Effect on the practice of the kangaroo method on the formation and strengthening of the mother-baby bond: a systematic review

Caetano, Carolina; Pereira, Bianca Baptista; Konstantyner, Tulio

doi:10.1590/1806-93042022000100002

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REVIEW • Rev. Bras. Saúde Mater. Infant. 22 (01) • Jan-Mar 2022 • https://doi.org/10.1590/1806-93042022000100002 copy

Effect on the practice of the kangaroo method on the formation and strengthening of the mother-baby bond: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

a systematic review study with the objective of estimating the effect on the practice of the kangaroo method (KM) on the formation and strengthening of the mother-baby bond (MBB).

Methods:

independent searches were performed in three international databases in the United States National Library of Medicine - PubMed, Scientific Electronic Library Online - Scielo and Web of Science databases. Searches were made without limit on languages and year of publication.

Results:

the final selection consisted of 27 studies, 14 of a quantitative nature (nine clinical trials and five observational) and 13 qualitative. All qualitative articles and most quantitative ones (n=10) indicated the practice of the KM as favorable to the formation and strengthening of the MBB. Other quantitative studies did not show statistically significant differences in the comparisons made between groups. None of the 27 studies found unfavorable effects resulting from the practice of KM on the MBB.

Conclusion:

the results suggest that the KM favors the formation and strengthening of the MBB regardless of the weight and gestational age of the newborns or the place of measurement (hospital or residence). Thus, encouraging the execution of this biopsychosocial intervention of qualified and humanized care is recommended for the promotion of children’s health.

Key words
Kangaroo-mother care method; Mother-child relations; Newborn; Child health; Maternal and child health; Maternal-child nursing

