Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

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In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs). Methods: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC. Results: 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants. Conclusions: After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health. Pediatrics Preterm infants Kangaroo mother care Neonatal intensive care unit Figures Figure 1 Figure 2 Figure 3 Figure 4 Background China has sustained significant improvements in reducing child mortality, with deaths in children under the age of five falling from an estimated 18.5 per 1000 live births in 2008 to 8.6 per 1000 live births in 2018 [1]. Half of deaths in children under the age of five in China occur in the neonatal period (<28 days) and 31% of these are due to complications of prematurity [2]. China had a preterm birth rate of 6.9 per 100 live births in 2014, equating to approximately 1.2 million preterm newborns, the second highest annual number in the world [3]. These statistics show that an intervention proven to reduce mortality and morbidity in preterm newborns if adopted across China has the potential for huge beneficial impact. Kangaroo mother care (KMC) is such an intervention. KMC originated in Bogota, Colombia in the 1970s [4]. The World Health Organization defines KMC as “care of preterm infants carried skin to skin with the mother. Its key features include continuous and prolonged skin to skin contact between the mother and the baby, and exclusive breastfeeding (ideally) or feeding with breast milk” [5]. KMC is an evidence-based and cost-effective intervention that has been demonstrated to increase newborn survival, exclusive breastfeeding, weight gain and reduce the risk of hypothermia, apnea, and serious newborn infections such as sepsis and pneumonia [6,7]. Evidence showed that KMC increases parent-infant bonding and improves long-term psychological and intellectual development [8.9]. WHO recommends newborns weighing less than 2000g receive continuous KMC when possible; and that when continuous KMC is not feasible, intermittent KMC should be provided based on evidence of decreased morbidity when compared to conventional care [10]. Before China’s Premature Birth and Preterm Infants Intervention Program started to actively promote KMC in 2014, the policy of most neonatal intensive care units (NICUs) in China was not to allow parents into the NICUs and those that permitted parental access tended to prohibit physical contact between parent and the child [11], a practice largely in place to prevent newborn infections. A few hospitals implemented KMC to varying degrees [12-14], however it was not established as part of routine care in China and there was no standardized guideline or training. Chinese doctors and nurses had few opportunities to witness or experience the provision of KMC which hindered uptake and the development of KMC implementation strategies [15]. KMC was widely perceived by clinical staff to pose an infection risk and place an additional burden on the workload of already stretched medical staff. In addition, the space available on NICUs for KMC implementation was limited and commonly cited as a major barrier for successful initiation of KMC [16]. In 2014, the Department of Maternal and Child Health of the National Health Commission of China established the Premature Birth and Preterm Infants Intervention. The Intervention Program has worked to raise awareness and promote the implementation of KMC amongst its network of 50 hospitals through the use of lectures, training in the approach, and exchange experience. Ten of these hospitals volunteered to take part in a structured pilot of KMC implementation. In 2015 the hospitals were provided with three days theoretical and practical training in Beijing, China. In 2016 a meeting was held between representatives of these hospitals, the Premature Birth and Preterm Infants Intervention Program and external experts to draft a KMC implementation protocol for use in the pilot. Eight of these hospitals agreed to participate in implementation research to understand the feasibility and method of adoption of KMC in the context of China’s NICUs. This would inform national KMC guidelines and create ‘centers of excellence’ to promote implementation and scale up of KMC across China. In 2017 the study design and data capture tools were developed, piloted and finalized. This cross-sectional study of KMC practice was conducted for preterm infants discharged from NICUs during the month of April 2018, it provides a snapshot of KMC implementation in participating NICU’s a couple of years after the protocol had been agreed. Methods Study design and population This was a cross-sectional study of infants discharged from eight NICUs in April 2018. The protocol and standard operating procedures were designed by the academic study group along with international experts, with contributions from each hospital’s NICU medical and nursing staff. The eight NICUs were self-selected from a network established under China’s Premature Birth and Preterm Infants Intervention Program, these hospitals were promoting KMC and had incorporated it into their routine practice. The hospitals from seven different provinces are located in major urban cities, two are teaching hospitals and six are specialized maternal and child-health care hospitals. All are tertiary level hospitals, the number of beds in eight NICUs rang from 22 to 60 (on average 33). Over a two-year period, staff from the eight hospitals participated in training sessions on KMC