Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care

Abstract

ObjectiveKangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.DesignThis Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.Data sourceOVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.Eligibility criteriaStudies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.ResultsThe paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.ConclusionThe lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.

Respectful maternity care in the UK using a decolonial lens

“…31 Kangaroo care as a reverse innovation should acknowledge the indigenous/traditional roots of the intervention as a decolonial redressment. (Stefani et al 2022 ).…”

“…31 Kangaroo care as a reverse innovation should acknowledge the indigenous/traditional roots of the intervention as a decolonial redressment. (Stefani et al 2022). Some of the above therapies come under the umbrella of complementary and alternative medicine (CAM) and the RCM position statement on these therapeutic modalities says that it has been estimated that as many as 87% of women use complementary therapies and/or natural remedies during pregnancy, childbirth and postnatally.…”

Programmatic implementation of kangaroo mother care: a systematic synthesis of grey literature

“…A systematic review and realist synthesis of KMC scale-up in the United Kingdom identified lack of training, knowledge and confidence, and absence of clear guidelines as the main barriers. The authors propose a focus on the potential cost-effectiveness of KMC in reducing the need for incubator use [64].…”

Parents and healthcare professionals' attitudes to Kangaroo Care for preterm infants in the United Kingdom

“…8 Qualitative studies show that clear guidelines, procedures, experience and continued education is required to improve HCPs confidence in supporting parents practice KC with their preterm infants. 5,9 Available evidence does not suggest that KC interferes with intensive care no adverse events were reported even when infants receive KC post cardiac surgery. 11 However, in the extremely preterm infants (born at <28 weeks' gestational age), the risk of intraventricular haemorrhage, particularly in the first 72 hours after birth, may be a cause for caution.…”