333 - Timing Of Kangaroo Care and Neurodevelopmental Outcomes in Extremely Preterm Infants

Publication Number: 4326.333

Sarah G. Eknoyan, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Sepideh Saroukhani, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Allison Davidson, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Jaclyn Ruggiero, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Kangaroo Care (KC) improves neonatal survival and supports neurodevelopment (ND). Despite strong evidence, KC initiation in extremely preterm (EP) infants remains inconsistent and is often delayed due to standardized protocols, perceived medical fragility, and systemic barriers.

Objective: This study evaluated the relationship between time to first KC and long-term neurodevelopmental (ND) outcomes at 22-28 months corrected gestational age (CGA).

Design/Methods: A retrospective cohort study was conducted of inborn infants born at 22-27 weeks’ gestation at Children’s Memorial Hermann Hospital (2019-2022). Infants were stratified into two subgroups: 220/7-246/7 weeks (n=63) and 250/7-276/7weeks (n=79). The primary outcome was Bayley Scales of Infant and Toddler Development, 3rd and 4th editions (Bayley-III/IV) scores at follow-up. Secondary outcomes included head circumference, growth velocity, maternal expressed breast milk (EBM) provision, and therapy referrals. Infant medical variables including respiratory support, oxygen requirement, vasopressor use, presence of central lines, and diagnosis of intraventricular hemorrhage were collected from NICU admission through follow-up. Associations between time to first KC and outcomes were analyzed using regression analyses.

Results: Median time to KC was 27.3 days (IQR 14.8, 39.5) for 22-24-week infants and 16.9 days (IQR 12.6, 26.9) for 25-27-week infants (p=0.007). Among 25–27-week infants, longer time to KC was associated with lower Bayley-III/IV cognitive scores (p=0.04), with each 24-hour delay associated with a 0.18-point decrease (95% CI -0.34, -0.009). In 22-24-week infants, delayed KC was associated with longer time to first maternal EBM (p=0.03) and smaller head circumference at 12-months CGA (p=0.04). Peripherally inserted central catheter (PICC) presence significantly delayed KC in both groups (22-24-weeks, p=0.004; 25-27-weeks, p< 0.001). Mechanical ventilation was an additional barrier for 22–24-week infants (p=0.003).

Conclusion(s): Earlier KC initiation, even in infants requiring ventilators or PICC lines, is feasible and associated with improved cognitive and growth outcomes. These findings support efforts to prioritize earlier and consistent KC in EP infants and highlight the need for cultural change in NICU practices.