Every year, more than 34,000 infants born a few weeks early in England and Wales fail to get the breastfeeding that would protect their long-term health. These "late preterm" babies—born between 34 and 37 weeks—fall into a gap. They are too mature for the intensive support given to very premature infants, yet too immature to breastfeed as easily as full-term babies. Only a minority achieve exclusive breastfeeding. The World Health Organization recommends Kangaroo Mother Care (KMC) for these infants: prolonged skin-to-skin contact, exclusive breastmilk feeding, early discharge with home support, and follow-up. But the NHS has no concerted programme to implement it. This project will develop the first NHS-tailored KMC interventions. Researchers will interview parents and healthcare staff to identify barriers, review existing evidence, and co-design practical changes—such as a digital diary to track skin-to-skin contact, information resources for families, and training for NHS staff. If successful, the approach could improve breastfeeding rates and long-term health outcomes for a large, vulnerable population of newborns, while reducing demands on health services.
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Background: Breastmilk is the optimal nutrition for newborn infants, with proven health benefits for mothers and babies. Yet only 20-30% of infants born late preterm (LPT; between 34+0 and 36+6 weeks gestation) achieve exclusive breastfeeding. More than 34,000 LPT infants are born in England and Wales each year. They often experience worse breastfeeding outcomes than infants born at term or more preterm (<34 weeks gestation), and are at risk of neonatal complications, long-term health and neurodevelopmental problems. Kangaroo Mother Care (KMC) is a WHO-recommended low-cost, multi-component intervention for preterm infants consisting of: (1) early, continuous and prolonged skin-to-skin contact (SSC) between mothers and infants for >8 hours/day; (2) exclusive breastfeeding or breastmilk feeding; (3) early discharge after hospital-initiated KMC with continuation at home; (4) adequate support and follow-up for mothers at home. There is currently no concerted effort to implement KMC in the UK. Aims: To develop a research programme evaluating the impact of KMC implementation interventions on breastfeeding and other neonatal and maternal outcomes following LPT birth. In this programme development grant (PDG), we will develop our team and collaboration, conduct formative research, develop a reliable outcome data collection method, and co-develop KMC interventions with key stakeholders. PDG plan: Work package (WP) 1 Team building and collaboration: We will further establish the research team and expert advisory group, building collaborations between the NHS, academia, third section organisations and industry. We will engage with potential NHS sites for the future trial, and draft the PGfAR. WP2 Systematic Review: We will conduct a systematic review of existing KMC implementation interventions, specifying the behavioural and implementation strategies used, and examining which are associated with improved outcomes. WP3 Formative research: We will conduct theory-based interviews, focus groups and surveys with parents/caregivers and healthcare professionals to explore perceived barriers and enablers of KMC implementation in NHS settings. We will use the Behaviour Change Wheel and COM-B model to map barriers/enablers to behaviour change techniques. WP4 Digital Diary: We will develop and pilot a digital KMC-diary , in collaboration with Cogniss and Health Innovation East, to facilitate measurement of the frequency and duration of SSC undertaken, alongside type and mode of feeding by parents/caregivers. WP5 Co-design: We will triangulate findings from WP2-4 to inform co-design. Following an Experience Based Co-Design approach, we will run workshops with parents/caregivers and NHS staff to co-design theory-informed, NHS-tailored intervention(s) to increase KMC uptake/delivery. We envisage this may include the behaviour change interventions delivered through the digital KMC diary, information resources for families, educational package for healthcare professionals, and modification of care pathways. Impact and dissemination: We will achieve in-depth understanding of factors influencing KMC implementation and co-produce prototypical interventions, which will be piloted and evaluated in a future trial. In addition to presentations and peer-review articles, we will submit a NIHR PGfAR application. By increasing KMC uptake for a large population of infants at high risk of breastfeeding problems, this work could significantly improve long-term health for these infants and their mothers, with associated economic benefits for health services.
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