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The impact of kangaroo mother care on the prevalence of blood product transfusions in infants < 1800 g managed in a developing country

Low birth weight infants (LBW, < 2500 g) constitute 20% and very low birth weight (VLBW, < 1500 g) 6% of the newborn population in the Western Cape compared to 6% and 1%, respectively, in first world countries. The management of these infants remains a challenge especially in developing countries where neonatal intensive care facilities are limited, neonatal wards are overcrowded and understaffed and nosocomial infections and necrotizing enterocolitis (NEC) are endemic. Blood product transfusion remains an integral part of the management of VLBW infants with the transfusion rate inversely related to the birth weight and gestational age. About 65–80% of VLBW infants receive at least one red blood cell transfusion during the neonatal period [1]. Reasons for this include replacement of phlebotomy losses (so-called ‘bleeding into the laboratory’), correction of symptomatic anaemia of prematurity and red cell haemolysis with bone marrow suppression due to sepsis and NEC [2]. Blood product transfusions are not only expensive but may be potentially dangerous as they can result in volume overload, immuno-sensitizations, graft vs. host disease, metabolic derangements and transmission of infections such as HIV and CMV [3]. Blood for transfusion in a country with a high HIV rate has become a scarce and very expensive commodity. Due to financial constraints and the increase in the workload of thrice-weekly injections on overburdened nursing staff, the administration of erythropoietin in a developing country is not a viable option. The need for blood product transfusions therefore needs to be minimized by adherence to strict transfusion guidelines, limiting sample losses and by limiting nosocomial infection and NEC as far as possible. VLBW infants are immune compromised with their mucous membranes, such as that of the gastro-intestinal tract, being an important port of entry of bacteria [4]. Passive immunity in the form of sIgA, oligosaccharides, lactoferrin, etc., is transferred to the intestinal tract of the infant through breast milk [4]. Reduced infection and NEC rates have been reported for VLBW infants fed breast milk compared to preterm formula [5]. Although its exact role is still uncertain the presence of erythropoietin in breast milk further supports the importance of breast milk in the management of these infants [6]. Kangaroo Mother Care (KMC), consisting of nursing the VLBW infant between the mother’s breasts combined with breast milk feeding, has resulted in a significant improvement in the survival rate of VLBW infants in developing countries [1]. It was introduced at Tygerberg Hospital during 1998 and resulted in a significant decrease in NEC, gut colonization with extended spectrum Klebsiella pneumonia, duration of hospital stay and in costs [7]. The aim of our study was to determine the prevalence of blood product transfusions (packed red cells, fresh frozen plasma and platelets) in infants < 1800 g nursed with KMC and fed mainly breast milk compared to mainly formula fed infants < 1800 g nursed with conventional incubator care.