Journal of Perinatology (2007) 27, 255–256
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LETTERS TO THE EDITOR
Response to Darmstadlt et al.
Journal of Perinatology (2007) 27, 255. doi:10.1038/sj.jp.7211670
We are pleased to see our colleagues’ article ‘Introduction of
community-based skin-to-skin care (STSC) in rural Uttar Pradesh,
India’1 published in the Journal of Perinatology. We believe STSC
is a promising way to reduce mortality in rural communities of
developing countries where the incidence of NMR and home births
is high. While there is currently insufficient evidence to promote
‘introduction’ of STSC, it is our understanding that Darmstadt
et al. are actually ‘testing’ the acceptability and effects of
community mobilization to provide an essential newborn care
(ENC) package including STSC. As investigators of community-
based kangaroo mother care (CKMC), our pilot study2 and current
cluster trial of in Bangladesh tests a smaller combination of
interventions limited to promoting skin-to-skin care as soon as
possible after birth until the baby no longer wishes to be held STS,
prompt and exclusive breastfeeding, delayed immersion in water to
bathe newborns and promptly seeking care for specific danger
signs, with the intervention provided by being piggy-backed on to
an existing community-based government program.
We would like to raise a few points emanating from the article.
First, we suggest that STSC in Uttar Pradesh not be considered
‘nearly universal’ as ill newborns and/or newborn deaths may be
concentrated in the fairly large B25% of babies that did not
receive STSC. The prevalence of hypothermia encountered by
Darmstadt et al.1 in normal as well as low birth weight newborns
may not have been statistically significant, but it was high in both
groups during the hypothermia peak seasons. This supports the
approach taken in both the Bangladesh CKMC and India ENC trials
that, if effective in reducing NMR or IMR, CKMC would be
promoted for all, not just low birth weight babies. Numerous small
Community-based skin-to-skin care: letter in response to Sloan
Journal of Perinatology (2007) 27, 255–256. doi:10.1038/sj.jp.7211666
We appreciate the interest of our colleagues in our article,
‘Introduction of community-based skin-to-skin care in rural Uttar
hospital-based studies have found STSC is as good as or better than
conventional incubator or thermal crib care in preventing and
treating hypothermia.3,4 However, the few hospital-based studies
testing the effects of early KMC on NMR or some derivation of NMR
have methodologic limitations that render them insufficient to
conclude that early KMC reduces NMR.5,6
NL Sloan and S Ahmed
Department of Epidemiology, Columbia University, New York,
NY, USA
E-mail: nls35@columbia.edu
References
1 Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S et al.
Introduction of community-based skin-to-skin care in rural Uttar Pradesh,
India. J Perinatol 2006; 26: 597–604 doi:10.1038/sj.jp.7211569; published
online 17 August 2006.
2 Quasem I, Sloan NL, Chowdhury A, Ahmed S, Winikoff B, Chowdhury AMR.
Adaptation of kangaroo mother care for community-based application.
J Perinatol 2003; 23(8): 646–651.
3 Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for
mothers and their healthy newborn infants. The Cochrane Database Syst Rev
2003; (2), Art. No.: CD003519.
4 Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-
skin contact from birth versus conventional incubator for physiologic
stabilization in 1200- to 2199-gram newborns. Acta Paediatrica 2004; 93:
779–785.
5 Lincetto O, Nazir AI, Cattaneo A. Kangaroo mother care with limited
resources. J Tropic Pediatr 2000; 46(5): 293–295.
6 Worku B, Kassie A. Kangaroo mother care: a randomized controlled trial on
effectiveness of early kangaroo mother care for the low birthweight infants in
Addis Ababa, Ethiopia. J Tropic Pediatr 2005; 51(2): 93–97.
Pradesh, India’.1 As noted in the article, we examined the process
of introducing skin to skin care (STSC) into a low-resource
community with poor access to health care, and found that within
a year of implementation, acceptance rates reached and have
remained over 90%. For this reason, we suggested that acceptance