REGULAR ARTICLE Implementing Kangaroo mother care in a resource-limited setting in rural Bangladesh Jesmin Pervin (jpervin@icddrb.org) 1 , Frida E Gustafsson 2 , Allisyn C Moran 3 , Suchismita Roy 4 , Lars  Ake Persson 2 , Anisur Rahman 1 1.Centre for Reproductive Health, ICDDR,B, Dhaka, Bangladesh 2.International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden 3.Global Health Fellows II Program, US Agency for International Development, Washington, DC, USA 4.London School of Hygiene and Tropical Medicine, London, UK Keywords Early Kangaroo mother care, Exclusive breastfeeding, Neonatal mortality, Resource-limited hospital, Skin- to-skin contact Correspondence Jesmin Pervin, Assistant Scientist, Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. Tel: 88-01713257397 | Fax: 880-2-8826050 | Email: jpervin@icddrb.org Received 17 June 2014; revised 3 December 2014; accepted 12 January 2015. DOI:10.1111/apa.12929 ABSTRACT Aim: This study evaluated stable and unstable low birthweight infants admitted to a Kangaroo mother care (KMC) unit at a resource-limited rural hospital in Bangladesh. Methods: This was a descriptive consecutive patient series study of 423 low birthweight neonates <2500 g enrolled from July 2007 to December 2010. KMC was initiated as soon as possible after birth, regardless of health, and we monitored skin-to-skin contact, weight gain, exclusive breastfeeding, length of hospital stay and death rates. Results: Mean birthweight was 1796 g, and mean gestational age was 34.9 weeks. Mean (median, 90th percentile) time of skin-to-skin initiation for stable and unstable neonates was 1.1 h (0.3–2.5) and 1.7 h (0.3–3.0), respectively. Adjusted mean daily skin-to-skin contact duration was significantly higher for unstable infants. About 99% of neonates were exclusively breastfed. The death rate was 8.3% (stable 1.9%, unstable 19%) at discharge. Neonatal mortality rate was 90 per 1000 live births (stable: 23 per 1000; unstable: 203 per 1000). Conclusion: Skin-to-skin duration was higher for unstable than stable low birthweight infants, and exclusive breastfeeding was almost universal at discharge. KMC was suitable for unstable infants and may be successfully implemented in resource-limited hospitals. BACKGROUND Low birthweight (LBW) and, or, prematurity are well- known risk factors for neonatal morbidity and mortality (1). Kangaroo mother care (KMC) has become a widely recommended method of care for stable LBW infants (2– 4). KMC is defined as early, prolonged and continuous skin- to-skin contact between the mother or substitute and her LBW infant after stabilisation, both in the hospital and after discharge, until at least the 40th week of postgestation age, ideally with exclusive breastfeeding (5). A Cochrane meta- analysis showed that KMC increased breastfeeding and growth and was associated with a reduction in severe infections and a decreased risk of neonatal mortality (6). A considerable proportion of LBW infant mortality occurs during the first few days of life, prior to stabilisation (5,7,8). Early KMC, defined as KMC initiated soon after birth prior to stabilisation, is of special relevance in resource-limited settings where other methods of thermal control or respiratory support are virtually absent (3). Evidence on the effectiveness of early KMC in lower-level health facilities is lacking, as the majority of KMC studies have been conducted at tertiary level hospitals (9). Knowl- edge is limited about whether early KMC in resource- limited settings can be implemented well enough to result in better health outcomes in comparison with conventional medical care. The few studies available show inconclusive results and provide very little information about how well early KMC was implemented in stable and unstable LBW Abbreviations CI, Confidence Interval; HDSS, Health and Demographic Sur- veillance System; ICDDR,B, International Centre for Diarrhoeal Disease Research, Bangladesh; KMC, Kangaroo Mother Care; LMP, Last Menstrual Period; MNCH, Maternal, Neonatal and Child Health. Key notes  This study evaluated 423 stable and unstable low birthweight infants who were admitted to a Kangaroo mother care (KMC) unit at a resource-limited rural hospital in Bangladesh.  We found that skin-to-skin duration was higher for unstable than stable low birthweight infants and exclu- sive breastfeeding was almost universal (99%) at discharge.  KMC was suitable for unstable infants and may be successfully implemented in resource-limited hospitals. 458 ©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2015 104, pp. 458–465 Acta Pædiatrica ISSN 0803-5253