Establishing and Optimizing Kangaroo Mother Care Practices Among Very-Low-Birth-Weight Neonates in a Tertiary Neonatal Intensive Care Unit (NICU): A Quality Improvement Approach.

Background Kangaroo Mother Care (KMC) is an evidence-based practice that improves outcomes in very-low-birth-weight (VLBW) neonates by lowering neonatal mortality, hypothermia, sepsis, and hospital stay duration while enhancing breastfeeding, physiological stability, and neurodevelopmental outcomes. Despite recommendations for initiating KMC within the early postnatal period (within the first 24-72 hours of life) and maintaining prolonged (six to eight hours/day) daily skin-to-skin contact, implementation and continuation of KMC remain inconsistent in neonatal intensive care units (NICUs). This study aims to improve early initiation within seven days of birth and duration of KMC among VLBW neonates in the NICU. Methodology The implementation phase was conducted from September to December 2024 in the NICU of Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology Deemed to be University, Bhubaneswar, India. This quality improvement (QI) study aimed to improve the early initiation and duration of KMC among haemodynamically stable VLBW neonates weighing <1.5 kg. The QI team comprised the principal investigator, a neonatologist, a senior resident, two senior nursing officers, and NICU staff. Interventions were implemented through multiple Plan-Do-Study-Act (PDSA) cycles. During the planning phase, baseline gaps in KMC practices were identified through team discussions. The implementation phase included staff training on KMC eligibility, positioning, monitoring, and safe practices, alongside enhanced maternal counselling using bedside demonstrations and audiovisual aids. The study phase evaluated intervention effectiveness using predefined indicators and stakeholder feedback. In the act phase, successful strategies were standardized and refined for subsequent PDSA cycles, ensuring sustained improvement in KMC implementation. Results With the implementation of the QI interventions, the median time to initiation of KMC decreased from 18 days at baseline to 10 days during the first PDSA cycle and further to seven days during the second cycle, indicating substantial improvement in early KMC initiation among VLBW neonates. The median daily duration of KMC increased progressively from 3.28 hours at baseline to 4.08 hours in the first cycle and 6.19 hours in the second cycle, demonstrating improved adherence to prolonged KMC practices. In the present study, maternal age, gestational age, and mode of delivery differed significantly across baseline, PDSA1, and PDSA2 phases, suggesting potential case-mix variation over time. Conclusion QI interventions led to a marked improvement in both the early initiation and the duration of KMC among VLBW neonates. Key gaps were successfully identified in the initial phases. Structured QI interventions effectively improved the early initiation and daily duration of KMC among VLBW neonates in the NICU. Identification of practice gaps, followed by targeted interventions including staff training, caregiver education, standardized KMC protocols, and regular monitoring through PDSA cycles, enhanced adherence to KMC practices and promoted more consistent implementation of KMC in the NICU.