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. 2026 Jan 21;115(5):1077–1084. doi: 10.1111/apa.70451

Kangaroo Mother Care Is Beneficial for Both Infants and Parents: An Umbrella Review

Edwina Hurme 1, Ulla Sankilampi 1,2, Leena Hintikka 2, Ilari Kuitunen 1,2,✉
PMCID: PMC13063357  PMID: 41560555

ABSTRACT

Aim

To evaluate the overall effectiveness of kangaroo mother care (KMC) for newborn infants and parents.

Methods

In February 2024, PubMed, Scopus, and Web of Science were searched to identify systematic reviews with meta‐analyses of randomised controlled trials that investigated KMC. Two authors independently screened the literature to identify relevant studies, which were extracted by one author and verified by another author.

Results

Thirty‐one systematic reviews with meta‐analyses were included in the umbrella review. KMC demonstrated multiple benefits for infants, such as improved thermoregulation, glycemic stability, head circumference growth, reduced infection risk, shorter hospital stays, and enhanced physiological stability. Among preterm or low‐birthweight newborn infants, KMC was associated with reduced mortality when compared to standard care, particularly in low‐ and middle‐income countries. Maternal benefits included higher breastfeeding rates and improved psychological well‐being among mothers practicing KMC compared to mothers who did not practice KMC.

Conclusion

The KMC intervention provides numerous advantages for both infants and mothers. As a safe, simple, and cost‐effective intervention, KMC should be widely promoted and integrated into neonatal practices globally. However, limitations in the quality of evidence from previous systematic reviews and meta‐analyses warrant cautious interpretation of the findings.

Keywords: kangaroo mother care, low birthweight, neonatal mortality, preterm birth, skin‐to‐skin contact

Summary

  • Evidence was synthesised from systematic reviews and meta‐analyses on the effectiveness of kangaroo mother care, or skin‐to‐skin contact, for infants and parents.

  • Kangaroo mother care improved infant thermoregulation, growth, and physiological stability and reduced infection, mortality, and hospital stay while increasing breastfeeding and maternal psychological well‐being.

  • Kangaroo mother care should be widely integrated into neonatal practices globally; however, higher‐quality evidence is necessary to strengthen confidence in clinical recommendations.

Abbreviations

KMC

kangaroo mother care

LBW

low birthweight

LMICs

low‐ and middle‐income countries

SSC

skin‐to‐skin contact

WHO

World Health Organization

1. Introduction

In kangaroo mother care (KMC), naked newborn infants are placed on their mothers' or fathers' bare chests to achieve skin‐to‐skin contact (SSC). Hence, KMC and SSC refer to the same type of intervention. In 1978, KMC was first introduced in Colombia as an innovative treatment method in response to a shortage of incubators in a neonatal care unit for premature and low birthweight (LBW) babies [1, 2]. Initiated in hospitals and continued at home, the KMC intervention is based on early, continuous, and prolonged SSC between the mother and her newborn infant, as well as exclusive breastfeeding [3]. Newborn infants can also be placed in SSC with their father or another caregiver. The most significant KMC benefits for newborn infants include decreased morbidity in low‐ and middle‐income countries (LMICs) and lower mortality rates. Many other positive outcomes have been reported, such as increased weight gain and breastfeeding, and a reduction in hypothermia and sepsis by discharge [4, 5, 6, 7]. The benefits of KMC are not limited to newborn infants but include positive outcomes for parents, such as a decrease in depressive symptoms [5, 6, 8]. However, these caregiver benefits have not been well studied in the literature.

In particular, KMC plays an important role in the care of preterm and LBW newborn infants (i.e., birth weight < 2500 g), as neonatal mortality and morbidity is high in these groups [4, 5]. Each year, over 20.5 million babies are estimated to be born with LBW, including > 90% in LMICs [6, 9, 10]. Compared with routine care, community‐based KMC can close these neonatal care gaps and reduce newborn mortality in LMICs [11, 12]. The World Health Organization's (WHO) updated 2022 guidelines now recommend that all newborn infants who were born preterm or have LBW should receive continuous SSC as soon as possible after birth [4, 5, 6]. Despite the WHO's recommendations in favour of KMC, this intervention is rarely used in health facilities around the world [5, 6, 11] due to various barriers [13, 14, 15].

