New research shows kangaroo care enhances brain development in premature infants

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A recent study found that skin-to-skin cuddling with a parent, or kangaroo care, offers significant cognitive benefits for premature babies, setting the stage for improved neurological development during their first year of life.¹

Kangaroo care involves a parent holding their infant directly against their skin, such as the chest. For premature babies, who are often hooked up to numerous medical devices, this practice may seem difficult. However, the study emphasizes that even a small increase in the amount of skin-to-skin contact can lead to significant improvements in neurodevelopmental outcomes by the time the child reaches 1 year of age.¹

Background

The practice of kangaroo care was first adopted in low-income countries to help newborns survive in resource-limited settings. In these environments, skin-to-skin contact is used to keep babies warm and to strengthen the parent-child bond and facilitate breastfeeding.¹

While it has been slower to gain traction in the United States, particularly for premature infants who often receive high-tech medical care, the increasing evidence in support of its cognitive benefits is beginning to shift perspectives.¹

“Our goal is for these children to achieve the same milestones as their full-term counterparts," said Melissa Scala, MD, clinical professor of pediatrics and neonatologist at Lucile Packard Children’s Hospital Stanford, and co-author of the study. "Skin-to-skin care is emerging as a critical component of our efforts to ensure that these children can leave the hospital with the best possible start."

Methods

The study, conducted by a group of Stanford Medicine researchers, reviewed the medical records of 181 preterm infants born at least 8 weeks early and cared for at Lucile Packard Children’s Hospital Stanford between May 2018 and June 2022. The researchers examined the duration of skin-to-skin contact recorded by nurses and assessed the babies’ neurodevelopmental outcomes at 6 and 12 months of adjusted age.²

Results

The results of the study found that “small increases in the amount of skin-to-skin care were linked to large differences in 12-month neurodevelopmental scores.” Moreover, 20 minutes more per day of skin-to-skin care was associated with a 10-point increase on a standardized cognitive development scale, where a score of 70 or below indicates significant developmental delays.²

Additionally, these benefits persisted even after accounting for variables such as the infants’ gestational age, medical complications, and the family's socioeconomic status. The researchers hypothesized that kangaroo care may mimic some of the developmental stimuli a fetus would experience in the womb, such as the sound of the mother’s heartbeat, contributing to better brain development.²

"It’s interesting and exciting that it doesn’t take much to really improve babies’ outcomes," said Katherine Travis, PhD, an assistant professor at Weill Cornell Medical School and Burke Neurological Institute, and the study’s senior author. "The effects were consistent regardless of the baby’s socioeconomic background or the severity of their condition."

She also noted, “It didn’t matter if the baby was from a high- or low-income family; the effects we found were the same. And it didn’t matter if the baby was sicker or less sick—both responded to this treatment.”

Additionally, the study highlighted the potential for skin-to-skin care to reduce parental stress, which can be heightened in the high-pressure environment of a neonatal intensive care unit (NICU). By nurturing a closer bond between parent and child, kangaroo care may offer emotional benefits that further support the infant’s development, according to the study’s authors.

In response to the study's findings, Lucile Packard Children’s Hospital Stanford has expanded its infant developmental care program, adding specialists to tailor care plans for high-risk infants. Scala hopes that other hospitals will follow this model, integrating kangaroo care as a standard component of neonatal treatment plans.

"We want this to be seen as a fundamental part of the medical care plan, not just an optional add-on," said Scala. "Our findings highlight the importance of involving parents in this crucial aspect of their child’s early care."

References

1. Stanford Medicine. Skin-to-skin ‘kangaroo care’ found to boost neurodevelopment in preemies. Eureka Alert. August 7, 2024. Accessed August 20, 2024. https://www.eurekalert.org/news-releases/1053954

2. Lazarus MF, Marchman VA, Brignoni-Pérez E, et al. Inpatient Skin-to-Skin Care Predicts 12-month Neurodevelopmental Outcomes in Very Preterm Infants. Preprint. medRxiv. 2024;2023.04.06.23288260. Published 2024 Apr 8. doi:10.1101/2023.04.06.23288260