Author (year)	Metodology					Results
Author (year)	Country	Sample	Intervention	Outcome	Analysis	Results
Lewis et al.¹⁹19 Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, et al. Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth. 2019 Jul; 19: 227. (2019)	USA	n=20 MBP (GA 30-37 wks)	KM on H	Maternal experiences (SEI on HD)	I	75% of the mothers felt closer to the baby
Maastrup et al.²⁰20 Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. “Now she has become my daughter”: parent’s early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci. 2017 Jun; 32 (2): 545-53. (2017)	Denmark	n=13 MBP (GA <28 wks)	1 sec KM on H	Maternal opinion (SEI)	I	Mothers pointed out the SSC is essential for the formation of the MBB
Flacking et al.¹⁰10 Flacking R, Thomson G, Axelin A. Pathways to emotional closeness in neonatal units - a cross-national qualitative study. BMC Pregnancy Childbirth. 2016 Jul; 16: 170. (2016)	Europe MuC	n=23 MBP (GA <37 wks)	KM on H	Maternal experience (OI on H)	T	Mothers affirmed that the KM has promoted the MBB
Hagen et al.²¹21 Hagen IH, Iversen VC, Svindseth MF. Differences and similarities between mothers and fathers of premature children: a qualitative study of parent’s coping experiences in a neonatal intensive care unit. BMC Pediatr. 2016 Jul; 16 (92): 1-9. (2016)	Norway	n=8 MBP (GA <32 wks)	KM on H	Maternal experiences (SEI 1 and 6 months after H)	P	Mothers affirmed that the KM was more effective than holding on the strengthening of the MBB
Cooper et al.²²22 Cooper L, Morrill A, Russell RB, Gooding JS, Miller L, Berns SD. Close to me: enhancing kangaroo care practice for NICU staff and parents. Adv Neonatal Care. 2014 Dec; 14 (6): 410-23. (2014)	USA	n=50 MBP (GA 26-35 wks)	KM 1sec 1h/d for 6d + EI	Opinions and feelings (Mother registers on H)	TB	Mothers reported feeling a stronger MBB “during” KM
Borck²³23 Borck M, Santos EKA. Método canguru: práticas investigativas e de cuidado de enfermagem no modelo de adaptação de Roy. Esc Anna Nery. 2012 Jun; 16 (2): 263-9. (2012)	Brazil	n=6 MBP (GA <37 wks)	KM during and after H	Maternal opinion (SEI after HD)	CC	Most mothers affirmed that the KM helped with the affection
Dalbye et al.²⁴24 Dalbye R, Calais E, Berg M. Mothers’ experiences of skin-to-skin care of healthy full-term newborns - a phenomenology study. Sexual Reprod Healthc. 2011 Aug; 2 (3): 107-11. (2011)	Europe MuC	n=20 MBP (GA 37-41 wks)	KM on H and after HD	Maternal experiences (OI 1wkpostpartum)	P	Mothers affirmed that the KM increased the MBB
Arivabene e Tyrrell²⁵25 Arivabene JC, Tyrrell MAR. Método mãe canguru: vivências maternas e contribuições para a enfermagem. Rev Latino-Am Enferm. 2010; 18 (2): 262-8. (2010)	Brazil	n=13 MBP (GA <37 wks)	KM on H and after HD	Maternal experiences (OI with FG after HD)	T	Mothers affirmed that the KM increased the MBB
Guimarães e Monticelli²⁶26 Guimarães GP, Monticelli M. A formação do apego pais/recém-nascido pré-termo e/ou de baixo peso no método mãe-canguru: uma contribuição da enfermagem. Texto Contexto Enferm. 2007; 16 (4): 626-35. (2007)	Brazil	n=3 MBP (GA <37 wks)	KM on H	Maternal opinion (OI on H)	CC	Mothers affirmed that the KM promotes the MBB during H
Johnson²⁷27 Johnson AN. The maternal experience of kangaroo holding. J Obstet Gynecol Neonatal Nurs. 2007 Nov/Dec; 36 (6): 568-73. (2007)	USA	n=18 MBP (GA 28,8 wks)	KM 1 sec of 1h/d for 3d	Maternal opinions and feelings (OI)	T	Mothers reported the increase of attachment and connection with the baby
Flacking et al.²⁸28 Flacking R, Ewald U, Nyqvist KH, Starrin B. Trustful bonds: a key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit. Social Sci Med. 2006; 62 (1): 70-80. (2006)	Sweden	n=23 MBP (GA <32 wks)	KM on H	Maternal opinion (SEI after 2 wks of HD)	TB	Mothers affirmed that the KM increased the MBB
Roller²⁹29 Roller CG. Getting to know you: mothers’ experiences of kangaroo care. J Obstet Gynecol Neonatal Nurs. 2005 Mar/Apr; 34 (2): 210-7. (2005)	USA	n=10 MBP (GA 32-36 wks)	KM on H	Maternal experiences (OI on H)	P	Mothers affirm that the KM is more effective than B to the MBB
Neu³⁰30 Neu M. Parents’ perception of skin-to-skin care with their preterm infants requiring assisted ventilation. J Obstet Gynecol Neonatal Nurs. 1999 Mar/Apr; 28 (2): 157-64. (1999)	USA	n=8 MBP (GA 27.2 wks)	KM 2 sec (1h)	Maternal opinion (OI on H and after 4 m)	T	Most of the mothers affirmed that the KM increased the MBB

