- Design
- Cochrane systematic review and meta-analysis of 35 randomised trials
- Population
- About 12,000 preterm or low-birthweight infants and 10,000 caregivers after hospital discharge
- Primary outcome
- Mortality, neurodevelopment, morbidity, growth and breastfeeding
- Effect
- Breastfeeding at 6 months RR 1.26 (1.16 to 1.37); intensified visits, mortality HR 0.75 (0.60 to 0.93)
A Cochrane review pooled 35 randomised trials of home visiting for families of preterm and low-birthweight infants after hospital discharge; 28 trials, with about 12,000 infants, contributed outcome data. Most trials came from high-income countries, but roughly 70% of all participants came from one large Indian trial of community-initiated kangaroo mother care.
Compared with no home visits, visits likely increased the share of infants still breastfeeding at six months (RR 1.26, 95% CI 1.16 to 1.37; four trials, I² = 0%, moderate certainty). Effects on cognitive and motor development and on growth were small or absent, and the mortality estimate from a single small trial was too imprecise to interpret.
Where home visits were already standard, making them more intensive — with kangaroo mother care, more frequent contact and trained staff — likely reduced death by six months (HR 0.75, 95% CI 0.60 to 0.93; one trial, 8402 infants) and modestly reduced possible serious bacterial infection by 28 days (RR 0.89, 0.82 to 0.97).
For Indian practice this is unusually direct evidence: the mortality signal comes largely from an Indian community setting. The discharge plan for a small baby should name who will visit, when, and whether skin-to-skin care is being supported at home.
- At discharge of a preterm or low-birthweight baby, confirm a named home-visit plan rather than leaving follow-up to clinic attendance alone.
- Ask at each contact whether skin-to-skin kangaroo care is continuing at home, and who is supporting it.
- Use home visits to support breastfeeding to six months — the most consistent benefit in this review.
- Do not promise families developmental benefit from home visits; the trials found little effect on cognition, motor skills or growth.
- Where community health workers already visit, the evidence favours more intensive visits with kangaroo care over a single check.
Why it matters
The strongest survival evidence for post-discharge care of small babies comes from an Indian community programme, not from a high-income setting.
Don't overread it
The mortality benefit rests on one large trial of intensified visits, not on home visiting in general.
The statistics, in plain English
A risk ratio of 1.26 means about a quarter more babies were still breastfeeding at six months with visits; I² of 0% means the four trials agreed. A hazard ratio of 0.75 means the rate of death was about a quarter lower over six months, and because its interval (0.60 to 0.93) stays below 1, chance is an unlikely explanation — but it comes from a single trial.
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