Could you share a bit about your journey into neonatal research and what inspired your focus on pre-term infants? 

In 2014, I attended an international conference on Kangaroo Mother Care (KMC), and that changed my research interest in the direction of global health, where the most impact can be made with regard to lives saved.

Globally, neonatal mortality rates are still unacceptably high. The first month of life is the most vulnerable period for child survival, with 2.3 million newborns dying each year. Despite some progress, the reduction in neonatal mortality has been slow. We need to focus on accelerating research and implementing evidence-based interventions for those most at risk. Prematurity is among the leading causes of neonatal deaths, where we will have the most impact. Most of these deaths could be avoided by the implementation of affordable, high-quality small and sick newborn care.

What are some of the most significant findings about Kangaroo Mother Care (KMC) and its impact on newborn survival? 

A WHO randomized clinical trial on immediate KMC in Malawi, Ethiopia, Nigeria, Ghana, and India showed a 25% reduction in mortality among infants who received immediate KMC compared to standard care in incubators or radiant heaters. WHO has estimated that if implemented worldwide, an additional 150,000 newborn lives could be saved every year. Based on this evidence, the WHO guidelines were changed in 2022, recommending immediate and continuous KMC for all preterm and low birth weight infants.

How has your work highlighted the role of families in the care of preterm infants, and why is this so crucial? 

For decades, we have been separating mothers and their preterm newborns not out of negligence - but because we did not know better. Now we know better.

The findings from the immediate KMC trial represent a paradigm shift in neonatology. Immediate KMC is a proven lifesaving intervention. It is not evidence-based medicine to separate mothers/fathers and preterm newborns after birth and in the neonatal intensive care unit, even if they are sick. The small and sick are the ones who need KMC the most.

Can you give us a picture of the status of small and sick newborns in Ethiopia? 

I am very impressed with the Saving Little Lives program in Ethiopia that aimed to reduce neonatal mortality by 35% across 290 hospitals through scale-up of evidence-based minimum care packages at birth throughout the hospital stay during a three-year period. Despite challenges with health system gaps, armed conflicts, inflation, and the Covid-19 pandemic, they succeeded in implementing complex interventions on a large scale. 

Can you give us an overview of the current project on Immediate Kangaroo Mother Care (iKMC) in Ethiopia? What does the project hope to achieve? 

We know that immediate KMC is effective in reducing mortality in low- and middle-resource settings. Despite this, coverage has remained low. 

WHO is currently conducting implementation research on immediate KMC in four of the countries with the highest burden of neonatal deaths: Ethiopia, Nigeria, India, and Bangladesh. What has impressed me is the commitment to adopt new practices to improve outcomes despite limitations in infrastructure, equipment, and a shortage of healthcare providers. To quote the Principal Investigator, Abiy Seifu, “It's all about the people.” 

Looking ahead, what long-term outcomes do you hope iKMC will bring for both babies and their families? 

Importantly, immediate KMC is not only for those in low-resource settings who cannot afford incubators. Immediate and continuous KMC is the optimal treatment for every preterm and low birth weight infant. Mothers and fathers should not merely be visitors to their newborns in the neonatal care unit, they are essential both in keeping the baby alive and to thrive. 

We learned from the Scandinavian immediate KMC study that there seems to be a sensitive window in the first hours after birth when mothers and fathers should not be separated from their newborns. Skin-to-skin contact for the first six hours after birth resulted in improved cardiorespiratory stability, temperature stability, mother-infant interaction at four months, stress coping at four months, and language development at two years of age, as compared to standard care. 

In many settings, fathers have not had access to the delivery ward, KMC ward, and neonatal intensive care unit. I hope this will change, as fathers can provide essential support for their newborn and the mother in this vulnerable situation. 

Based on your experience in Ethiopia, what lessons could inform the wider adoption of iKMC in other limited-resource settings? 

The most important lesson is probably that immediate KMC is possible to implement in limited-resource settings. Successful iKMC implementation requires transforming the neonatal intensive care units, allowing mothers or surrogates to stay with the preterm infant to provide continuous skin-to-skin contact throughout the hospital stay. 

This requires buy-in and prioritization from hospital administration, leaders, and a close collaboration between maternity and neonatal healthcare workers. Every infant cared for in immediate KMC, must also receive quality small and sick newborn care to accelerate progress in newborn health worldwide.