Preterm birth, defined as delivery before 37 completed weeks of gestation, contributes significantly to neonatal morbidity and long-term disability worldwide. Improvements in neonatal intensive care have reduced mortality but the prevalence of neurodevelopmental impairments remains high, including cognitive delay, motor dysfunction, and language deficits[1-2]. The first year of life represents a period of rapid brain development, influenced by genetic, environmental, and caregiving factors.

Kangaroo Mother Care (KMC), introduced in the 1970s, encompasses prolonged skin–to–skin contact between mother and infant, exclusive breastfeeding encouragement, and facilitated maternal-infant bonding[3]. Previous research indicates KMC reduces mortality, sepsis, hypothermia, and length of hospital stay in low-birth-weight and preterm infants. However, evidence on its impact on long-term neurodevelopmental outcomes is limited, particularly in low- and middle-income settings[4].

Mechanisms by which KMC may favor neurodevelopment include regulation of infant stress responses, enhanced sensory stimulation, promotion of breastfeeding and maternal attachment, and improved sleep patterns. Few controlled studies have systematically examined the long-term developmental impact of early KMC initiation[5-6].

This study aimed to investigate the effects of early KMC initiated within 72 hours of birth on neurodevelopmental outcomes at 12 months corrected age in a cohort of 100 preterm neonates.

METHODS
A prospective cohort study was conducted for 01 Year in the neonatal care unit of a tertiary care hospital.

Participants

Preterm neonates with gestational age between 28 and 36 weeks were screened. Inclusion criteria were:

• Birth weight ≥1000 g
• Hemodynamically stable within 72 hours
• Informed parental consent

Exclusion criteria included congenital anomalies, severe intraventricular hemorrhage (grade III/IV), or conditions preventing KMC initiation.

Interventions

Infants were allocated to either:

• KMC Group: Structured early KMC started within 72 hours of birth; minimum daily duration goal ≥ 4 hours.
• Control Group: Standard care without structured early KMC protocol (neonates received conventional neonatal care; KMC initiated only as routine advice post-discharge).

Maternal education on KMC was provided, and regular follow-ups were scheduled.

Outcomes

Primary outcome: Neurodevelopmental outcomes at 12 months corrected age, assessed using the Bayley Scales of Infant and Toddler Development–III (BSID-III), including cognitive, language, and motor composite scores.

Secondary outcome: Incidence of neurodevelopmental delay (defined as composite score <85 in any domain).

Data Collection

Demographics, clinical characteristics, duration of KMC, and feeding practices were recorded. Trained pediatric psychologists blinded to group allocation performed BSID-III assessments.

Statistical Analysis

Data were analyzed using SPSS v26. Continuous variables were compared with t-tests or Mann-Whitney U tests as appropriate; categorical variables were compared with chi-square tests. Multivariate regression was performed to adjust for potential confounders. P < 0.05 was considered significant.

RESULTS

Participant Flow and Baseline Characteristics

Of 128 eligible preterm neonates, 100 were included: 50 in the KMC group and 50 in the control group. Eight infants were lost to follow-up (4 from each group).

Table 1. Baseline characteristics of study population

*IQR: interquartile range; SD: standard deviation; p < 0.05 significant

The groups were comparable in baseline characteristics except for exclusive breastfeeding rates at discharge (higher in KMC group).

Duration of KMC

Daily mean duration of KMC in the intervention group was 5.2 ± 1.3 hours.

Neurodevelopmental Outcomes at 12 Months Corrected Age

Table 2. BSID-III mean composite scores at 12 months

*Values are mean ± SD; p < 0.05 significant

Preterm infants in the KMC group scored significantly higher in all BSID-III domains compared with controls.

Incidence of Neurodevelopmental Delay

Table 3. Incidence of developmental delay by domain

• p < 0.05 significant

KMC infants had lower incidence of neurodevelopmental delay across all domains.

Association Between KMC Duration and Development

Table 4. Multivariate associations between daily KMC duration and BSID-III scores

*Adjusted for gestational age, birth weight, maternal education; p < 0.05 significant

Longer daily KMC was independently associated with higher composite scores.

DISCUSSION
This study demonstrated that early initiation of KMC is associated with significantly better neurodevelopmental outcomes at 12 months corrected age in preterm infants. Infants who received structured early KMC exhibited higher cognitive, language, and motor composite scores and had lower rates of neurodevelopmental delay[7-8].

Comparison with Previous Research

Our findings align with previous smaller trials and observational studies reporting enhanced developmental outcomes with KMC. A randomized controlled trial from South Africa found improved cognitive and motor performance at 6 months in KMC infants[9]. Similarly, randomized data from Colombia reported significant improvements in cognitive scores at 40 weeks corrected age in KMC recipients. This study extends these findings by evaluating outcomes at 12 months and using standardized BSID-III assessment[10].

Mechanisms

Potential mechanisms for improved development include enhanced parent–infant bonding, increased opportunities for sensory stimulation, stress reduction through maternal contact, improved nutritional status via increased breastfeeding, and optimized sleep patterns. Early KMC may modulate infant cortisol levels, influencing neural connectivity and plasticity[11].

Clinical and Policy Implications

Given the simplicity and low cost of KMC, its widespread adoption could have substantial impact, especially in resource-limited settings. Early KMC may serve as a safe intervention to improve long-term developmental trajectories in preterm infants[12].

Strengths and Limitations

Strengths include prospective design, standardized neurodevelopmental assessments, and adjustment for confounders. Limitations include non-randomized allocation, potential residual confounding, and follow-up limited to 12 months.

CONCLUSION
Early Kangaroo Mother Care initiated within 72 hours of birth significantly improves neurodevelopmental outcomes at 12 months corrected age in preterm neonates. These results support the integration of early KMC protocols into routine neonatal care to enhance long-term developmental outcomes.

REFERENCES

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