Effect of Kangaroo Mother Care during the first 72 hours of life on early growth and breastfeeding in normal birthweight newborns: protocol for a randomised controlled trial.

Abstract

Skin-to-skin contact (SSC) during the first hour of birth is recommended for healthy newborn infants and their mothers and improves early stabilisation and breastfeeding outcomes. Kangaroo Mother Care (KMC), involving prolonged SSC and exclusive breastfeeding, provides an optimal physiological transition from intrauterine to extrauterine life for preterm and low birthweight infants, improving survival by 32% and conferring multiple clinical and neurodevelopmental benefits. Extending the duration of SSC contact beyond the first hour may similarly provide underexplored benefits to normal birthweight infants, including improved stabilisation, breastfeeding, growth and maternal-infant bonding. The study aims to evaluate the effect of KMC during the first 72 hours on early weight loss, weight gain velocity and breastfeeding quality in normal birthweight infants. This multicentre, individually randomised, controlled, open-label superiority trial will enrol 516 healthy singleton newborn infants with birth weight ≥2500 g and their mothers with uncomplicated vaginal deliveries from three public health facilities in Uttar Pradesh, India. Dyads will be randomised (1:1) and stratified by site to either intervention or control groups. The intervention involves prolonged KMC (≥8 hours of daily SSC with exclusive breastfeeding in the KMC position) during the initial 3 days after birth, with a recommendation to continue KMC at home throughout the newborn period. Both intervention and control groups will receive a common minimum care package, including breastfeeding initiation through uninterrupted SSC in the first hour, essential newborn care counselling, vaccinations and other standard facility care. The primary outcomes are: (1) mean percentage weight loss at 48 hours; (2) weight gain velocity up to 28 days; and (3) the proportion of dyads with moderate-to-poor quality breastfeeding scores (Bristol Breastfeeding Assessment Tool <7) at age 7 completed days. Secondary outcomes include exclusive breastfeeding rates, maternal breastfeeding experience, incidence of possible serious bacterial infection, maternal depression and maternal-infant bonding. Data will be collected electronically using standardised tools with quality control measures. Primary outcomes will be analysed using linear mixed-effects models (continuous) and mixed-effects logistic regression (binary) on an intention-to-treat basis, adjusting for study site, parity, infant sex and baseline birth weight. A p value <0.05 will be considered statistically significant. The study is approved by the institutional ethics committees of the Community Empowerment Lab and King George's Medical University. Written informed consent will be obtained from participating mothers. All findings will be disseminated regardless of the outcome, through publication in peer-reviewed journals, presentations at international conferences and policy briefings to local health authorities. Data will be deposited in an open-access repository to promote data sharing and transparency. The results are intended to inform national and international guidelines on essential newborn care for the global population of healthy, term infants. CTRI/2024/01/062057.