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Background <p>Respiratory Distress Syndrome (RDS) remains a leading cause of mortality among preterm infants weighing &lt; 2000&#xa0;g, particularly in resource-limited settings. While Kangaroo Mother Care (KMC) has shown promise in stable preterm infants, its effectiveness for those requiring respiratory support remains unclear. This study evaluated nurse-led implementation of KMC for preterm infants with RDS.</p> Methods <p>A prospective, multicenter, randomized controlled trial was conducted across four neonatal intensive care units in Tanta, Egypt (January 2023–June 2024). Two hundred forty preterm infants (&lt;2000&#xa0;g) with RDS were randomly assigned to either nurse-implemented KMC (<i>n</i> = 120) or standard care (<i>n</i> = 120). The KMC protocol, implemented for a minimum of 6&#xa0;h per day until hospital discharge, integrated continuous skin-to-skin contact, exclusive breastfeeding promotion, and structured parental education. Outcomes included 28-day survival, respiratory status (Silverman-Anderson Scores), nosocomial infections, maternal-infant bonding, growth trajectories, and clinical course metrics.</p> Results <p>The KMC intervention significantly improved 28-day survival (adjusted HR = 0.42, 95% CI 0.28–0.63, <i>p</i> &lt; 0.001) and reduced nosocomial infections by 55% (RR = 0.45, 95% CI 0.27–0.75, <i>p</i> &lt; 0.001). KMC recipients demonstrated faster respiratory improvement, shorter CPAP duration (−2.2&#xa0;days, <i>p</i> &lt; 0.001), and higher rates of exclusive breastfeeding at discharge (74.2% vs. 48.3%, <i>p</i> &lt; 0.001). Maternal competency scores showed progressive improvement with enhanced bonding and responsiveness.</p> Conclusion <p>Nurse-implemented KMC is a safe, effective intervention for preterm infants with RDS, yielding significant improvements in survival, clinical outcomes, and family-centered care metrics.</p> Implications for practice <p>These findings support the expansion of nursing roles in implementing KMC for high-risk infants in resource-limited settings.</p> Trial registration <p>ClinicalTrials.gov (NCT06707376).</p>

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Transforming neonatal nursing: a randomized controlled trial comparing kangaroo care and standard protocols for survival in preterm infants with respiratory distress syndrome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月16日

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  • Osama Mohamed Elsayed Ramadan,
  • Afrah Madyan Alshammari,
  • Abeer Nuwayfi Alruwaili,
  • Nadia Bassuoni Elsharkawy,
  • Ali Alhaiti,
  • Nagwa Ibrahim Mabrouk Baraka

摘要

Background

Respiratory Distress Syndrome (RDS) remains a leading cause of mortality among preterm infants weighing < 2000 g, particularly in resource-limited settings. While Kangaroo Mother Care (KMC) has shown promise in stable preterm infants, its effectiveness for those requiring respiratory support remains unclear. This study evaluated nurse-led implementation of KMC for preterm infants with RDS.

Methods

A prospective, multicenter, randomized controlled trial was conducted across four neonatal intensive care units in Tanta, Egypt (January 2023–June 2024). Two hundred forty preterm infants (<2000 g) with RDS were randomly assigned to either nurse-implemented KMC (n = 120) or standard care (n = 120). The KMC protocol, implemented for a minimum of 6 h per day until hospital discharge, integrated continuous skin-to-skin contact, exclusive breastfeeding promotion, and structured parental education. Outcomes included 28-day survival, respiratory status (Silverman-Anderson Scores), nosocomial infections, maternal-infant bonding, growth trajectories, and clinical course metrics.

Results

The KMC intervention significantly improved 28-day survival (adjusted HR = 0.42, 95% CI 0.28–0.63, p < 0.001) and reduced nosocomial infections by 55% (RR = 0.45, 95% CI 0.27–0.75, p < 0.001). KMC recipients demonstrated faster respiratory improvement, shorter CPAP duration (−2.2 days, p < 0.001), and higher rates of exclusive breastfeeding at discharge (74.2% vs. 48.3%, p < 0.001). Maternal competency scores showed progressive improvement with enhanced bonding and responsiveness.

Conclusion

Nurse-implemented KMC is a safe, effective intervention for preterm infants with RDS, yielding significant improvements in survival, clinical outcomes, and family-centered care metrics.

Implications for practice

These findings support the expansion of nursing roles in implementing KMC for high-risk infants in resource-limited settings.

Trial registration

ClinicalTrials.gov (NCT06707376).