Background: Kangaroo Mother Care (KMC) is a cornerstone practice for managing preterm infants, with established benefits for thermoregulation, physiologic stability, and breastfeeding. However, the interplay between KMC duration and different red blood cell (RBC) transfusion strategies—restrictive versus liberal—in influencing anemia of prematurity and short-term outcomes has not been well delineated, particularly in low- and middle-income country (LMIC) settings.
Objective: To evaluate the impact of KMC duration and transfusion protocols (restrictive vs liberal) on hematologic status and early growth outcomes in preterm very low birth weight (VLBW) infants, and to explore incidental trends in neurodevelopmental outcomes.
Methods: This prospective observational cohort study included 73 preterm infants (birth weight 700-1300 g) admitted to the step-down nursery of a tertiary medical center between April 2021 and November 2024. Infants in the primary investigator’s unit were managed with a restrictive transfusion protocol and reinforced KMC; infants in other units were managed with a liberal transfusion protocol, reflecting natural practice variation. KMC duration was categorized as short (?8 hours/day) or long (>8 hours/day). Primary outcomes were hemoglobin at discharge and frequency of RBC transfusions. Secondary outcomes included growth trajectories (weight gain and Fenton chart centiles) and neurodevelopmental status at 6 months, assessed by the Developmental Assessment Scale for Indian Infants (DASII). Linear and logistic regression models, including an interaction term for KMC duration × transfusion protocol, were used.
Results: Infants in the restrictive transfusion protocol with prolonged KMC had higher mean discharge hemoglobin (10.43 g/dL, 95% CI: 10.05-10.81) and required fewer transfusions compared with infants in liberal units, while growth outcomes were comparable across groups. The interaction term between KMC duration and transfusion protocol did not reach conventional statistical significance but suggested that long KMC can mitigate the hematologic impact of restrictive thresholds. Neurodevelopmental outcomes at 6 months were similar between groups.
Conclusion: Prolonged KMC appears to support better hematologic outcomes and reduced transfusion requirements in preterm infants managed with restrictive transfusion protocols, without compromising growth or early neurodevelopment. These findings highlight the complementary role of KMC and conservative transfusion strategies in managing anemia of prematurity in resource-limited settings and provide hypothesis-generating evidence for larger multicentre trials.
International Journal of Clinical Obstetrics and Gynaecology
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