This umbrella review of systematic reviews and meta‐analyses aimed to provide an overview of the effectiveness of KMC for both newborn infants and their parents. In addition, subgroups were also considered, such as preterm versus full‐term infants and high‐income countries versus LMICs. In particular, this umbrella review captured the quality of evidence in systematic reviews and meta‐analyses, including randomised controlled trials (RCTs), of KMC or SSC for the first time.

2. Methods

This umbrella review was reported according to a version of the Preferred Reporting Items for Overviews of Reviews developed for health‐care interventions [16]. Our systematic review protocol was preregistered in PROSPERO, an international systematic review registry (No. CRD42024551136).

2.1. Literature Search

In February 2024, we searched PubMed, Scopus, and Web of Science databases for relevant systematic reviews and meta‐analyses using the following phrase: “(kangaroo OR skin‐to‐skin) AND care AND meta‐analysis.” The search results were uploaded to Covidence software (Covidence, Melbourne, Australia), and two authors independently screened the abstracts and full texts. Mutual consensus was achieved to resolve any conflicting cases. Additional filters were not used in this literature search.

2.2. Inclusion and Exclusion Criteria

The inclusion criteria were systematic reviews and meta‐analyses of RCTs that mentioned KMC or SSC interventions and focused on both newborn infants and parent outcomes, as defined in the articles. In particular, control interventions and the quality of breastfeeding were excluded from the search criteria. In addition, we excluded studies that focused solely on procedural pain in newborn infants, as the related evidence is well established [7, 17]. Nonsystematic reviews and reviews without meta‐analyses were excluded. Similarly, meta‐analyses of observational studies or meta‐analyses that did not stratify randomised and nonrandomised studies were also excluded. Finally, studies published in languages other than English were excluded.

2.3. Data Extraction

The data were extracted by one author after two authors pilot‐tested the data extraction template, which was created for this work. Two authors extracted 10% of the included systematic reviews and meta‐analyses to check for potential errors in the process, and then one author extracted the remaining 90%. The authors, journals, patient populations, interventions, comparators, study settings, all outcomes where at least two studies were pooled statistically, effect estimates, and evidence certainty, as reported by the original authors, were extracted from the obtained systematic reviews and meta‐analyses.

2.4. Quality Appraisal

The quality of the included systematic reviews and meta‐analyses was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR, v. 2) by one author who had prior experience with AMSTAR.

2.5. Statistics

This umbrella review of systematic reviews and meta‐analyses was conducted according to the Joanna Briggs Institute's guidelines. However, we decided not to pool the effect estimates from the included studies due to the expected high heterogeneity in the patient populations and study settings. Statistical pooling would have further increased these heterogeneity issues. Instead, we collected all outcomes and their effect estimates, which were summarised in evidence tables (Supporting Information) and traffic‐light plots (Figures 1, 2, 3). In the traffic‐light plots, green indicates that KMC was superior, yellow indicates no difference, and red indicates that KMC was inferior to the control intervention.

FIGURE 1.

FIGURE 1

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Summary of the effects and effectiveness of KMC for preterm and LBW babies. Effects for babies born in low‐ and middle‐income countries are presented separately on the right of the traffic‐light plot. Green, KMC superior to routine care; Yellow, no evidence of any difference; Red, routine care was better.

FIGURE 2.

FIGURE 2

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Summary of the effects and effectiveness of KMC for all newborn infants regardless of birth weight or gestational age. Green, KMC superior to routine care; Yellow, no evidence of any difference; Red, routine care was better.

FIGURE 3.

FIGURE 3

Open in a new tab

Summary of the effects and effectiveness of the kangaroo mother care for parents. Green, KMC was superior to routine care; Yellow, no evidence of any difference; Red, routine care was better.

