Abstract
BACKGROUND: Kangaroo mother care (KMC) plays a significant role in reducing mortality among preterm or low birth weight (LBW) infants. However, comprehensive evidence regarding various clinical outcomes during hospitalization for neonates receiving KMC remains limited. This meta-analysis focuses on hospital-based KMC and aims to evaluate its efficacy and safety for neonates during their hospital stay. METHODS: A systematic search of the literature was undertaken across major databases, including PubMed, Web of Science, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) published up to July 9, 2025. Binary outcomes were analyzed using risk ratio (RR), while continuous data were assessed using standardized mean difference (SMD) or mean difference (MD), each reported with corresponding 95% confidence intervals (CIs). To evaluate heterogeneity among studies, the Cochrane Q test, I (2) statistic, and 95% prediction intervals (PIs) were utilized. Additionally, trial sequential analysis (TSA) was applied to mitigate potential type I and type II errors in the meta-analysis. RESULTS: This meta-analysis synthesized data from 31 RCTs, encompassing 8561 preterm and/or LBW infants. The findings of this meta-analysis indicated that compared with conventional care, KMC significantly reduced in-hospital mortality [RR (95% CI) = 0.791 (0.696-0.899), 95% PI: 0.679-0.925] and 28-day all-cause mortality [RR (95% CI) = 0.810 (0.709-0.926), 95% PI: 0.605-1.085]. Furthermore, KMC was associated with shorter duration of hospitalization [MD (95% CI) = -0.809 (-1.601, -0.017), 95% PI: -3.219, 1.601] and notable improvements in growth parameters, including accelerated weight gain, increased length growth, and enhanced head circumference growth during the hospital stay (all p < 0.05). Regarding clinical safety, KMC was associated with lower risks of hypothermia, hyperthermia, apnea, sepsis, and necrotizing enterocolitis (all p < 0.05). Subgroup analyses further emphasized the marked clinical effectiveness and favorable safety profile of KMC, particularly in lower-middle-income countries. CONCLUSION: KMC is a clinically effective and safe intervention for the management of preterm and/or LBW neonates. Present evidence highlights its role in reducing neonatal mortality, expediting hospital discharge, fostering growth and developmental outcomes, as well as mitigating the incidence of complications. Moreover, the benefits of this intervention are particularly significant in lower-middle-income countries.