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      Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

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          Abstract

          Background

          In a randomized controlled trial (RCT) with 8402 stable low birthweight (LBW) infants, majority being late preterm or term small for gestational age, community-initiated KMC (ciKMC) showed a significant improvement in survival. However, the effect of ciKMC on neurodevelopment is unclear. This is important to elucidate as children born with low birth weight are at high risk of neurodevelopmental deficits. In the first 552 stable LBW infants enrolled in the above trial, we evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy.

          Method

          This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500–2250 g at birth. The intervention comprised of promotion of skin-to-skin contact and exclusive breastfeeding by trained intervention delivery team through home visits. The intervention group mother-infant-dyads were supported to practice ciKMC till day 28 after birth or until the baby wriggled-out. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers. Cognitive, language, motor and socio-emotional outcomes were assessed at infant-ages 6- and 12-months using Bayley Scale of Infant Development (BSID-III). Other outcomes measured were infant temperament, maternal depression, maternal sense of competence, mother-infant bonding and home-environment. We performed post-hoc equivalence testing using two one-sided tests of equivalence (TOST) to provide evidence that ciKMC does not do harm in terms of neurodevelopment.

          Results

          In the intervention arm, the median (IQR) time to initiate ciKMC was 48 (48 to 72) hours after birth. The mean (SD) duration of skin-to-skin-contact was 27.9 (3.9) days with a mean (SD) of 8.7 (3.5) hours per day. We did not find significant effect of ciKMC on any of the child developmental outcomes during infancy. The TOST analysis demonstrated that composite scores for cognitive, language and motor domains at 12 months among the study arms were statistically equivalent.

          Conclusion

          Our study was unable to capture any effect of ciKMC on neurodevelopment during infancy in this sample of stable late preterm or term small for gestational age infants. Long term follow-up may provide meaningful insights.

          Trial registration

          The trial is registered at clinicaltrials.gov NCT02631343 dated February 17, 2016; Retrospectively registered.

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          Most cited references23

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          Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64 061 children

          Preterm birth may leave the brain vulnerable to dysfunction. Knowledge of future neurodevelopmental delay in children born with various degrees of prematurity is needed to inform practice and policy.
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            Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life.

            Maternal-newborn contact enhances organization of the infant's physiological systems, including stress reactivity, autonomic functioning, and sleep patterns, and supports maturation of the prefrontal cortex and its ensuing effects on cognitive and behavioral control. Premature birth disrupts brain development and is associated with maternal separation and disturbances of contact-sensitive systems. However, it is unknown whether the provision of maternal-preterm contact can improve long-term functioning of these systems. We used the Kangaroo Care (KC) intervention and provided maternal-newborn skin-to-skin contact to 73 premature infants for 14 consecutive days compared with 73 case-matched control subjects receiving standard incubator care. Children were then followed seven times across the first decade of life and multiple physiologic, cognitive, parental mental health, and mother-child relational measures were assessed. KC increased autonomic functioning (respiratory sinus arrhythmia, RSA) and maternal attachment behavior in the postpartum period, reduced maternal anxiety, and enhanced child cognitive development and executive functions from 6 months to 10 years. By 10 years of age, children receiving KC showed attenuated stress response, improved RSA, organized sleep, and better cognitive control. RSA and maternal behavior were dynamically interrelated over time, leading to improved physiology, executive functions, and mother-child reciprocity at 10 years. These findings are the first to demonstrate long-term effects of early touch-based intervention on children's physiologic organization and behavioral control and have salient implications for the care practices of premature infants. Results demonstrate the dynamic cascades of child physiological regulation and parental provisions in shaping developmental outcome and may inform the construction of more targeted early interventions. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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              Imaging biomarkers of outcome in the developing preterm brain.

              The neurodevelopmental disabilities of those who were born prematurely have been well described, yet the underlying alterations in brain development that lead to these changes remain poorly understood. Processes that are vulnerable to injury in the developing brain include maturation of oligodendrocyte precursors and genetically programmed changes in cortical connectivity; recent data have indicated that diffuse injury of the white matter accompanied by neuronal and axonal disruption is common in prematurely born infants. Recent advances in MRI include diffusion tensor imaging and sophisticated image analysis tools, such as functional connectivity, voxel-based morphometry, and mathematical morphology-based cortical folding strategies. These advanced techniques have shown that white matter structure is dependent on gestational age and have started to provide important information about the dynamic interactions between development, injury, and functional recovery in the preterm brain. Identification of early biomarkers for outcome could enable physicians and scientists to develop targeted pharmacological and behavioural therapies to restore functional connectivity.
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                Author and article information

                Contributors
                sunita.taneja@sas.org.in
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                4 April 2020
                4 April 2020
                2020
                : 20
                : 150
                Affiliations
                [1 ]GRID grid.465049.a, Centre for Health Research and Development, , Society for Applied Studies, ; 45, Kalu Sarai, New Delhi, 110016 India
                [2 ]GRID grid.502801.e, ISNI 0000 0001 2314 6254, Department of Paediatrics, Faculty of Medicine and Health Technology, , Tampere University, ; Tampere, Finland
                [3 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway
                [4 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway
                [5 ]GRID grid.418193.6, ISNI 0000 0001 1541 4204, Norwegian Institute of Public Health, ; Oslo, Norway
                [6 ]State Health System Resource Centre, Haryana, India
                [7 ]GRID grid.464877.e, ISNI 0000 0004 1769 3499, Department of School Education, , Government of Haryana, ; Panchkula, India
                [8 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, Center for Effective Global Health, , University of California, ; Berkeley, USA
                [9 ]GRID grid.3575.4, ISNI 0000000121633745, Department of Maternal, Newborn, Child and Adolescent Health, , World Health Organization, ; Geneva, Switzerland
                [10 ]GRID grid.3575.4, ISNI 0000000121633745, Department of Mental Health and Substance Abuse, , World Health Organization, ; Geneva, Switzerland
                Article
                2046
                10.1186/s12887-020-02046-4
                7126178
                32247311
                56d95a54-6695-4854-87ec-517ffc3d8346
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 November 2019
                : 24 March 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Pediatrics
                child development,kangaroo mother care,low birth weight, community initiated
                Pediatrics
                child development, kangaroo mother care, low birth weight, community initiated

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