3. Results

After screening a total of 168 studies and assessing a further 70 reports, we included 31 meta‐analyses (Figure S1) [7, 8, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49], which were published between 2010 and 2024 (Table S2). The highest number of included studies was 124, and the highest number of included participants in the meta‐analyses was 17 110 (Table S3). The included systematic reviews were rated according to their overall AMSTAR quality scores as high in 11, moderate in seven, low in eight, and critically low in five (Table S1). Similarly, the certainty of evidence in 13 meta‐analyses was assessed for 59 outcomes, of which two were rated as high, 28 as moderate, 24 as low, and 5 as very low (Table S3). Of the 31 meta‐analyses, 23 focused on newborn infants and 17 focused on parents (Table S3). The newborn infants included in these studies were mainly preterm or LBW (18 studies), and the study settings were mainly delivery rooms (Table S2). Of the studies focusing on preterm newborn infants, six were from LMICs. The majority of studies focusing on preterm newborn infants included all income levels or did not specify the income level. Traffic‐light plots were used to present an overview of KMC's outcomes and effectiveness (Figures 1, 2, 3).

3.1. Preterm Newborn Infants in Countries of All Income Levels

Mortality among preterm babies was assessed in five systematic reviews (Figure 1). Four of these systematic reviews found KMC to be superior to the control intervention in mortality prevention, while one found no difference between KMC and the control intervention. Hypothermia was assessed in five systematic reviews, where four found KMC to be superior to the control intervention and one found no difference (Figure 1). Weight gain was assessed in three systematic reviews, which all found KMC to be superior to the control intervention (Figure 1). Length and head circumference growth were assessed in two systematic reviews that were both in favour of KMC. Sepsis or infection rate were assessed in three systematic reviews, which found KMC to be superior to the control intervention (Figure 1). Length of hospital stay was assessed in three systematic reviews: one found KMC to be superior to the control intervention, while two observed no difference. Psychomotor development was assessed in one systematic review that found no difference between KMC and the control intervention. One systematic review assessed cerebral palsy, severe disability, and neurodevelopmental outcomes and found no difference between KMC and the control intervention (Figure 1). Table S3 presents the specific effect estimates.

3.2. Preterm and LBW Newborn Infants in LMICs

Six meta‐analyses focusing on preterm newborn infants were from LMICs, and three found that KMC had a positive effect on mortality compared to routine care (Figure 1). One systematic review assessed mean body temperature and another risk for sepsis, and both found KMC to be superior to routine care (Figure 1). One systematic review did not find any difference in the need for surfactants compared to the control intervention. Length of hospital stay was assessed by two systematic reviews: one found that KMC led to shorter stays, while the other observed no difference compared to standard care. One systematic review assessed apnea and found KMC to be superior to normal care. Table S3 presents the specific effect estimates for all the included comparisons.

3.3. Newborn Infants Regardless of Birth Weight or Gestational Age

Two systematic reviews assessed the mortality of all newborn infants and found no difference between KMC and the control intervention (Figure 2). However, Boundy et al. [7] specifically found that KMC had a positive effect on mortality between 3 and 12 months of age compared to routine care. One systematic review assessed infection, sepsis, and necrotizing enterocolitis and found no difference between KMC and the control intervention regarding infection or necrotizing enterocolitis (Figure 2). Hypothermia was assessed in three systematic reviews, and two found KMC to be superior to the control intervention. Hyperthermia was assessed in two systematic reviews: one was in favour of KMC, while the other observed no difference (Figure 2). Increased mean body temperature was assessed in three systematic reviews that were all in favour of KMC. Hypoglycemia was assessed in three systematic reviews and increased blood glucose concentrations in two systematic reviews, which found KMC to be superior to the control intervention. Length of hospital stay was assessed in three systematic reviews, and two found that KMC had a positive effect, while one found no effect compared to routine care. Readmission to hospital was assessed in one systematic review, which observed no difference between KMC and the control intervention. Table S3 presents the specific effect estimates for all the included comparisons.

