***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Kangaroo care ( KC ) has been the intervention for preterm infants in numerous published studies . However , most well design ed studies to date have used a one-group repeated measure design . This methodology is not as definitive as an experimental design . Because of the absence of a comparable control group , change between pretest and posttest may be due to any other environmental variables or normal variation of subjects ( Kirk , 1995 ) . This r and omized controlled trial ( RCT ) was done to test the hypotheses that KC infants would have higher mean tympanic temperatures , less weight loss , more optimal behavioral states , and lower acuity ( length of stay ) . Thirty-four eligible mother-infant dyads were r and omly assigned to the KC or the control group by computerized minimization on the day following birth . Stratification variables included infant gender , birth weight , delivery method , and parity . KC infants compared to control infants had higher mean tympanic temperature ( 37.3 degrees C vs. 37.0 degrees C ) , more quiet sleep ( 62 % vs. 22 % ) , and less crying ( 2 % vs. 6 % ) all at p=.000 . No significant difference was found for weight loss and acuity ( length of stay ) . These findings can be used for evidence -based nursing practice in Taiwan . With the knowledge attained from this RCT , nurses can educate and motivate mothers to keep their stable preterm infants warm by skin-to- skin contact inside their clothing , thereby encouraging self-regulatory feeding Purpose : To compare kangaroo mother care ( KMC ) and conventional cuddling care ( CCC ) in premature and smallfor-gestational-age infants . Design and Sample : Thirty mother-infant dyads in two Australian neonatal nurseries were r and omly assigned to the KMC group or the CCC group . Both groups of mothers cuddled their babies for a minimum of two hours a day , five days a week while in the study , with the KMC group having skin-to-skin contact while the CCC group had contact through normal clothing . Main Outcome Variable : The main outcome variables were infant weight gain , temperature maintenance during KMC and CCC , and length of hospital stay . Results : The results showed no difference between groups on the Parental Stress Scale ( NICU ) or the Parental Expectations Survey . Infants in both groups experienced equivalent maintenance of or rise in temperature while out of the incubators , equal weight gain , equal length of stay in the hospital , and equal duration of breastfeeding BACKGROUND Extremely preterm birth , even in the absence of significant neurological impairment , is associated with altered pain responses and impaired memory and behaviour . Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship , factors that in turn are also associated with impaired infant outcome . Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects . METHODS We conducted a pragmatic , prospect i ve , controlled , intention-to-treat trial in two neonatal intensive care units . Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving st and ard care , or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks . We assessed  infant behaviour at time of discharge from hospital  , responses to immunisation at 4 and 12 months of age , and memory , behaviour and development at 1 year corrected ( postmenstrual ) age . Indices of maternal depression , stress , anxiety , lactation performance and infant interaction were assessed at time of infant discharge , 4 months and 1 year . RESULTS No significant difference was identified in any infant or maternal measure at any time point . CONCLUSIONS Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences . Although there is no reason to dissuade mothers who wish to provide STS contact , we are unable to recommend re source allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting Background . Based on the general bonding hypothesis , it is suggested that kangaroo mother care ( KMC ) creates a climate in the family whereby parents become prone to sensitive caregiving . The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant 's cues . Method . The r and omized controlled trial was conducted on a set of 488 infants weighing < 2001 g , with 246 in the KMC group and 242 in the traditional care ( TC ) group . The design allows precise observation of the timing and duration of mother – infant contact , and takes into account the infant 's health status at birth and the socioeconomic status of the parents . Bonding Assessment . Two series of outcomes are assessed as manifestations of a mother 's attachment behavior . The first is the mother 's feelings and perceptions of her premature birth experience , including her sense of competence , feelings of worry and stress , and perception of social support . The second outcome is derived from observations of the mother and child 's responsivity to each other during breastfeeding at 41 weeks of gestational age . Interventions . KMC has three components . The first is the kangaroo position . Once the premature infant has adapted to extrauterine life and is able to breastfeed , he is positioned on the mother 's chest , in a upright position , with direct skin-to-skin contact . The second component is kangaroo nutrition . Although breastfeeding is the prime source of nutrition , infants also may receive preterm formula whenever necessary and vitamin supplements . The third component is the clinical control ; infants are monitored on a regular basis , daily until they are gaining at least 20 g per day . Afterward , weekly clinic visits are scheduled until term , which constitutes the ambulatory minimal neonatal care . In the TC group , infants are kept in incubators until they are able to self-regulate their temperature and are thriving ( ie , have an appropriate weight gain ) . Infants are discharged according to current hospital practice , usually not before their weight is ∼1700 g. Afterward , as with the KMC group , weekly clinic visits are scheduled until term . Results . We observed a change in the mothers ' perception of her child , attributable to the skin-to-skin contact in the kangaroo-carrying position . This effect is related to a subjective “ bonding effect ” that may be understood readily by the empowering nature of the KMC intervention . Moreover , in stressful situations when the infant has to remain in the hospital longer , mothers practicing KMC feel more competent than do mothers in the TC group . This is what we call a resilience effect . In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC . We interpret this as an isolation effect . To thwart this deleterious effect , we would