Evidence Classic · Maternal and newborn care · Issue 00
The incubator that walks
An idea born of a shortage became, four decades later, one of the strongest survival findings in newborn care.
Bogotá, Colombia, 1978 · five-country trial published 2021
In 1978, in a public maternity hospital in Bogotá, the paediatrician Edgar Rey Sanabria faced a problem many hospitals still know: too many small babies, too few incubators, and infections that spread when babies had to share them.
His answer, developed with Héctor Martínez-Gómez, was the mother. Babies were held skin to skin, upright on the parent’s chest, fed breast milk, and sent home earlier with close follow-up. It became known as kangaroo mother care.
For years it was dismissed as a poor-country substitute for technology. The evidence slowly said otherwise. In a trial coordinated by the World Health Organization in Ghana, India, Malawi, Nigeria and Tanzania, 3,211 babies weighing 1.0 to 1.8 kg were randomly assigned to start continuous skin-to-skin contact immediately after birth, or only after they had been stabilised.
Deaths in the first 28 days were 12.0% with immediate contact and 15.7% with usual care. The trial was stopped early because the benefit was clear.
The most advanced piece of equipment in the room was a parent.
Evidence Passport
- What changed
- Continuous skin-to-skin contact starting immediately after birth, instead of after the baby was stabilised.
- What was measured
- Deaths within 28 days of birth, in a randomised controlled trial of 3,211 babies weighing 1.0 to 1.8 kg.
- Result
- 12.0% vs 15.7% (relative risk 0.75). The trial stopped early for clear benefit.
- Limits
- Carried out in hospitals that could keep mothers and babies together in a special care unit. The benefit depends on that space and on staff to support mothers.
Sources
- WHO Immediate KMC Study Group. Immediate “kangaroo mother care” and survival of infants with low birth weight. N Engl J Med 2021
- Kangaroo mother care: origins (Embryo Project Encyclopedia, Arizona State University)
An editorial feature about published work. The people named did not apply to Evinca, were not reviewed by us, and are not Evinca honorees.