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‘Kangaroo mother care’ to prevent neonatal deaths due to pre-term birth complications.

Lawn JE, Mwansa-Kambafwile J, Barros FC, Horta BL, Cousens S - Int J Epidemiol (2011)

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We are writing in response to the letter by Sloan et al. regarding our review of ‘Kangaroo mother care’... For example, the Cochrane review meta-analysis for Kangaroo mother care (KMC) combined mortality outcomes at 12 months, 6 months and pre-discharge... In the paper, we clearly defined, a priori, that for mortality outcomes we were examining the intervention of KMC commencing in the first week of life... Sloan et al. suggest that studies were excluded based on results... As stated in the paper, mortality studies were included or excluded based on explicit criteria—recruitment of babies with birth weight ≤2000 g and on their median day of initiating KMC (Figure 1 and Table 1 in the original article)... We did not use terms mentioned in her letter such as ‘early KMC’ and ‘traditional KMC’, as these may mean different things to different expert groups—we preferred a specific, reproducible measure regarding median day of initiation of KMC... However, we applied a conservative and clear cut-off for median commencement of KMC by day 7... We do not accept that studies were selected based on their results... Our review focused on ‘neonatal’ mortality, which differs from the earlier Cochrane review (Conde Aguedelo 2003) in which the mortality meta-analysis combined infant mortality, 6-month mortality and pre-discharge mortality... We do not agree with Sloan et al. ’s point that it is incorrect to undertake meta-analysis of trials for an outcome (in this instance neonatal mortality) that those trials were not individually powered to examine... We followed standard meta-analysis rules to examine for heterogeneity using the I statistic as laid out in our methods section under the subtitle ‘Analyses, and summary measures’... For these three RCTs, the I= 0.0%, P = 0.539 and so a fixed effects meta-analysis was appropriate... The paper explicitly allocates these observational studies a low level of evidence... This meta-analysis is of relevance to programmatic planners since the results suggest that wide-scale, routine implementation of KMC is still associated with considerable mortality reduction of around 32% reduction in deaths for babies under 2000 gms.

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Daily risk of death during first month of life based on analysis of 47 DHS data sets (1995–2003) with 10 048 neonatal deaths. Deaths in first 24 h recorded as occurring on Day 0, or possibly Day 1, depending on interpretation of question and coding of response. Preference for reporting certain days (7, 14, 21 and 30) is apparent. Between 73 and 76% of neonatal deaths occur in the first 7 days after birth. Source: The Lancet.12
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Figure 1: Daily risk of death during first month of life based on analysis of 47 DHS data sets (1995–2003) with 10 048 neonatal deaths. Deaths in first 24 h recorded as occurring on Day 0, or possibly Day 1, depending on interpretation of question and coding of response. Preference for reporting certain days (7, 14, 21 and 30) is apparent. Between 73 and 76% of neonatal deaths occur in the first 7 days after birth. Source: The Lancet.12

Mentions: In the paper, we clearly defined, a priori, that for mortality outcomes we were examining the intervention of KMC commencing in the first week of life. Sloan et al. suggest that studies were excluded based on results. As stated in the paper, mortality studies were included or excluded based on explicit criteria—recruitment of babies with birth weight ≤2000 g and on their median day of initiating KMC (Figure 1 and Table 1 in the original article2). We did not use terms mentioned in her letter such as ‘early KMC’ and ‘traditional KMC’, as these may mean different things to different expert groups—we preferred a specific, reproducible measure regarding median day of initiation of KMC. We included studies in which the median day of KMC initiation was ≤7 (Charpak,5 4 days; Suman,6 3.7 days; Worku,7 <1 day) and we excluded those studies in which the median day of KMC initiation was >7 days (Sloan et al.,8 12.4 days; Cattaneo et al.,9 10 days). We also excluded the more recent Sloan study from Bangladesh10 since birth weight was not measured for most neonates in the study, and there were other limitations in implementing this trial in a challenging setting in rural Bangladesh as discussed in the paper and as noted in Sloan et al.’s communication now. In the paper, we reported a sensitivity analysis including the two late initiation studies in the meta-analysis (Sloan et al.8 and Cattaneo et al.9). The mortality result remained significant {relative risk (RR) 0.64 [95% confidence interval (CI) 0.42–0.96]}.2Figure 1


‘Kangaroo mother care’ to prevent neonatal deaths due to pre-term birth complications.

