'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications.
'Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications.
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DOI：
10.1093/ije/dyq031
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发表时间：
2010-04
影响因子：
7.7
通讯作者：
Cousens S
中科院分区：
文献类型：
--
作者：
Lawn JE;Mwansa-Kambafwile J;Horta BL;Barros FC;Cousens S
背景袋鼠母亲护理(KMC)包括持续皮肤接触的热护理，支持纯母乳喂养或其他适当的喂养，以及对疾病的早期识别/反应。虽然在高收入和低收入国家越来越多地被接受，但Cochrane审查(2003年)没有发现KMC提高死亡率的证据，也没有报告特定于新生儿的数据。目的评价KMC对早产并发症新生儿死亡率的影响。方法采用系统综述的方法。采用标准化摘要表，采用改进的评分方法对研究质量进行评估。进行了Meta分析。结果我们确定了15项报告死亡率和/或发病率结果的研究，包括9项随机对照试验(RCT)和6项观察性研究，均来自低收入或中等收入环境。除一例外，所有病例均以医院为基础，仅包括出生体重及2000克(假设为早产)的婴儿。这项基于社区的试验缺少出生体重数据，以及其他限制，因此被排除在外。新生儿特有的数据由两位作者提供。对出生第一周开始进行KMC的三项随机对照试验的Meta分析显示，与标准护理相比，新生儿死亡率显著降低[相对风险(RR)0.49，95%可信区间(CI)0.29-0.82]。对三项观察性研究的荟萃分析也显示出显著的死亡率益处(RR 0.68，95%CI 0.58-0.79)。5项随机对照试验显示婴儿的严重发病率显著降低(RR为0.34，95%CI为0.17-0.65)。结论这是首次发表的荟萃分析显示，KMC显著降低了住院早产儿(出生体重和体重2000克)的新生儿死亡率，并且在减少严重发病率方面非常有效，尤其是感染。然而，在大多数低收入国家，KMC仍然无法大规模提供。
Background ‘Kangaroo mother care’ (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, and early recognition/response to illness. Whilst increasingly accepted in both high- and low-income countries, a Cochrane review (2003) did not find evidence of KMC’s mortality benefit, and did not report neonatal-specific data. Objectives The objectives of this study were to review the evidence, and estimate the effect of KMC on neonatal mortality due to complications of preterm birth. Methods We conducted systematic reviews. Standardized abstraction tables were used and study quality assessed by adapted GRADE methodology. Meta-analyses were undertaken. Results We identified 15 studies reporting mortality and/or morbidity outcomes including nine randomized controlled trials (RCTs) and six observational studies all from low- or middle-income settings. Except one, all were hospital-based and included only babies of birth-weight <2000 g (assumed preterm). The one community-based trial had missing birthweight data, as well as other limitations and was excluded. Neonatal-specific data were supplied by two authors. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29–0.82] compared with standard care. A meta-analysis of three observational studies also suggested significant mortality benefit (RR 0.68, 95% CI 0.58–0.79). Five RCTs suggested significant reductions in serious morbidity for babies <2000 g (RR 0.34, 95% CI 0.17–0.65). Conclusion This is the first published meta-analysis showing that KMC substantially reduces neonatal mortality amongst preterm babies (birth weight <2000 g) in hospital, and is highly effective in reducing severe morbidity, particularly from infection. However, KMC remains unavailable at-scale in most low-income countries.
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