Effect of kangaroo mother care initiated within the first 24 h in preterm or low birth weight infants: A systematic review and meta-analysis

BACKGROUND: In preterm or low birth weight newborns, kangaroo mother care offers relevant emotional, physiological and clinical benefits. However, uncertainty remains regarding the optimal timing for initiating this intervention. OBJECTIVE: This systematic review aims to evaluate the effects of kangaroo mother care initiated within the first 24 h of life, compared with conventional neonatal care without skin-to-skin contact and with its late initiation (beyond 24 h). METHODS: A systematic review with meta-analysis of randomised controlled trials was conducted. Randomised controlled trials were included that addressed two comparisons: early kangaroo mother care versus conventional neonatal care, analysing physiological outcomes during the first 24 h (thermoregulation, cardiorespiratory stability, glucose levels, surfactant administration, and referral to neonatal intensive care units); and early kangaroo mother care versus its late initiation, assessing subsequent clinical outcomes (neonatal mortality, physical growth, type of feeding, and length of hospital stay). Fixed- or random-effects models were used depending on heterogeneity and risk of bias was assessed using the RoB 2.0 tool. Studies were searched in PubMed, Web of Science, Scopus, Cochrane, and CINAHL. The protocol for this review was previously registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251102466). RESULTS: Thirteen studies were included (n = 4162). Early initiation of kangaroo mother care was associated with a reduced risk of cumulative hyperthermia (RR 0.63; 95% CI: 0.47 to 0.85) and greater cardiorespiratory stability within the first 6 h of life, as measured by the SCRIP score (MD 0.54; 95% CI: 0.07 to 1.00). The mean temperature was slightly lower but remained within physiological ranges (MD -0.20 °C; 95% CI: -0.32 to -0.09), and a possible reduction in the risk of point hypothermia between 6 and 24 h was observed (RR 0.02; 95% CI: 0.00 to 0.26). No significant differences were identified in glucose levels, surfactant administration, or referral to intensive care. Compared to its late initiation, early initiation of kangaroo mother care was associated with lower neonatal mortality (RR 0.78; 95% CI: 0.66-0.92) and a higher likelihood of receiving breastfeeding at discharge (RR 1.23; 95% CI: 1.04-1.46). CONCLUSIONS: Initiating kangaroo mother care within the first 24 h of life is a safe intervention, associated with improvements in early physiological stability and with clinical benefits compared to its later initiation. These findings support its inclusion as part of early neonatal care, in line with current recommendations advocating for its implementation within the first hours after birth.