“Effect of Kangaroo Mother Care (KMC) on Cerebral Blood flow in stable preterm neonates assessed by transcranial sonography in Middle Cerebral Artery (MCA)-A Systematic Review and Meta-analysis”

Introduction Prematurity exposes the infants to an abnormal extrauterine environment with a heightened vulnerability to cerebral injury due to immature cerebral vasculature and inadequate autoregulatory mechanisms. Kangaroo Mother Care (KMC) optimises physiological stability, growth, and neurobehavioral development and has emerged as one of the forefront strategies for developmental supportive care and neuroprotection. We, therefore, conducted this systematic review to investigate the effect of KMC on cerebral hemodynamics in stable preterm neonates. Methods For this review, we followed the PRISMA guidelines (PROSPERO ID: CRD42025642355). PubMed, EMBASE, CINAHL, and Web of Sciences databases were searched from inception to January 2025. Prospective observational studies of clinically stable preterm neonates (<37 weeks) were included. The primary outcome was a change in the Pulsatility Index (PI) in the middle cerebral artery (MCA) assessed non-invasively via transcranial ultrasonography. Meta-analysis was performed using fixed and random effects models. Results Five studies (N=284) were included. KMC significantly decreased PI (SMD=-0·64 [95% CI: -0·92, -0·36], p<0·00001) and Resistive Index(RI) (SMD=-1·05 [95% CI: -1·85, -0·25], p=0·01). End Diastolic Velocity(EDV) (SMD=0·77 [95% CI: 0·53, 1·01], p<0·00001) and Mean Velocity( MV) (SMD=0·47 [95% CI: 0·29, 0·65], p<0·00001) significantly increased following KMC. Peak Systolic Velocity (PSV) showed positive trends without statistical significance. Conclusion KMC improves cerebral hemodynamics in stable preterm neonates, potentially through neurohumoral mechanisms triggered during skin-to-skin contact. There is a reduction in the cerebral vascular resistance, thereby enhancing cerebral blood flow. Hence, KMC may provide neuroprotective benefits by stabilizing cerebral perfusion and potentially replicating intrauterine conditions.