Reinforcing kangaroo mother care uptake in resource limited settings.

Background: The national and global coverage of kangaroo mother care (KMC) remains low. Hence, adjuncts to KMC may be necessary, especially on day1 of life when neonatal mortality is high. It is important to provide warmth and reduce mortality in preterm low birth weight (LBW) infants in the community/hospital setting. In this manuscript, the outcome of using a Styrofoam box (SB) for LBW infants in various situations in India, such as in a home-setting in tribal/extra-remote areas, at a primary health center in tribal/extra-remote areas and at a referral hospital, is presented. It is suggested that use of an SB may complement KMC.

The study: In this retrospective observational study, an SB (50 × 36 × 25 cm, weight: 500 g) was used in diverse settings: a) as a home incubator in the early neonatal period, b) for providing warmth after hospital discharge and c) as a transport incubator for home-to-hospital and inter-hospital transportation.a) All six infants, presenting on day 1 of life with a foot length of less than 6.5 cm, remained warm and survived when the box was used as a home incubator. b) The babies discharged from hospital ( N  = 7) were warm in the box at the home setting. c) Use of the box as a home-to-hospital transport incubator improved the number of referrals from 13 to 24 in one year. d) Oxygen saturations were well-maintained and hypothermia did not occur in any infant during inter-hospital transfers when oxygen was administered in the SB. e) The concentration of oxygen delivered was predictable and was well maintained when administered to infants in the SB. The acceptance of the use of an SB by the parents was beneficial.

Conclusion: An SB may be used to complement KMC in resource-limited settings. Well-designed studies are required to confirm the safety and efficacy of this approach in reducing neonatal hypothermia, morbidity, and mortality.