3.4. Parents

Exclusive breastfeeding was assessed in seven systematic reviews, which found KMC to be superior to routine care (Figure 3). Sivanandan and Sankar [44] found no difference in exclusive breastfeeding at 1–3 months follow‐up compared with the control intervention. Two systematic reviews assessed the likelihood of mothers breastfeeding, and both found that KMC had a positive effect. Three systematic reviews assessed successful first breastfeeding and found KMC to be superior to the control intervention. Four systematic reviews assessed breastfeeding initiation time: three found that KMC had a positive effect, while one found no effect compared to routine care. Two systematic reviews explored the duration of the first breastfeeding and found that KMC was superior to the control intervention. One systematic review assessed breastfeeding duration and found that KMC had a positive effect. Two systematic reviews assessed mothers' anxiety and mental health, and both found KMC had a positive effect compared to the control intervention. One systematic review assessed the third stage of labor and found that KMC had a positive effect compared to routine care. One systematic review assessed parents' satisfaction and parents' preference for the same postdelivery care but found that KMC had no effect compared to routine care. Mother–infant attachment was assessed in two systematic reviews, both of which found KMC to be superior to the control intervention. One systematic review assessed the father's salivary oxytocin and cortisol levels and anxiety scores but found no difference between KMC and routine care. One systematic review assessed moderate to severe postpartum maternal depressive symptoms and found KMC to be superior to routine care, with no difference in postpartum maternal depressive symptoms scores between KMC and the control intervention. Table S3 presents the specific effect estimates.

4. Discussion

This umbrella review of 31 previous systematic reviews and meta‐analyses found that KMC showed multiple positive effects for both infants and mothers compared with routine care. However, differences in outcomes were found between preterm and LBW babies and newborn infants of any gestational age or birth weight. Positive effects on both groups included normothermia and normoglycemia, improved head circumference growth, reduced risk of infections, shorter hospital stays, and improved physiological stability. Surprisingly, there was no difference found in mortality between KMC and routine care among all newborn infants. However, Boundy et al. [7] found that KMC had a positive effect on mortality among 3–12‐month‐old infants. In contrast, decreased mortality was the most important finding for preterm and LBW babies. Improved weight gain and changes in height were also observed in this group. Positive outcomes for mothers included improvements in breastfeeding and mental health, in addition to deeper mother–infant attachment.

The largest KMC studies were Boundy et al.'s [7] meta‐analysis, which included 124 studies that focused on neonatal outcomes among infants of all birth weights or gestational age, and Sivanandan and Sankar's [44] meta‐analysis, which included 31 RCTs that focused only on preterm or LBW infants. In particular, Boundy et al. [7] observed that mortality among newborn infants with LBW was 36% lower when using KMC compared to conventional care. KMC was also found to decrease the risk of neonatal sepsis, hypothermia, and hypoglycemia, and increased rates of exclusive breastfeeding. Similarly, Sivanandan and Sankar [44] found that KMC reduced mortality risks in preterm and LBW infants.

All the systematic reviews and meta‐analyses included in our umbrella review supported these findings. In particular, our most important finding was that KMC also decreased mortality rates in preterm and LBW babies. While hypothermia, especially in preterm babies, is associated with higher mortality [4, 5], we found that KMC protected infants from hypothermia and helped maintain normal body temperature. We also found that the use of KMC protected children from hypoglycemia and helped to keep their blood glucose levels stable, which is beneficial to preterm babies who often have difficulty breastfeeding [4].

However, the effects of KMC on parents have not been well studied. This umbrella review found that KMC had multiple positive effects on breastfeeding, including shorter initiation time, better success on first breastfeeding, and longer overall breastfeeding time. While the benefits of breastfeeding for both babies and mothers are well known [50, 51], global breastfeeding rates remain below international targets [51].

In addition, KMC had a positive effect on the mothers' mental health, as their anxiety and stress levels were lower compared to the control intervention. In addition, mothers experienced a decrease in moderate to severe postpartum maternal depressive symptoms, which is significant because the global prevalence of these symptoms is estimated to be around 13%–30% [52]. Postpartum depression is also generally more common in LMICs than in high‐income countries (54). Therefore, KMC should be promoted in LMICs. However, only one systematic review evaluated the effect of KMC on fathers, and no positive outcomes for fathers were observed in this umbrella review.

In 2025, the Lancet Child and Adolescent Health Commission discussed the future of neonatal care [15], particularly barriers to care provision. The problems affecting LMICs include poor financial resources and inadequate equipment and maintenance. As KMC is a cost‐free intervention that requires no equipment and is easy to perform, it offers a solution to these barriers. In high‐income countries, the use of KMC could also be beneficial because it leads to shorter hospital stays, which improves hospital capacity and cost‐effectiveness. As a low‐cost method with positive outcomes and no risks, KMC is beneficial for both high‐income countries and LMICs; therefore, it should be encouraged and promoted globally.

