A study to compare morbidity of very low birth weight neonates between 1.3 and 1.5 kg receiving Kangaroo Mother Care at the University Teaching Hospital, in Lusaka, Zambia

Abstract

Background - New born deaths account for approximately 40% of all deaths under five years of age in developing countries with the three major causes being birth asphyxia, infections, and complications due to prematurity and low birth weight (LBW). Birth weight is a significant determinant of newborn survival. Prematurity is the largest direct cause of neonatal mortality accounting for an estimated 29% of the 3.6 million neonatal deaths every year (Lawn et al. 2010). Kangaroo Mother Care (KMC) is a strategy that was created and developed by a team of pediatricians in Bogota, Colombia. Its introduction was associated with significant reduction in neonatal morbidity, however, the most dramatic result, documented through a pre- and post-intervention study was a drop in neonatal mortality from 70% to 30%. The benefits of KMC in neonatal development have been documented by studies worldwide. Despite the recognition, benefits and longevity of KMC, few developing countries have made the intervention available and accessible to families with LBW babies. The Department of Paediatrics, UTH, has introduced Kangaroo Mother Care KMC as one of the strategies in the management for Very Low Birth Weight Neonates. This study investigated the effect of Kangaroo Mother Care KMC, on the morbidity of Very Low Birth Weight VLBW neonates at the University Teaching Hospital Lusaka, Zambia. Methodology- The study was an observational cohort study conducted in the NICU and KMC wards of the UTH in Lusaka, Zambia. Enrolment of all eligible participants was v from June to November, 2015. Neonates with birth weight above 1.0 kg and less than 1.49 kg delivered in UTH, local clinic or home either via spontaneous vaginal delivery or caesarean section who meet the study definition of stable neonate were enrolled in the study. The two study groups were naturally obtained due to limited space on the KMC ward which is unable to accommodate all eligible neonates for admission and results in neonates being admitted to the NICU thus providing two cohorts of neonates within the same weight band receiving two different modalities of neonatal care. No randomizing or assigning was involved in the process. Initial clinical state and progression was assessed with daily weight, six hourly temperature, respiratory rate and heart rate in addition to monitoring the frequency of clinical events including apneic spells, fevers and respiratory infections in each group. The data was then compared between the two groups. All data collected during the course of the study was collected by standard and routine procedures which are performed as part of daily care. No additional procedures invasive or otherwise were performed for study purposes. Results - This study found an average weight gain in the KMC group of 9 grams per day compared to an average of 5 grams per day in the NICU group. The mean follow-up weight for the KMC group was 1.38 kg, 95% CI (1.32 – 1.45) compared to baseline mean weight 1.30 kg, 95% CI (1.24 – 1.35) while the mean follow-up weight for the NICU group was 1.34 kg, 95% CI (1.32 – 1.35) compared to baseline mean weight 1.34 kg, 95% CI (1.29 – 1.38). The mean hospital stay for the NICU group was 6.8 days (SD = 1.2) whereas for the KMC group 4.1 days (SD = 1.3). In addition, The NICU cohort vi showed an increased frequency of clinical events at 21% compared to 5% observed in the KMC cohort. The KMC cohort further showed more thermal stability in core body temperature and indeed the heart rate and respiratory rates showed less fluctuations in follow up relative to the NICU cohort. Conclusion - KMC was associated with a shorter hospitalization of 4.1 days relative to 6.8 days in the NICU group. This was associated with an average weight gain of 9 grams per day compared to an average of 5 grams per day that was observed in the NICU group. In addition, KMC was associated with more thermal and cardio-respiratory stability with less fluctuations during follow up relative to the NICU group. The NICU cohort showed an increased frequency of clinical events at 21% compared to 5% observed in the KMC cohort during the six months of the study duration. Key words- Apnea, Necrotizing Enterocolitis, Kangaroo Mother Care, Cardio-respiratory.