Lawn JE, Mwansa-Kambafwile J, Barros FC, Horta BL, Cousens S - Int J Epidemiol (2011)

Daily risk of death during first month of life based on analysis of 47 DHS data sets (1995–2003) with 10 048 neonatal deaths. Deaths in first 24 h recorded as occurring on Day 0, or possibly Day 1, depending on interpretation of question and coding of response. Preference for reporting certain days (7, 14, 21 and 30) is apparent. Between 73 and 76% of neonatal deaths occur in the first 7 days after birth. Source: The Lancet.12
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3066426&req=5

Figure 1: Daily risk of death during first month of life based on analysis of 47 DHS data sets (1995–2003) with 10 048 neonatal deaths. Deaths in first 24 h recorded as occurring on Day 0, or possibly Day 1, depending on interpretation of question and coding of response. Preference for reporting certain days (7, 14, 21 and 30) is apparent. Between 73 and 76% of neonatal deaths occur in the first 7 days after birth. Source: The Lancet.12
Mentions: In the paper, we clearly defined, a priori, that for mortality outcomes we were examining the intervention of KMC commencing in the first week of life. Sloan et al. suggest that studies were excluded based on results. As stated in the paper, mortality studies were included or excluded based on explicit criteria—recruitment of babies with birth weight ≤2000 g and on their median day of initiating KMC (Figure 1 and Table 1 in the original article2). We did not use terms mentioned in her letter such as ‘early KMC’ and ‘traditional KMC’, as these may mean different things to different expert groups—we preferred a specific, reproducible measure regarding median day of initiation of KMC. We included studies in which the median day of KMC initiation was ≤7 (Charpak,5 4 days; Suman,6 3.7 days; Worku,7 <1 day) and we excluded those studies in which the median day of KMC initiation was >7 days (Sloan et al.,8 12.4 days; Cattaneo et al.,9 10 days). We also excluded the more recent Sloan study from Bangladesh10 since birth weight was not measured for most neonates in the study, and there were other limitations in implementing this trial in a challenging setting in rural Bangladesh as discussed in the paper and as noted in Sloan et al.’s communication now. In the paper, we reported a sensitivity analysis including the two late initiation studies in the meta-analysis (Sloan et al.8 and Cattaneo et al.9). The mortality result remained significant {relative risk (RR) 0.64 [95% confidence interval (CI) 0.42–0.96]}.2Figure 1

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We are writing in response to the letter by Sloan et al. regarding our review of ‘Kangaroo mother care’... For example, the Cochrane review meta-analysis for Kangaroo mother care (KMC) combined mortality outcomes at 12 months, 6 months and pre-discharge... In the paper, we clearly defined, a priori, that for mortality outcomes we were examining the intervention of KMC commencing in the first week of life... Sloan et al. suggest that studies were excluded based on results... As stated in the paper, mortality studies were included or excluded based on explicit criteria—recruitment of babies with birth weight ≤2000 g and on their median day of initiating KMC (Figure 1 and Table 1 in the original article)... We did not use terms mentioned in her letter such as ‘early KMC’ and ‘traditional KMC’, as these may mean different things to different expert groups—we preferred a specific, reproducible measure regarding median day of initiation of KMC... However, we applied a conservative and clear cut-off for median commencement of KMC by day 7... We do not accept that studies were selected based on their results... Our review focused on ‘neonatal’ mortality, which differs from the earlier Cochrane review (Conde Aguedelo 2003) in which the mortality meta-analysis combined infant mortality, 6-month mortality and pre-discharge mortality... We do not agree with Sloan et al. ’s point that it is incorrect to undertake meta-analysis of trials for an outcome (in this instance neonatal mortality) that those trials were not individually powered to examine... We followed standard meta-analysis rules to examine for heterogeneity using the I statistic as laid out in our methods section under the subtitle ‘Analyses, and summary measures’... For these three RCTs, the I= 0.0%, P = 0.539 and so a fixed effects meta-analysis was appropriate... The paper explicitly allocates these observational studies a low level of evidence... This meta-analysis is of relevance to programmatic planners since the results suggest that wide-scale, routine implementation of KMC is still associated with considerable mortality reduction of around 32% reduction in deaths for babies under 2000 gms.

Show MeSH
Related in: MedlinePlus