Immediate Skin-to-Skin Care Linked to Lower Mortality in Preterm Infants, Review Finds

A comprehensive review published in the World Journal of Pediatrics provides strong evidence that immediate skin-to-skin contact, known as kangaroo mother care (KMC), can dramatically improve survival and health outcomes for premature and low-birth-weight infants. The analysis, which synthesized data from five randomized controlled trials across multiple countries, found that immediate KMC (iKMC), initiated as soon as possible after birth and ideally within the first 24 hours, was associated with lower 28-day neonatal mortality, reduced hypothermia, fewer suspected sepsis cases, improved exclusive breastfeeding rates, and better weight gain compared with delayed KMC.

Preterm birth and low birth weight remain leading causes of neonatal death and long-term developmental challenges worldwide. Kangaroo mother care, which combines skin-to-skin contact, exclusive breastfeeding, early discharge, and follow-up support, was originally developed as an alternative to incubator care in resource-limited settings. Earlier guidelines recommended KMC only after clinical stabilization, but newer evidence has shifted focus toward starting care immediately after birth. However, implementation varies widely across hospitals due to differences in timing, duration, monitoring, staffing, privacy, and family support.

The review, conducted by researchers from the Faculty of Medicine, Universitas Indonesia; Dr. Cipto Mangunkusumo National General Hospital; and Universitas Indonesia Hospital, was published online on November 14, 2025, in the World Journal of Pediatrics (DOI: 10.1007/s12519-025-00993-5). The authors searched Medline (PubMed), Scopus, EuropePMC, and Google Scholar up to June 2024 and included five randomized controlled trials comparing immediate and delayed KMC. These studies covered both low- and high-resource settings, including Ghana, India, Malawi, Nigeria, Tanzania, Madagascar, Norway, Gambia, and Uganda.

Across the evidence, iKMC showed a strong survival signal. The World Health Organization iKMC trial reported lower 28-day mortality in the immediate-care group than in the delayed-care group, while other trials showed similar favorable trends. iKMC also reduced hypothermia, a critical risk for preterm and low-birth-weight infants who struggle to regulate body temperature. In addition, early skin-to-skin contact may support protective maternal microbiota transfer, reduce hospital-acquired exposure, and encourage earlier breastfeeding, all of which can strengthen neonatal immunity.

Beyond infant outcomes, the review notes potential maternal benefits, including greater satisfaction and improved postpartum recovery markers. Economic analyses also suggest that iKMC can lower provider and household costs by reducing reliance on more resource-intensive care. The authors said the findings make a strong case for treating iKMC not as an optional add-on, but as a core part of neonatal care for eligible preterm and low-birth-weight infants. They emphasized that success depends on safe monitoring, trained staff, suitable facilities, and practical support for mothers and caregivers.

The implications extend beyond individual hospitals. To scale iKMC safely, health systems may need mother–neonatal intensive care units (mother–NICUs), shared protocols between obstetric and neonatal departments, family-centered education, privacy solutions, and support for fathers or relatives as alternative caregivers. The review also identifies key gaps: long-term neurodevelopmental outcomes after iKMC remain unclear, evidence from high-resource settings is still limited, and implementation for extremely low-birth-weight infants requires more study. If implemented effectively, iKMC could offer a rare combination in global healthcare: a low-cost intervention capable of saving lives while reducing pressure on overstretched neonatal systems.