Home visits after discharge helped breastfeeding; intensive visits with kangaroo care likely cut deaths

Design

Cochrane systematic review and meta-analysis of randomised trials

Population

35 RCTs; 12,021 preterm or low-birthweight infants contributing data

Primary outcome

Mortality, neurodevelopment, morbidity, growth, breastfeeding

Effect

Breastfeeding at 6 months RR 1.26 (1.16–1.37); intensive visits with KMC: mortality HR 0.75 (0.60–0.93)

This Cochrane review included 35 randomised trials of home visits after hospital discharge for preterm and low-birthweight infants; 28 trials with 12,021 infants contributed data.

Compared with no home visits, visits likely increased breastfeeding at six months (RR 1.26, 95% CI 1.16–1.37, I² 0%) and may increase exclusive breastfeeding. They likely made little difference to cognitive or motor development or growth, and effects on mortality were very uncertain. Where home visits were already standard, more intensive visits — including community-initiated kangaroo mother care — likely reduced deaths at six months (HR 0.75, 95% CI 0.60–0.93) and serious bacterial infection at 28 days (RR 0.89). That comparison rests on a single large trial from India with about 8,400 infants.

The Indian context makes this directly relevant here. Continuing skin-to-skin care at home, supported by community health workers, is the component with the strongest survival signal for small babies after discharge.

• Arrange home follow-up after discharge for preterm and low-birthweight babies where services allow.
• Encourage kangaroo mother care to continue at home, not just on the ward.
• Use home visits to support breastfeeding; this was the clearest benefit.
• Link families to community health workers before discharge.
• Home visits alone did not improve development scores — continue developmental follow-up separately.

Why it matters

The weeks after discharge are high-risk for small babies, and this identifies which home support makes a difference.

Don't overread it

The mortality benefit comes from one large Indian trial of an intensified programme, not from home visits in general.

The statistics, in plain English

A hazard ratio of 0.75 means about a quarter fewer deaths over six months. I² of 0% for breastfeeding means the four trials agreed closely. GRADE certainty was moderate for mortality but low or very low for exclusive breastfeeding.

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