Author (year)	Methodology				Results
Author (year)	Design	Sample	Kangaroo Strategy	Outcome	Results
Cho e Jeong³¹31 Cho H, Jeong IS. The relationship between mother-infant contact time and changes in postpartum depression and mother-infant attachment among mothers staying at postpartum care centers: an observational study. Nurs Health Sci. 2021 Jun; 23 (2): 547-55. (2021)	Co South Korea	n=101 MBP2 MT: 14 d during H	KM $\bar{X}$ 58min/d	Mother perception over the MBB (MAS)	Mothers have felt closer to their babies after using the KM (p=0.001)
Kurt et al.³²32 Kurt FY, Kucukoglu S, Ozdemir AA, Ozcan Z. The effect of kangaroo care on maternal attachment in preterm infants. Niger J Clin Pract. 2020 Jan; 23(1): 23-32. (2020)	RCT Turkey	n=60 MBP (GA <37 wks) IG 30 x CG 30	KM5 sec 1h/d for 5d	Mother perception over the MBB (MAS)	$\bar{X}$ IG (35.03) > CG (29.87); p=0.001
Taneja et al.³³33 Taneja S, Sinha B, Upadhyay RP, Mazumder S, Sommerfelt H, Martines J, et al. Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial. BMC Pediatr. 2020; 20 (150): 1-12. (2020)	RCT India	n=552 MBP (BW 1500-2250g)2IG 276 x CG 276	EI: KM + EB until 28 d of life	Mother perception of herself and her baby (PHQ-9)	There was no difference between groups (p>0.05)
Nuneset al.³⁴34 Nunes CRN, Campos LG, Lucena AM, Pereira JM, Costa PR, Lima FAF, et al. Relação da duração da posição canguru e interação mãe filho pré termo na alta hospitalar. Rev Paul Pediatr. 2017; 35 (2): 136-43. (2017)	Co Brazil	n=32 MBP (GA 28-32 wks) FP: H	Total KM time on H	MBP interaction on the HD (Film) (POIMB 0-6)	Baby’s physical contact to the mother: r=0.38 (p=0.03) Mother’s verbal contact to the baby: r=-0.47 (p=0.01). Other 18 items (p>0.05)
Cho et al.³⁵35 Cho ES, Kim SJ, Kwon MS, Cho H, Kim EH, Jun EM, et al. The effects of kangaroo care in the neonatal intensive care unit on the physiological functions of preterm infants, maternal-infant attachment, and maternal stress. J Pediatr Nurs. 2016 Jul/Aug; 31 (4): 430-8. (2016)	CT South Korea	n=40 MBP (GA 33-37 wks) IG 20 x CG 20	KM 30min 3x/wk (10 wks)	Maternal perception over the MBB (MIA)	IG > perception (p=0.001)
Kritzinger and Rooyen³⁶36 Kritzinger A, Van Rooyen E. The effect of formal, neonatal communication-intervention training on mothers in kangaroo care. Afr J Prim Health Care Fam Med. 2014 Nov; 6 (1): E1-E9. (2014)	RCT South Africa	n=30 MBP (GA <37 wks) IG1 10 x IG2 10 x CG 10	IG1: 1 sec KM+EI IG2: 1 sec KM	Mother and baby’s reaction (Film) (KB)	IG1> $\bar{X}$ touching stimulation (p=0.02); pleasure when interacting withthe NB (p=0.001); responding to the baby’s agony (p=0.04); eye contact (p=0.008); smiling to the NB (p<0.001); talking to the NB (p<0.001)
Mudduet al.³⁷37 Muddu GK, Boju SL, Chodavarapu R. Knowledge and awareness about benefits of kangaroo mother care. Indian J Pediatr. 2013 Oct; 80 (10): 799-803. (2013)	Co India	n=46 MBP (GA 28-37 wks)	KM for 1h 1 sec	Maternal perception (Interview)	93,5% (CI95% 82,1- 98,6) of the mothers have felt closer to their babies after using the KM
