oa Editorial from Guest Editor [Hot Topic:Kangaroo Mother Care: Past, Present and Future (Guest Editors: Nathalie Charpak and Juan Gabriel Ruiz)]

THE PAST Kangaroo Mother Care (KMC) began sometime during 1978, at the Instituto Materno Infantil (IMI) one of the largest maternity facilities at that time, in Bogota, Colombia. Its creators, E. Rey and colleagues were confronting problems generated mainly by overcrowding at their Neonatal Care Unit (NCU). Despite that there were numerous beds and incubators, the demand greatly exceeded the available slots. Preterm infants frequently had to share incubators, and nurse and doctor-patient ratios were suboptimal. “Healthy” preterm infants, who had survived the neonatal and post-neonatal adaptation remained in incubators or heated cribs, until able to regulate temperature and therefore being eligible for discharge. Periodic outbreaks of nosocomial infection and necrotizing enerocolitis decimated these infants who had reached the stable growth period, were mainly bottlefed, and could not be discharged because their continued incubator need. Rey looked for a way of securing thermal stability and proper feeding outside the incubators and of the NCU. If that could be achieved, these infants could be discharged earlier, protecting them against nosocomial risks and easing the burden on the already insufficient neonatal beds. His solution was “natural”, simple and elegant: the stable preterm infant was placed in skin-to-skin contact on top of the mother's bare chest (under her clothes). In that way, the infant could regulate temperature, and had easy on demand access to breastfeeding. Once mother and infant were adapted to this position (the “kangaroo position”), they could be discharged home, and an incubator was freed to accommodate another infant. Mothers and infants needed follow-up in an outpatient clinic that was started in a small pre-fabricated house in the yard of the IMI, the “Casita Canguro” (Kangaroo little house). This eventually evolved into a kind of daytime hospital that substituted for the minimal care neonatal unit....