Bridging the Gap: A Quality Improvement Initiative to Achieve Early Kangaroo Mother Care Adoption in the NICU

Introduction Kangaroo Mother Care (KMC) is an evidence-based intervention that improves thermoregulation, breastfeeding, bonding and neonatal outcomes, particularly among preterm and low-birth-weight infants. Despite strong recommendations, initiation of KMC within the first 24 h of life may remain inconsistent in busy neonatal units because of gaps in protocol standardisation, staff readiness, parental confidence and infrastructure. Objective To improve early KMC initiation among eligible neonates in a tertiary-care Neonatal Intensive Care Unit (NICU) using a structured quality-improvement approach based on sequential Plan–Do–Study–Act (PDSA) cycles. Methods This single-centre before–after quality-improvement initiative was conducted in a level 3 NICU from January 2023 to September 2024. Eligible infants included all preterm neonates irrespective of birth weight and term neonates with birth weight <2,500 g. Neonates with haemodynamic instability, shock or severe respiratory distress were excluded. Baseline data were collected during January-December 2023. Four PDSA cycles were then implemented, focusing on protocol standardisation, staff training, structured parental counselling and infrastructure strengthening. Temporal trends were assessed primarily through run charts, while chi-square and t -tests were used as supportive analyses. Results A total of 257 neonates were included: 100 during the baseline phase and 157 during the intervention/post-intervention phase. Early KMC initiation within 24 h increased from 50% at baseline to 76% after the quality improvement (QI) intervention. KMC initiation within 72 h increased from 60% to 85%, and staff knowledge scores and positive parental feedback also improved after the interventions. Conclusion A structured, multidisciplinary QI initiative that combined protocol standardisation, staff education, parental engagement and improved KMC infrastructure was associated with improved early KMC initiation in the NICU. Continued monitoring is required to confirm sustainability and to evaluate clinical outcome benefits.