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Lancet. 1985 May 25;1(8439):1206-8.

Myth of the marsupial mother: home care of very low birth weight babies in Bogota, Colombia.


Because of the shortage of equipment and staff and the frequency of cross-infection in hospital, paediatricians at San Juan de Dios Hospital, Bogota, have been sending home babies weighing as little as 700 g, cared for between the mother's breasts in a vertical position and fed only on mother's milk ("kangaroo babies"). Infants as immature as 32 weeks gestation were successfully cared for at home in this way. Mother's milk was supplemented with guava juice and later with soup, but mean time to regain birth weight was 36 days. The previously publicised high survival figures for this home-care programme were found to be misleading because they omitted babies who had died in the first few days after birth. Although this approach is valuable in developing countries, home care of very low birth weight babies would not improve survival in industrialised nations. Nevertheless, care of such tiny infants in special care baby units in developed countries could benefit from similar emphasis on education and motivation of mothers and early skin-to-skin contact.


This report presents the observations of a neonatologist and a neonatal nursing sister on the home care program of the San Juan de Dios Hospital in Bogota, Colombia and considers the scope for applying some of the innovations in developing and developed countries. The home care and birth weight program was based on the following principles: discharge home without regard to weight once the baby's condition is stable and it has adapted to extrauterine life, thereby removing the baby from the disease-ridden hospital; no artificial milk formula to be given, only mother's milk supplemented with guava juice; encouragement of early bonding by nursing the baby next to the mother's body between the breasts; and maintenance of the baby in a head-up position. The 2 pediatricians that operate the program reported that 539 babies entered the program during the 1979-81 period. 30 of the 539 babies were lost to follow-up and presumed to be still alive. Survival of babies weighing 501-1000 g rose from 0 with conventional special baby care unit (SBCU) care in 1975-76 to 72% in 1979-81 with home care. Survival of babies weighing 1001-1500 g rose from 27% in 1975-76 to 89% in 1979-81. The number of babies abandoned annually fell from 34 to 10. Babies weighing under 2000 g whose condition is stable may be selected for the home care program. Mothers are then invited to attend several hours a day to express milk, breast feed, and receive instructions on the importance of breast milk, hygiene, temperature maintenance, and upright posture. During this time the mothers gained confidence and got to know their babies. The number of babies under 200 g was reviewed in 1984. It was found that only 1/3 of them were in the home care program, confirming that they are a highly selected and relatively low risk group. The most immature baby that entered the home care program was 32 weeks gestation. At each visit the baby is weighed on an electronic balance and is then examined. Mothers are taught in groups about nutrition and infant stimulation. All babies in the program are routinely immunized against whooping cough, diptheria, tetanus, and poliomyelitis at the age of 2 months. Care of tiny babies in special care baby units in developed countries could benefit from similar emphasis on education and motivation of mothers and early skin-to-skin contact.

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