2023-05-20-世界卫生组织-袋鼠妈妈护理_医疗保健领域的变革性创新_52页_5mb

报告摘要

Summary of the Global Position Paper on Kangaroo Mother Care (KMC)

Core Content

This global position paper outlines Kangaroo Mother Care (KMC) as a transformative innovation in maternal and newborn health care. KMC is a care model that emphasizes skin-to-skin contact, exclusive breastfeeding, and close monitoring of preterm or low birth weight (LBW) infants, aiming to improve survival rates and long-term health outcomes for both mothers and newborns. It is presented as a critical component of universal health coverage and a foundation for small and/or sick newborn care.

Main Points

1.1 What is Kangaroo Mother Care (KMC)?

KMC is a method of care for preterm or LBW infants involving continuous and prolonged skin-to-skin contact (8–24 hours per day, as much as possible) immediately after birth unless the infant is critically ill.
It includes support for exclusive breastfeeding or breast-milk feeding.
When initiated in healthcare facilities, it involves timely discharge of the infant to a lower level of care or home, with continued skin-to-skin contact and monitoring.
KMC is distinct from routine skin-to-skin contact, which is recommended for all newborns within the first hour after birth.

1.2 Rationale for a Global Position Paper on KMC

1.2.1 Potential Impact

KMC significantly reduces neonatal mortality and morbidity.
A 2016 Cochrane review found that KMC reduces mortality among LBW infants by 40% at discharge or at 40–41 weeks postmenstrual age.
Universal implementation of KMC for stable newborns ≤2 kg could save 125,680 newborn lives annually.
As part of small and/or sick newborn care, KMC is estimated to save 747,000 lives annually.
Community-initiated KMC within 72 hours of birth for LBW infants ≥1.5 kg without danger signs reduces mortality by 30%.
Immediate KMC (starting as soon as possible after birth) for infants with birth weight between 1.0 and 1.799 kg reduces mortality by 25%.

1.2.2 Need for Translating Evidence into Practice

The classical newborn care model separates mothers and infants, which is not optimal for preterm or LBW infants.
A new model is needed that allows continuous mother-infant contact unless the infant is critically ill.
This requires system-level changes, including infrastructure, training, and policy reforms to support the implementation of KMC.
A harmonized approach is essential to ensure that KMC is implemented consistently across different settings and countries.

1.2.3 Availability of Solutions to Overcome Implementation Barriers

Despite strong evidence of KMC's benefits, implementation remains a challenge.
Several countries have successfully implemented KMC, but it is not yet widespread.
New implementation research provides insights into effective strategies for scaling up KMC globally.

Key Information

Purpose of the Position Paper

To advocate for KMC as the foundation of small and/or sick newborn care.
To spur collaborative global action and support the integration of KMC into maternal, newborn, and child health programs.
To provide a joint vision and position from a multistakeholder working group.

Audience

National governments and ministries of health and finance.
Professional associations (e.g., WHO, UNICEF, USAID, Save the Children, ICM, FIGO, AAP, MSF, IPA, COINN).
Donor organizations and parent organizations.
Academics, private sector, and civil society.

Process of Development

The paper was developed by the WHO Strategic and Technical Advisory Group of Experts (STAGE) on Maternal, Newborn, Child and Adolescent Health and Nutrition.
It includes contributions from international experts, organizations, and stakeholders.
It was reviewed and approved by all participating organizations.

Call to Action

National governments should prioritize KMC as an essential service for all mothers and their preterm or LBW infants.
Professional associations and multilateral/bilateral partners should support the development and implementation of KMC.
Parents, families, and civil society should be empowered and involved in the care process.
Donor organizations and academicians should promote research, training, and policy development.
The private sector should support the scaling up of KMC through innovation and investment.

Vision for KMC

KMC should be the foundation of small and/or sick newborn care.
The model should be implemented at scale and integrated into health systems.
It should be centered on the needs of mothers and families, not just on medical or technological solutions.
A shift in power dynamics between mothers and healthcare providers is essential to ensure that mothers are empowered to take an active role in their infant’s care.

Conclusion

KMC is a high-impact intervention that has the potential to transform maternal and newborn health care.
It is cost-effective and should be scaled up globally.
The paper calls for a paradigm shift in health systems to center mothers and families in the care of preterm and LBW infants.
The vision is for KMC to be available to all and to become a cornerstone of universal health coverage.