Ahn et al.³⁸38 Ahn HY, Lee J, Shin HJ. Kangaroo care on premature infant growth and maternal attachment and post-partum depression in South Korea. J Trop Pediatr. 2010 Oct; 56 (5): 342-4. (2010)	CT South Korea	n=20 MBP (GA< 36 wks) IG 30 x CG 30	KM for 1h 10 sec in 3 wks	Maternal attachment (MA) (Interview)	$\bar{X}$ IG (85.9) > CG (83.2); p=0.066 before KM $\bar{X}$ IG (89.9) > CG (78.2); p=0.003 after KM
Carbonell et al.³⁹39 Carbonell OA, Plata SJ, Peña PA, Cristo M, Posada G. Calidad de cuidado materno: una comparación entre bebés prematuros en cuidado madre canguro y bebés a término en cuidado regular. Univ Psychol. 2010; 9 (3): 773-86. (2010)	Controlled Co Colombia	n=94 MBP (TM) (GA>30 wks) KMG 49 x CG 44	KMG: PT+ LBW+ KM in H (does not describe the number of sec) CG: PTNB	MBP behavior (MBQS at 3mCAg) (EQCTM at 7m)	There was no difference between groups (p>0.05)
Jang e Youg⁴⁰40 Jang MY. Effects of kangaroo care on growth in premature infants and on maternal attachment. Korean Acad Child Health Nurs. 2009; 15 (4): 335-42. (2009)	CT South Korea	n=53 MBP (GA<35 wks) IG 24 x CG 29	KM for 1h 10 sec - 3sec/wk	Maternal attachment (MA) (interview)	IG > attachment (p=0.048)
Parmar et al.⁴¹41 Parmar VR, Kumar A, Kaur R, Parmar S, Kaur D, Basu S, et al. Experience with kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India. Indian J Pediatr. 2009 Jan; 76 (1): 25-8. (2009)	T India	n=135 MBP (GA 26-37 wks)	KM 4h/d at least on the H ( $\bar{X}$ 7 d)	Maternal opinion (KMQ)	98% have felt closer or a lot closer to their NB after using the KM
Gathwala et al.⁴²42 Gathwala G, Singh B, Balhara B. KMC facilitates mother baby attachment in low birth weight infants. Indian J Pediatr. 2008 Jan; 75 (1): 43-7. (2008)	RCT India	n=100 MBP (BW<1800g) IG 50 x CG 50	KMfor at least 6h/d on H 4 sec	MBP behavior (ASFU 3mCAg)	$\bar{X}$ IG > in all 9 items of ASFU (p<0.05)
Ortiz et al.⁴³43 Ortiz JA, Borré A, Carrillo S, Gutiérrez G. Relación de apego en madres adolescentes y sus bebés canguro. Rev Latino-Am Psicol. 2006; 38 (1): 71-86. (2006)	Controlled Co Colombia	n=40 MBP LSL KMG1 10 x KMG2 10 x CG1 10 x CG2 10	KMG1: PT+TM+KM KMG2: PT+KM GC1: PTNB+TM GC2: 10 PTNB	MBP behavior at home Attachment Q-sort	There was no difference between groups: p>0.,05
Tallandini and Scalembra⁴⁴44 Tallandini MA, Scalembra C. Kangaroo mother care and mother-premature infant dyadic interaction. Infant Mental Health J. 2006 May; 27 (3): 251-75. (2006)	CT Italy	n=40 MBP (BW<1800g) IG 19 x CG 21	KM 1h/d (during H) ( $\bar{X}$ 24,4d)	MBP behavior (Film) (NCAFS)	IG > $\bar{X}$ in all items (p=0.015)
Tessier et al.⁴⁵45 Tessier R, Cristo M, Velez S, Girón M, Calume ZF, Ruiz-Paláez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics. 1998 Aug; 102 (2): e17. (1998)	RCT Colombia	n=488 MBP 2 (BW<2001g $\bar{X}$ GA=33wks) IG 246 x CG 242	MC 24h/d (around3 wks during H)	MBP behavior (Film with 1 wk CI) (NCAFS)	There was no difference between groups: p>0,05

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[1] Author’s contribution

Caetano C: Conception, writing, collecting and dataanalyzing. Pereira BB: collecting and dataanalyzing. Konstantyner T: conception, writing, collecting and dataanalyzing and critical review. All authors have approved the final version of the article. The authors declare no conflict of interest.