Charpak N, Ruiz-Peláez J G, Charpak Y
Departamento de Pediatría, Universidad Nacional de Columbia, Santa Fe de Bogotá.
Pediatrics. 1994 Dec;94(6 Pt 1):804-10.
To assess the effectiveness and safety of the Kangaroo mother intervention (KMI).
Observational, analytic, prospective (two cohorts) study.
Two large tertiary care obstetric hospitals, one offering "traditional" care and the other KMI.
Newborn infants with birth weights < or = 2000 g, who survive the neonatal period and are eligible for an in-patient minimal care unit (MCU) (having overcome major adaptation problems to extra uterine life).
"Kangaroo infants" (KI) were discharged as soon as they were eligible for MCU, regardless of weight or gestational age. Infants were kept 24 hours a day in an upright position, in skin-to-skin contact and firmly attached to the mother's chest until the KMI was not tolerated anymore. Control babies (from the other facility) were kept in incubators at the MCU until they satisfied usual discharge criteria for the control hospital. Both groups were followed periodically up to the age of 1 year.
Three hundred thirty-two eligible infants were recruited, 162 at the Kangaroo hospital and 170 at the control hospital. KI came from a much lower socio-economic class and were more ill before eligibility. Relative risk of death was higher for KI (RR 1.9), although this figure was reversed after adjusting for weight at birth and gestational age (RR 0.5). KI grew less in the first 3 months and had a higher proportion of developmental delay at 1 year, and a multivariate analysis failed to control for the large baseline differences in socioeconomic levels and babies' health status between the two cohorts.
In spite of major baseline differences between studied cohorts, the survival of LBW infants in Bogotá is similar between the KMI and the "traditional care". Questions remain about quality of life, especially regarding weight gain and neurodevelopment, that may be answered by a Randomized Controlled Trial.
评估袋鼠式护理干预（KMI）的有效性和安全性。
观察性、分析性、前瞻性（两个队列）研究。
两家大型三级护理产科医院，一家提供“传统”护理，另一家提供KMI。
出生体重≤2000g、度过新生儿期且符合住院最低护理病房（MCU）条件（已克服宫外生活的主要适应问题）的新生儿。
“袋鼠式护理婴儿”（KI）一旦符合MCU条件即出院，无论体重或胎龄如何。婴儿每天24小时保持直立姿势，进行皮肤接触并紧紧贴在母亲胸前，直到不再耐受KMI。对照组婴儿（来自另一家机构）在MCU的保温箱中直至符合对照医院的常规出院标准。两组均定期随访至1岁。
共招募了332名符合条件的婴儿，袋鼠式护理医院162名，对照医院170名。KI来自社会经济阶层低得多的群体，在符合条件前病情更重。KI的相对死亡风险更高（RR 1.9），不过在调整出生体重和胎龄后这一数字逆转（RR 0.5）。KI在头3个月生长较慢，1岁时发育迟缓比例较高，多变量分析未能控制两个队列在社会经济水平和婴儿健康状况方面的巨大基线差异。
尽管研究队列之间存在重大基线差异，但波哥大低出生体重婴儿在KMI和“传统护理”下的存活率相似。关于生活质量，尤其是体重增加和神经发育方面的问题仍然存在，可能需要通过随机对照试验来解答。
