In honor of prematurity awareness day, celebrated worldwide on November 17, I spoke with Dr. Nathalie Charpak, a longtime advocate of the Kangaroo Mother Care Method and Founder of the Kangaroo Foundation in Colombia. 

Interview with Nathalie Charpak

What is the Kangaroo Mother Care Method and how does it help newborns?

Kangaroo Mother Care (KMC) is a method of caring for premature and low birth weight babies where parents carry their newborns allowing for skin-to-skin contact to support the infant’s continued development – similar to how kangaroo joeys continue their development in the pouch of their mothers’ bellies.  The KMC is a multifaceted intervention that includes (1) the continuous use of the kangaroo skin-to-skin position, (2) exclusive breastfeeding where possible, and (3) timely hospital discharge with follow-up. The method was originally developed in Colombia as an outpatient alternative to neonatal care in incubators.[1] KMC has been proven widely effective in supporting the physiological and cognitive development of newborns, and more preferable in the care of stable premature and low birth weight babies than traditional handling in incubators.[1] Among its benefits are survival, infant stabilization, thermal regulation, appropriate neurodevelopment, shortened hospital stay, stronger parent-infant bonding, and parents empowered as primary caregivers.  The method is now recognized globally as a cost-effective, high-impact intervention by international associations (e.g., WHO names KMC as a key strategy to decrease neonatal mortality and UNICEF’s efforts to fund national implementation) and implemented across the world.  

How has the Kangaroo Foundation worked with the Ministry of Health and Social Protection to enable widespread implementation of the program in Colombia?

Since 1994, the Kangaroo Foundation has been working to increase awareness and implementation of KMC through research and data monitoring, guideline development and dissemination, and education and training of families and their care teams both in Colombia and abroad.  The Foundation has contributed to international care practice guidelines (see WHO’s KMC practical guidelines) and publishes its own clinical practice guidelines along with multiple studies and literature reviews to build the evidence base for KMC.

• Publication clinical practice guidelines for implementation (2007, updated 2017) – an evidence-based clinical practice guideline for the optimal use of KMC in preterm and/or low birth weight infants at birth

The Kangaroo Foundation has been collaborating with Colombia’s Ministry of Health and Social Protection (MoHSP) for over 20 years.  The collaboration has led to increased recognition and implementation of the KMC across hospitals and centers in Colombia – currently being practiced across 200 private and public neonatal units and 53 ambulatory programs in Colombia.  The collaboration has also led to publications, guideline dissemination, and annual programs, including:

• Publication of technical guidelines for implementation (2012, updated 2017) – to help guarantee quality of KMC programs offered in Colombia; developed in cooperation with the Colombian MoHSP, Acción Social, UNICEF, and the UN World Food Programme (WFP)

• Publication of training manuals on various topics, including the history and principles, the Kangaroo position, the processes for appropriate follow up, etc. 

• Establishment of KMC training portal (2012) – to support faster dissemination of training efforts among healthcare professionals; created in partnership with Grand Challenges Canada

• Annual National KMC workshop – to support the sharing of latest scientific progress, and best practices sharing; co-sponsored in collaboration with MoHSP and the Colombia Society of Neonatology (ASCON)

• Coordinated COVID response: joint recommendations for implementation of KMC during the pandemic, updated MoHSP resolutions to support recommendations, survey of ambulatory and neonatal units around the country and dissemination of findings  

What is next for the Kangaroo Foundation? How will you continue to leverage the collaboration with the Ministry of Health and Social Protection? 

The Foundation and the Colombian MoH will continue to collaborate to ensure access to the KMC method is guaranteed for all and all programs that meet the criteria set forth by the technical guidelines.  This includes surveying sites about implementation barriers, working with insurers, ensuring smooth referral pathways and parallel maternal perinatal care routes, supporting the training of healthcare workers, etc. The two organizations have shared a close working relationship for many years and only anticipate more aligned programs

As for the Kangaroo Foundation, we will continue to strengthen our efforts in Colombia, and more and more our expertise is supporting the development of other programs around the world.  For example, the Foundation runs an accreditation program for KMC programs around the world, which uses Colombia’s technical guidelines as reference standards.  We also provide training to centers around the world, most recently Guatemala, Salvador, Ecuador, and Paraguay in 2021, and Burkina Faso, Pakistan, Indonesia, Philippines, and Bhutan in 2020. Our goal is to humanize the care of newborn infants through the use, development, and dissemination of KMC and we will continue to work until newborns have access to the best possible care. 

Reference

[1] Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, Nadeau L, Mercier C, Maheu F, Marin J, Cortes D, Gallego JM, Maldonado D. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. 2017 Jan;139(1):e20162063. doi: 10.1542/peds.2016-2063. Epub 2016 Dec 12. PMID: 27965377.

 About the Interviewee

Dr. Nathalie Charpak is a French and Colombian pediatrician. She is the founder and director of the Kangaroo Foundation, and an associate researcher of the Pontifical Xavierian University.  Her research focuses on the care of low-birth-weight preterm infants and the application of kangaroo mother care. 

Nathalie has co-authored more than 120 research articles that have been cited more than 2,872 times. She has also contributed chapters to eight books and authored two books on the Kangaroo Mother Method that have been translated into more than five languages: She has also co-authored several technical publications, including the Kangaroo Mother Care guidelines for the WHO. In 2016, she released a publication in collaboration with Grand Challenges Canada, that presented a 20-year follow-up of the KMC method versus traditional care. It gained wide public attention and was covered by more than 50 publications in various countries.  

Nathalie's work has earned her, and the Kangaroo Foundation, multiple awards, including the Fundación San Valentino award in 1999 given by Pope John Paul II. In the 2000s she won the Colsubsidio Prize and a Best Practices for Global Health Award. In 2010, she won the South-South Cooperation's Excellence Award, followed by multiple achievements in 2013, including a Health Care Innovation Award from GlaxoSmithKline and Save the Children.