practice and management, these trainings were delivered by international and domestic experts, in addition twice yearly workshops were held to enable staffs from participating hospitals to share their experiences of KMC implementation. Our study population was all preterm infants (GA<37 weeks at birth) cared for in the eight NICUs. All preterm infants were discharged in April 2018, but their date of birth varied with the earliest born in January 2018. GA was determined by both early antenatal ultrasound records and clinical examination on admission to the NICU. Hospital neonatologists decided which newborns were eligible for KMC (Figure 1). This was based on the neonatologist’s perception of the balance of benefit and risk KMC posed for each newborn, dependent on their clinical condition. Provided a newborn’s parents were willing, intermittent KMC could then be provided. Due to the limited availability of space and staff in all eight units, it was not possible for all eligible newborns to receive KMC at the same time, therefore an appointment system was implemented, with parents booking time slots for KMC provision. Newborns receiving one or more sessions of intermittent KMC during the entire hospital stay were defined as the “KMC group”, others were defined as the “non KMC group”. Babies not considered eligible for KMC were those deemed by physicians to have very unstable vital signs, catheters in place preventing prone KMC position, and those whose parents refused to sign informed consent; NICU preterm babies considered by clinicians to be less benefited by KMC (ie, “low risk” infants) were not offered KMC given the limited available NICU space for KMC beds and the aim to provide babies who would experience greater KMC benefit if safely provided. Babies who never received KMC during the entire hospital stay for mainly these reasons were defined as the non-KMC group. In brief, the non-KMC group was largely comprised of two different groups – those considered too unstable for safe KMC; and those considered by medical staffs as “low risk” and less likely to benefit from KMC than smaller and/or sicker babies. KMC was practiced using a standard protocol and flow chart (Figure 2) developed for this KMC project, mostly adapted from international KMC practice guidance [14]. Each pilot hospital took part in the development and training of the protocol and KMC flow chart. Intermittent KMC was conducted in the NICUs on a lounge chair next to the baby’s incubator or bed. The baby was placed in the kangaroo position, skin to skin on the chest of its mother or father. Each KMC session last from 30 minutes to two hours, there’s usually 30 time slots available per day and NICU (usually from 8:00 to 20:00). The duration of each KMC session was determined by the availability of staff and space on the NICU, the infants’ condition and the parent’s availability. Likewise, the number of lounge chair next to the baby’s incubator or bed usually determine the number of slots available. NICUs and families were encouraged to practice KMC for longer duration and more sessions (>5) during the entire hospital stay as the project progressed, based on increasing confidence of clinical staff and adaptions made in NICU environment and practice routines. During KMC, nursing staff were available to help and support the parents, they monitored the infants heart rate, respiratory rate and oxygen saturation levels. If the newborns condition deteriorated or emergency intervention was required, KMC was discontinued immediately. Measures and variables General information was collected from the hospital records of all discharged preterm infants whether they received KMC or not. This included GA at birth, weight on admission and discharge, and length of hospital stay. For newborns who received KMC, each KMC session was documented by a nurse using a daily recording sheet that included information on the length of the KMC session, the infant’s age, gestational age (CGA), daily weight, vital signs and details of any respiratory support needed. The sheet also included the nurses name and the name of the parent providing KMC. Parents providing KMC were surveyed after two or three KMC sessions. The survey questionnaire was administered by NICU nurses with the intention of collecting information on parents’ knowledge and experience of KMC provision (See supplementary appendix). Questionnaire included closed-ended questions on KMC information (source of information), KMC experience (any assistance from medical staff, perceived benefits of KMC, intention to continue KMC after discharge) and KMC preference (best time period, duration and frequency of KMC). We also included the following questions in the questionnaire: “Did you receive family member accept?”, “How did medical staff help you during KMC?”, “What are the benefits of KMC for you?”. All data was entered onto a specially designed Epidata database. A nurse from each participating NICU was identified and assumed responsibility for data entry after receiving training on data collection. Epidata data from each hospital was compiled in a central location (Peking University First Hospital) for review, reconfirmation and analysis by the authors. Birth weight was measured using the scales available in each NICU. Respiratory support was defined as persistent oxygen via nasal cannula, invasive or non-invasive ventilation therapy. KMC exposure hours was the sum of each child's total exposure time over the course of his/her hospital stay. Statistical analysis Data analysis was performed using SPSS for Windows version 20 (IBM Inc., Chicago, IL). The test level was set at α=0.05, and p < 0.05 was considered statistically significant. Outcomes were presented for the full study population and separately for the KMC and non KMC groups. Percentage and chi-square were used to analyze subject questionnaires. Statistical significance was determined by chi-square, t-test or by Wilcoxon rank sum test based on the outcome of interest. Results KMC implementation in NICUs KMC was conducted in NICUs of all eight pilot hospitals. Table 1 shows the characteristics of preterm infants who received and did not receive KMC. Infants born at a lower gestational age (GA<32weeks), with a lower birth weight (BW14d) received more KMC. KMC practice Table 2 stratified infants who received KMC by GA and birth weight. 