Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Abstract

Background: KMC is a global standard for LBW and preterm neonates, supported by evidence for reducing morbidities and mortality. Integrated into India’s Newborn Action Plan since 2014, aiming for single-digit neonatal mortality by 2030, KMC practices in India have not reached the optimal levels. Hence, we attempted to study the KMC practices in tertiary care NICUs across India. Methods: A cross-sectional online national survey among neonatologists in level III NICUs in India was conducted. Utilizing Google Forms and a structured questionnaire of 30 questions on KMC, one respondent per unit participated. Results: Of the 110 NICUs invited to participate, a total of 52 units responded (47.3%). All units have a written KMC policy and conventionally provide KMC to neonates with BW < 2000 g, while 36.5% units provide KMC for neonates with BW between 2000 and 2500 g. Though 86.5% of NICUs provide KMC to infants on respiratory support, only 13.5% practice KMC for mechanically ventilated neonates. The time to initiate KMC within 48–72 hours is prevalent in 44.2% of NICUs, with 54% of NICUs providing an average KMC duration of 4–8 hours/day. A significantly lower percentage of NICUs (28.9%) have a KMC follow-up program. Conclusion: The study highlights the need to boost the ongoing KMC training programs for HCWs to increase the coverage of KMC for LBWs and sick preterm neonates. This includes requiring more uniform and structured KMC practices across the country, especially upscaling of infrastructure, earlier initiation and longer duration of KMC, better monitoring of neonates in KMC, and strengthening the follow-up program.