KMC, Concepts, Definitions and Praxis: What Elements are Applicable in What Settings in Which Local Circumstances?

Background: The Kangaroo Mother Care (KMC) method is a set of interventions for providing appropriate health care to preterm and/or low birth weight infants, based on the so-called kangaroo position (skin-to-skin contact). Since it was first described (Rey 1978) considerable variability has developed about: a) definition of the target population and of the therapeutic goals; b) time for starting skin-to-skin contact; c) continuity and duration of the kangaroo position, d) feeding strategies, and e) discharge and follow up policies. There is an urgent need to standardize the intervention, based on scientific evidence that supports its benefits and limitations. Objective: To develop a set of recommendations about the characterization and proper use of the different components of the Kangaroo Mother Care method, and to support each assertion with a systematic review of evidence. Design/Methods: A multidisciplinary group including experts in the field, heath care workers, users, parents of patients, and methodological and content experts worked between 2005 and 2007 in Javeriana University in Bogota. After defining terms and characterizing components of the intervention, a systematic review of published literature (Medline, Lilacs, hand searching and review of previously compiled bibliographies) was conducted to identify, appraise and summarize the evidence regarding the effects, risks, expected benefits and limitations of each component. Evidence based assertions were widely discussed until consensus with each statement was achieved, and then were evaluated by external peers experts in KMC method in developed countries. Results: Standardized definitions of Kangaroo Mother Care and its components, variants, target population, indications and precautions were produced. An evidence-based foundation for each component was developed, identifying the strength of the evidence, the knowledge gaps, the areas of controversy and the needs for further research. Conclusions: Although sound guidelines should be tailored to local needs and conditions (this particular exercise is focused in the Colombian situation), it is reasonable to expect that many of the recommendations and certainly most of the evidence appraised will be a useful input for guidelines development elsewhere.