Ramadan Osama Mohamed Elsayed, Alshammari Afrah Madyan, Alruwaili Abeer Nuwayfi, Elsharkawy Nadia Bassuoni, Alhaiti Ali, Baraka Nagwa Ibrahim Mabrouk
Pediatric Nursing Department, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt.
College of Nursing, Department of Maternity and Pediatric Health Nursing, Jouf University, Sakaka, 72388, Saudi Arabia.
BMC Nurs. 2025 Apr 16;24(1):430. doi: 10.1186/s12912-025-03088-8.
Respiratory Distress Syndrome (RDS) remains a leading cause of mortality among preterm infants weighing < 2000 g, particularly in resource-limited settings. While Kangaroo Mother Care (KMC) has shown promise in stable preterm infants, its effectiveness for those requiring respiratory support remains unclear. This study evaluated nurse-led implementation of KMC for preterm infants with RDS.
A prospective, multicenter, randomized controlled trial was conducted across four neonatal intensive care units in Tanta, Egypt (January 2023-June 2024). Two hundred forty preterm infants (<2000 g) with RDS were randomly assigned to either nurse-implemented KMC (n = 120) or standard care (n = 120). The KMC protocol, implemented for a minimum of 6 h per day until hospital discharge, integrated continuous skin-to-skin contact, exclusive breastfeeding promotion, and structured parental education. Outcomes included 28-day survival, respiratory status (Silverman-Anderson Scores), nosocomial infections, maternal-infant bonding, growth trajectories, and clinical course metrics.
The KMC intervention significantly improved 28-day survival (adjusted HR = 0.42, 95% CI 0.28-0.63, p < 0.001) and reduced nosocomial infections by 55% (RR = 0.45, 95% CI 0.27-0.75, p < 0.001). KMC recipients demonstrated faster respiratory improvement, shorter CPAP duration (-2.2 days, p < 0.001), and higher rates of exclusive breastfeeding at discharge (74.2% vs. 48.3%, p < 0.001). Maternal competency scores showed progressive improvement with enhanced bonding and responsiveness.
Nurse-implemented KMC is a safe, effective intervention for preterm infants with RDS, yielding significant improvements in survival, clinical outcomes, and family-centered care metrics.
These findings support the expansion of nursing roles in implementing KMC for high-risk infants in resource-limited settings.
ClinicalTrials.gov (NCT06707376).
呼吸窘迫综合征（RDS）仍是体重<2000克的早产儿死亡的主要原因，在资源有限的环境中尤其如此。虽然袋鼠式护理（KMC）已被证明对病情稳定的早产儿有效果，但其对需要呼吸支持的早产儿的有效性仍不明确。本研究评估了由护士主导实施的KMC对患有RDS的早产儿的效果。
在埃及坦塔的四个新生儿重症监护病房进行了一项前瞻性、多中心、随机对照试验（2023年1月至2024年6月）。240名患有RDS的早产儿（<2000克）被随机分为护士实施的KMC组（n = 120）或标准护理组（n = 120）。KMC方案每天至少实施6小时，直至出院，包括持续的皮肤接触、促进纯母乳喂养和系统的家长教育。结果包括28天生存率、呼吸状况（Silverman-Anderson评分）、医院感染、母婴亲密关系、生长轨迹和临床病程指标。
KMC干预显著提高了28天生存率（调整后HR = 0.42，95%CI 0.28 - 0.63，p < 0.001），并将医院感染率降低了55%（RR = 0.45，95%CI 0.27 - 0.75，p < 0.001）。接受KMC的婴儿呼吸改善更快，持续气道正压通气（CPAP）时间缩短（-2.2天，p < 0.001），出院时纯母乳喂养率更高（74.2%对48.3%，p < 0.001）。母亲能力得分随着亲密关系和反应能力的增强而逐步提高。
护士实施的KMC对患有RDS的早产儿是一种安全、有效的干预措施，在生存率、临床结局和以家庭为中心的护理指标方面有显著改善。
这些发现支持在资源有限的环境中扩大护士在为高危婴儿实施KMC方面的作用。
ClinicalTrials.gov（NCT06707376）。
