Effect of Community-Initiated Kangaroo Mother Care on Fecal Biomarkers of Gut Function in Low Birth Weight Infants in North India: A Randomized Clinical Trial

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  • 1 Centre for Health Research and Development, Society for Applied Studies, New Delhi, India;
  • | 2 Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, and Tampere University Hospital, Finland;
  • | 3 DBT/Wellcome India Alliance Clinical and Public Health Fellow;
  • | 4 Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
  • | 5 Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway;
  • | 6 Clinical and Research Laboratories, Society for Applied Studies, New Delhi, India;
  • | 7 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland

This individually randomized trial was conducted to estimate the effect of promoting community-initiated Kangaroo Mother Care (ciKMC) in low birth weight (LBW) infants on gut inflammation and permeability. Participants included 200 stable LBW infants (weighing 1,500–2,250 g) in North India enrolled between May and October 2017. The ciKMC intervention included promotion and support of continuous skin-to-skin contact and exclusive breastfeeding through home visits. The mothers in the intervention arm were supported to practice ciKMC until 28 days after birth, i.e., the neonatal period, or till the baby wriggled out of KMC position, if earlier. Infant stool specimens were collected during the first week of birth, and within 1 week after end of the neonatal period. Concentrations of fecal neopterin (nmol/L), myeloperoxidase (ng/mL), and alpha-1-antitrypsin (μg/mL) were determined using ELISA, and composite enteric enteropathy (EE) score at the end of the neonatal period was calculated by principal component analysis. We did not find any substantial difference in means between the ciKMC and control arm infants in the log-transformed values of neopterin (0.03; 95% CI −0.15 to 0.21), myeloperoxidase (0.28; 95% CI −0.05 to 0.61) and alpha-1-antitrypsin (0.02; 95% CI −0.30 to 0.34). The mean (SD) composite EE score was 13.6 (7.5) in the ciKMC and 12.4 (8.3) in the control arm infants, and the adjusted difference in means was negligible, 0.4 (95% CI −1.8 to 2.7). Our findings suggest that the promotion of ciKMC did not affect gut inflammation and permeability in our target population of LBW infants in North India.

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Author Notes

Address correspondence to Halvor Sommerfelt, Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, Bergen 5020, Norway. E-mail: halvor.sommerfelt@uib.no

Financial support: This work was funded by the Science and Engineering Research Board (SERB), a statutory body of the Department of Science and Technology, Government of India (File No. EMR/2017/003414). The project is also supported by the Centre for Intervention Science in Maternal and Child Health (CISMAC; project number 223269), which is funded by the Research Council of Norway through its Centres of Excellence scheme and the University of Bergen (UiB), Norway. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Authors’ addresses: Bireshwar Sinha, Sarmila Mazumder, Sunita Taneja, and Nita Bhandari, Centre for Health Research and Development, Society for Applied Studies, New Delhi, India, E-mails: bireshwar.sinha@sas.org.in, sarmila.mazumder@sas.org.in, sunita.taneja@sas.org.in, and nita.bhandari@sas.org.in. Halvor Sommerfelt, Centre for Intervention Science in Maternal and Child Health (www.cismac.org), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, E-mail: halvor.sommerfelt@uib.no. Per Ashorn, Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, and Tampere University Hospital, Finland, E-mail: per.ashorn@tuni.fi. Deepak More, Clinical and Research Laboratories, Society for Applied Studies, New Delhi, India, E-mail: drdeepak.more@yahoo.in. Rajiv Bahl, Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland, E-mail: bahlr@who.int.

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