Enhanced home visits with kangaroo care likely cut deaths in small babies after discharge

Design

Cochrane systematic review of 35 randomised trials

Population

12,021 preterm or low-birthweight infants and 10,056 caregivers

Primary outcome

Mortality, development, morbidity, growth and breastfeeding

Effect

Enhanced visits with KMC: mortality HR 0.75 (0.60–0.93); breastfeeding RR 1.26 vs none

A Cochrane review included 35 randomised trials of home visits after hospital discharge for families of preterm and low-birthweight infants; 28 trials with 12,021 infants contributed data. About 70% of participants came from one large trial in India.

Compared with no home visits, home visits likely increased breastfeeding at six months (RR 1.26) and may have increased exclusive breastfeeding, but had little or no effect on cognitive or motor development or growth. Where some home visiting was already standard, more intensive visits with community-initiated kangaroo mother care likely reduced mortality at six months (HR 0.75) and possible serious bacterial infection at 28 days (RR 0.89), with moderate certainty.

For Indian practice the second comparison is the one that matters, because it comes largely from an Indian community setting. It suggests the content of the visit — supporting skin-to-skin care, feeding and early recognition of illness — matters as much as whether a visit happens.

Where services exist, support kangaroo mother care at home and link discharged small babies to an intensive home-visit programme.

• Teach and encourage kangaroo mother care before discharging a preterm or low-birthweight baby
• Link families to a community home-visit programme where one exists
• Use home visits to support breastfeeding, which they reliably improve
• Teach parents the danger signs of serious infection in the first month
• Do not expect home visits alone to improve development or growth

Why it matters

The evidence that small babies survive better comes from a community setting like India's.

Don't overread it

The mortality benefit rests on one large trial; other outcomes and settings are less certain.

The statistics, in plain English

An HR of 0.75 means about a quarter fewer deaths over six months. The interval (0.60 to 0.93) stays below 1, but because the evidence comes from one trial, Cochrane rated certainty as moderate rather than high.

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