This umbrella review included only six systematic reviews from LMICs; hence, KMC should be studied further in these settings. The majority of the systematic reviews and meta‐analyses involved babies from countries at all income levels; therefore, a deeper investigation of birth settings would help evaluate the effects of KMC outcomes in different countries. In addition, only one meta‐analysis focused on fathers; hence, the effects of KMC on paternal health should also be studied in the future. Furthermore, evidence certainty remained mostly low to moderate; therefore, more evidence of the effectiveness of KMC could increase confidence in its benefits. Finally, the included reviews were limited in terms of quality, and future reviews should aim to improve the methodological quality to increase the validity of their findings.

Based on the available evidence from 31 systematic reviews and meta‐analyses of RCTs, KMC was found to be superior to routine care in many aspects. Therefore, all newborn infants, especially preterm or LBW babies, should receive continuous KMC as soon as possible after birth. In particular, KMC should be implemented in LMICs because the main finding of this umbrella review is reduced mortality, and most babies with LBW are born in LMICs. As a cost‐free intervention that shortens hospital stays, KMC should also be implemented in hospitals in high‐income settings to improve hospital capacity and cost‐effectiveness. In addition, the positive effects on breastfeeding and preventing postpartum maternal depressive symptoms are significant.

4.1. Strengths

To our knowledge, this umbrella review of systematic reviews and meta‐analyses of RCTs related to KMC and SSC is the largest to date. Neonatal, maternal, and paternal outcomes were included, with no notable protocol deviations.

4.2. Limitations

As this umbrella review included only one systematic review that focused on fathers, reliable conclusions could not be drawn from the limited data. Hence, more research is required to evaluate the effects of KMC on paternal health. In addition, the majority of systematic reviews and meta‐analyses did not specify the income levels of the relevant countries, with narrow data concerning LMICs. Therefore, future research should explore our findings. The exclusion of non‐English studies may have omitted relevant work published in other languages, which may have affected the overall interpretation of the results. Furthermore, we did not perform any statistical synthesis of the pooled results to reduce heterogeneity and overlapping reporting.

5. Conclusion

The overall evidence published in systematic reviews and meta‐analyses with RCTs demonstrated KMC's multiple positive outcomes for all newborn infants, especially preterm and LBW babies. Reduced mortality was the most significant outcome for newborn infants in LMICs because many were preterm or had LBW. In addition, KMC provides benefits for mothers, such as improvements in breastfeeding and mental health. Hence, KMC should be promoted worldwide as a safe and cost‐free intervention. As previous systematic reviews were limited in terms of their quality and lack of evidence certainty, future reviews should address these issues.

Author Contributions

Edwina Hurme: writing – original draft, data curation, data analysis. Ulla Sankilampi: conceptualization, methodology, supervision, resources, writing – review and editing. Leena Hintikka: methodology, supervision, writing – review and editing. Ilari Kuitunen: conceptualization, investigation, writing – review and editing, visualization, validation, methodology, software, formal analysis, project administration, resources, data curation, supervision.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Figure S1: PRISMA flowchart of the study selection process.

Table S1: AMSTAR‐2 assessment of the included meta‐analyses.

Table S2: Characteristics of the included reviews.

Table S3: Extracted data and information on included reviews and all outcomes used in the analyses.

APA-115-1077-s001.docx (118.6KB, docx)

Acknowledgements

We thank Peter Fogarty from Scribendi (www.scribendi.com) for editing a draft of this manuscript. Open access publishing facilitated by Ita‐Suomen yliopisto, as part of the Wiley ‐ FinELib agreement.

Data Availability Statement

All data are available upon request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Figure S1: PRISMA flowchart of the study selection process.

Table S1: AMSTAR‐2 assessment of the included meta‐analyses.

Table S2: Characteristics of the included reviews.

Table S3: Extracted data and information on included reviews and all outcomes used in the analyses.

APA-115-1077-s001.docx (118.6KB, docx)

Data Availability Statement

All data are available upon request.

Articles from Acta Paediatrica (Oslo, Norway : 1992) are provided here courtesy of Wiley

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