Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother–infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood.
From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests.
The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group.
This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.
Comments
RE: Charpak et al - 20 yr follow up of kangaroo mother care vdrsus traditional care
Dear Dr Juzer M Tyebkhan
Sorry for the delay to answer to your comment. Here are the data of the volume (mm3) of the left and right Caudate and Putamen nuclei in the 2 groups (KMC group N=115 versus Control group N=98) with the level of statistical significance of the difference.
Mean and 95% CI of Left Caudate volume in the KMC group: 3462 (3373-3550) versus 3313 (3210-3416) in the control group, p=0.029 Mean and 95% CI of Left Putamen volume in the KMC group: 6237 (6108-6366)versus 6075 (5926-6223)in the control group, p=0.103, Mean and 95% CI of right Caudate volume in the KMC group: 3703 (3610-3795) versus 3313 (3210-3416) in the control group, p=0.079, Mean and 95% CI of right Putamen volume in the KMC group: 6149 (6024-6274) versus 5930 (5778-6084) in the control group, p=0.029.
I also looked to the volume of the nuclei excluding 10 infants in the KMC group who were in kangaroo position less that 8 days (KMC group N=105 versus Control group N=98) during the neonatal period.
Mean and 95% CI of Left Caudate volume in the KMC group: 3478 (3385-3570) versus 3313 (3210-3416) in the control group, p=0.019 Mean and 95% CI of Left Putamen volume in the KMC group: 6250 (6115-6384) versus 6075 (5926-6223)in the control group, p=0.085;. Mean and 95% CI of right Caudate volume in the KMC group: 3725 (3627-3822)versus 3313 (3210-3416) in the control group, p=0.045, Mean and 95% CI of right Putamen volume in the KMC group: 6149 (6024-6274) versus 6160 (6027-6293)in the control group, p=0.026,
What was interesting in the model we presented in our paper was the interaction between the volume of the left Caudate, the duration of the kangaroo position and the results of the NHPtest a clinical test evaluation motricity.
Best regards
Nathalie Charpak
RE: Charpak et al - 20 yr follow up of kangaroo mother care vdrsus traditional care
Many congratulations to you and your research team for this very comprehensive, and the ultra-long-term outcomes that you have investigated after KMC in the newborn period. Data such as yours help us and others to promote KMC for babies in the NICU and to find strategies around the barriers that arise, as we try to provide this care to smaller and more fragile infants.
I was intrigued by the result "larger volume of left caudate nucleus in the KMC group".
Can you please provide some clarification about this. The text on page 7, states that "the KMC group had significantly larger caudate volumes than controls (table 11)". Table 11 however, does NOT present this specific result; table 11 informs us of the variables that were associated with increased left caudate volume - thus, "duration of KMC is associated with increased left caudate volume". This is, of course, important, but I think that the text is misleading.
Are you able to inform us of the left caudate volumes for the 2 groups, and what was the level of statistical significance of the difference?
Many thanks for the clarification.
Once again, felicitations on this wonderful study.