suggest adding social support as an integral component of KMC . The observations of the mothers ' sensitive behavior did not show a definite bonding effect , but rather a resilience effect . This is attributable to the KMC intervention ; mothers practicing KMC were more responsive to an at-risk infant whose development has been threatened by a longer hospital stay . Otherwise , we observed that the mothers ( in both the KMC group and the TC group ) had behavioral patterns that were adapted to the child 's at-risk health status and to the precarious condition of some premature infants requiring intensive care . We conclude that the infant 's health status may be a more prominent factor in explaining a mother 's more sensitive behavior , which overshadows the kangaroo-carrying effect . Conclusion . These results suggest that KMC should be promoted actively and that mothers should be encouraged to use it as soon as possible during the intensive care period up to the 40 weeks of gestational age . Thus , KMC should be viewed as a means of humanizing the process of giving birth in a context of prematurity . This finding confirms the conclusions of the 1996 Trieste workshop suggesting that KMC should be promoted both in hospitals and after early discharge OBJECTIVE To evaluate the effects of maternal-infant skin-to-skin contact ( SSC ) vs st and ard contact ( SC ) on low-birth-weight infants ' physiological profile , maternal milk production , and duration of breast-feeding . DESIGN Prospect i ve , r and omized , interventional study with cohort followed up for 6 months after discharge from the hospital . SETTING Special care nursery with follow-up telephone calls after discharge from the hospital . PATIENTS Fifty infants , with birth weights less than 1500 g and whose mothers planned to breast-feed , r and omized to 2 groups : SSC ( experimental ) and SC ( control ) . INTERVENTION In the SSC group , infants were clothed in diaper and held upright between mothers ' breasts ; both mother and infant were covered with a blanket . In the SC group , infants were clothed , wrapped in blankets , and held cradled in mother 's arms . MAIN OUTCOME MEASURES Infant physiological data , ie , oxygen saturation , heart rate , respiratory rate , and axillary temperature ; maternal milk production ; and duration of breast-feeding . RESULTS Oxygen saturation was higher during SSC than during SC ( P < .001 ) ; 11 % of the oxygen saturation recordings during SSC vs 24 % during SC indicated the values less than 90 % ( P < .001 ) . A more stable milk production was noted in the SSC group . No differences were noted in infant temperature , heart rate , or respiratory rate . Ninety percent of mothers in the SSC group vs 61 % in the SC group continued breast-feeding for the duration of the infants ' hospitalization ( P < .05 ) , and 50 % in the SSC group vs 11 % in the SC continued breast-feeding through 1 month after discharge ( P < .01 ) . CONCLUSIONS During SSC with their mothers , low-birth-weight infants maintain a higher oxygen saturation and are less likely to have desaturation to less than 90 % oxygen than are infants exposed to SC . Mothers in the SSC group are more likely to continue breast-feeding until 1 month after discharge OBJECTIVE To test the effects of kangaroo care ( KC ) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mother 's choice to use KC were related to breastfeeding measures . DESIGN Secondary analysis of a multisite , stratified , r and omized three-arm trial . The treatment groups used KC , auditory-tactile-visual-vestibular ( ATVV ) intervention , or received preterm infant care information . SETTING Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011 . PARTICIPANTS Racially diverse mothers ( N = 231 ) and their preterm infants born weighing less than 1,750 g. METHODS Mothers and their infants were enrolled once the infants were no longer critically ill , weighed at least 1,000 g , and could be safely held outside the incubator by parents . Participants were instructed by study nurses ; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity . RESULTS Feeding at the breast during hospitalization , the duration of postdischarge breastfeeding , and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups . Regardless of group assignment , married , older , and more educated women were more likely to feed at the breast during hospitalization . Mothers who practice d KC , regardless of r and omly allocated group , were more likely to provide their milk than those who did not practice KC .  Breastfeeding duration was greatest among more educated women . CONCLUSION As implemented in this study , assignment to the KC group did not appear to influence the measured breastfeeding outcomes OBJECTIVE To investigate the feasibility and safety of skin-to-skin care after birth for moderately preterm infants . DESIGN Prospect i ve cohort study . SETTING The study was conducted at the maternity wards and NICUs of three study sites in Norway . PARTICIPANTS Ninety preterm infants born vaginally with gestational ages of 32 weeks/0 days to 34 weeks/6 days . METHODS Comparison of groups of preterm infants who received  skin-to-skin care or conventional treatment in incubators after birth . RESULTS Median gestational age and birth weight were similar in the two groups : 33 weeks/5 days versus 34 weeks/3 days ( p = .464 ) and 2,100 versus 2,010 g ( p = .519 ) . There were no differences in the first body temperature ( p = .841 ) and blood glucose level ( p = .539 ) between the groups . CONCLUSION Early skin-to-skin contact in the delivery room for moderately preterm infants may be feasible and safe Purpose : To determine the effects of kangaroo care ( KC ) ( skin-to-skin contact ) on breastfeeding status in mother – preterm infant dyads from postpartum through 18 months . Design : R and omized , controlled trial . The control group received st and ard nursery care ; in the intervention group , unlimited KC was encouraged . Sample : A sub sample of 66 mothers and their preterm infants ( 32–36 completed weeks gestation , 1,300–3,000 g , 5 minute Apgar ≥6 ) who intended to breastfeed . Main Outcome Variables : Breastfeeding status at hospital discharge and at 1.5 , 3 , 6 , 12 , and 18 months as measured by the Index of Breastfeeding Status . Results : KC dyads , compared to control dyads , breastfed significantly longer ( 5.08 months vs 2.05 months ) , p = .003 . KC dyads also breastfed more exclusively at each measurement , p = .04 
    Output:
    
Sensitivity analysis suggested that inclusion of studies with high risk of bias did not affect the general direction of findings nor the size of the treatment effect for main outcomes .