deliveries. The shorter iKMC sessions after C-sections, were mostly because of regulations at the hospital and not enough staff or training in the post-anesthesia care unit. Although these findings reflect local contextual barriers, they underscore the importance of training, staffing, and perioperative adaptations to make iKMC equally feasible after both vaginal and Cesarean deliveries. The conclusion that iKMC was more feasible following vaginal births is also not well supported by the data for the group of under 30 weeks’ gestation, as only 2 of the 10 infants in this subgroup were delivered vaginally. A larger sample would be needed to substantiate this observation.

 

The study would be strengthened by a clearer definition of what was meant by “feasibility”—whether it referred the duration of iKMC sessions, the infant’s physiological stability, staff compliance, or parental involvement. Establishing a clear definition is essential for comparing studies and drawing policy-relevant conclusions. The reduced iKMC durations following Caesarean deliveries seem to indicate institutional barriers rather than general problems. Similarly, while the study focused on short-term safety outcomes (e.g., temperature and oxygen stability), future investigations could expand such as neurodevelopment, infection rates, or breastfeeding success; It also did not compare neonates receiving iKMC with those placed in incubators, which would have provided additional insight into the relative advantages and disadvantages of both approaches.

 

Another noteworthy finding is fathers did 73.1% of iKMC transfers, but the study did not report whether the type of caregiver affected the infant’s stability, bonding, or the mother’s recovery. This was a missed chance to learn more about how fathers can help care for newborns.

 

In summary, this study provides valuable early evidence that iKMC can be implemented safely in preterm infants from 28 weeks’ gestation onwards. At the same time, it highlights practical considerations—consent processes, staffing, perioperative adaptations, and consistent definitions of feasibility—that will be crucial for broader adoption. Future research should continue to expand inclusion criteria, measure both short- and long-term outcomes, and address staffing and training barriers to ensure equitable access to iKMC across all delivery settings.

REFERENCES

None

FUNDING

None

CONFLICTS OF INTEREST

None