“When babies are born early, they actually are not prepared to be in an environment that’s below [the temperature] of the human body, and they have to start pulling calories to be able to keep their body temperature at 37 degrees Celsius,” said Dr. Ann Hansen, a neonatologist at the Neonatal Intensive Care Unit at Boston Children’s Hospital and Founder of the Global Newborn Solution during a recent event held in commemoration of World Prematurity Day. “To keep them in what we call a thermal neutral environment, they need to have an external heat source.”

“[Premature babies] are born right at a very critical time in their own brain development. They are pulling calories that are intended for somatic growth—so brain growth and body growth—and wasting them on thermoregulation,” said Dr. Hansen. She explained that wealthy countries often use incubators and warming tables to warm babies, while nations with fewer resources often don’t have access to these technologies or face barriers of expense and maintenance.

One innovation to level the playing field is Kangaroo Mother Care (KMC)—which involves skin-to-skin contact between baby and the mother. KMC is recommended by the World Health Organization to improve thermoregulation, bonding, and breastfeeding success, and Dr. Hansen noted that her advocacy for the method is rooted in the disparities she glimpses every day in her work.

“I’m able to take care of babies with really the highest level of intervention, and we see essentially zero preventable deaths,” she continued. “This is not something that happens by chance, but rather because of the resources that we’re able to bring to our babies here at Boston Children’s. However, I felt increasingly uncomfortable with the moral predicament that, on the same day, on the same planet, there were babies who were dying and also suffering morbidities that were definitely preventable.”

Dr. Hansen has led efforts in Rwanda and elsewhere to improve newborn health outcomes. With her colleagues, she created the Dream Warmer (a low cost, non-electrical warming mattress) that will be particularly beneficial for newborns when immediate KMC is not an option or when KMC does not provide sufficient warming.

Effective Use in Humanitarian Settings

Humanitarian settings contribute the highest mortality burdens in global statistics, noted Elaine Scudder, Maternal and Newborn Health Advisor with the International Rescue Committee. She urged a continuing focus on newborns—and expansion of KMC interventions—to fight that trend. “The assumption is that KMC can be highly effective in humanitarian settings where health systems are disrupted, access to facilities and skilled providers is limited, and resources are constrained,” she said.

Scudder added that use of Kangaroo Mother Care must be a family effort. “KMC is often marketed as low-cost, which is accurate when considering financial constraints in such settings, though it is essential to also weigh the human cost,” she observed. “We do believe that it will require engagement of mothers-in-law, grandmothers, husbands, and aunts to be able to do this well in humanitarian settings.”

While KMC is not the “silver bullet” that low resources nations need, Scudder explained that working to adapt associated global recommendations and practice guides can truly serve the most vulnerable population on our globe. Creating a change in perceptions about KMC in humanitarian crisis zones such as Palestine or Ukraine is also essential. Parents in those places see KMC as a lesser quality intervention than incubators or other technologies that had previously been available to them.

 “The idea that Kangaroo Mother Care could deliver that similar quality of care does not align within people’s perspectives,” continued Scudder. “They think, ‘Why would I do KMC if I could and should demand even better for my baby?'”

Thus, Scudder concluded, better information can lead to better outcomes: “We need to ensure that those babies aren’t just surviving but are thriving, and that requires a shift in mindset within both the humanitarian and broader health systems.”