55.3% of infants below 32 weeks at birth were received KMC, and 56.9% had a birth weight of <1500g More infants that were immature and with less BW received KMC. Table 3 presents detailed information of KMC practice by infant’s GA at birth. Although babies born at a lower GA and with lower birth weight were more likely to receive KMC than premature newborns born at a greater GA and heavier birth weight, they were initiated on KMC later and once they had gained weight. Newborns with a lower gestational age at birth started KMC later compared with those whose GA ³ 32 weeks at birth. Infants GA< 32 weeks were initiated KMC later, at day 28.0 median (IQR: 17.0,29.5) and day 23.0 (16.0,32.0) for infants with GA < 28 weeks and GA 28 - <32 weeks respectively, compared to day 13.5 (8.8,17.3) for infants with GA ³ 32 weeks. The weight of smaller GA infants at the time of KMC was still lower: the average weight of all KMC infants were 1809.4±437.8g, while infants GA<28 weeks had an average weight of 1423.3±226.8g, lower than infants in other GA groups (GA 28-<32 weeks 1768.1±459.2g( mean ± SD), GA 32-<34 weeks 1852.8±333.6g, and GA ³34 weeks 1995.5 ±541.4 g). KMC duration per session (average hours of KMC received) was 1.7±1.0 hours on average. The duration per session and frequency of KMC did not vary by gestational age and birth weight groups, although there was a trend toward more frequent KMC in GA<28 weeks infants. Figure 3 describes the distribution of accumulated KMC hours for each baby (median, quartile) differed by GA category, with significantly increased greater exposure for infants born at a lower GA (19h for GA<28 weeks, and 10h, 6h, and 8.8h for GA 28-32 weeks, 32-34 weeks, and 34-37 weeks). Acceptability of KMC by parents A total of 135 questionnaires were sent out to parents providing KMC and 135 parents responded. Parents performed KMC are invited to the survey. Questionnaire respondents could either be the father or mother, though mothers will be selected if both provided KMC. 94.8% of the parents who participated in the survey stated that KMC was positively accepted by their family members (Figure 4). Over half of the participants indicated that KMC played a role in relieving anxiety (60.4%), increasing parental communication with doctors and nurses (57.3%), and assisted in increasing parental confidence in caring for their preterm babies (69.8%). Discussion Through the analysis of cross-sectional data collected from eight NICUs in China, we found that, under current circumstances, infants born at a lower gestational age and with a lower birth weight were more likely to receive KMC than premature infants born at a greater gestational age and with a higher birth weight. First, this potentially is due to more and more tiny and sicker preterm infants to be treated in NICU and they need more extra helps besides current standard therapy. Second, medical staff’s growing confidence in KMC as a safe and beneficial intervention is important for it could be feasibly provided in NICU. The results of our program emphasis to provide KMC to small/sick babies. Preterm infants born at a GA under 28 weeks had more KMC exposure hours during hospitalization than infants born at a higher GA. KMC was well accepted by parents and was perceived as beneficial to reduce anxiety and improve communications between parents and medical staff. Our study is one of the first to report on the implementation of KMC in China’s NICUs following its introduction in selected pilot hospitals. All eight research units included in this study are in tertiary hospitals - including both general teaching hospitals and maternal and child health care hospitals - located in major urban cities across seven different provinces in North, South, West and East China. The number of preterm infants in those NICUs are also relatively large. Our results show that intermittent KMC is both feasible and acceptable in typical NICU settings across China, and that use of KMC for relatively small and sick babies was observed. This suggests that our approach of systematic introduction, training and support for implementation may accelerate the use and scale-up of this high impact intervention across China. Despite observed differences in NICU location, bed capacity, patient population and relative differences in KMC implementation, our findings across NICUs showed largely consistent patterns of KMC use, feasibility and acceptability. We believe that combining data across these hospitals provides a valid snapshot of KMC use after introduction and establishment in China’s NICUs. Our study differs from previous studies in China that focused on very or extremely low birth weight infants admitted to NICUs in specific hospitals [17]. We looked at KMC use for all newborns admitted to eight participating NICU’s, allowing us to identify the newborns. Infants would be prioritized for KMC by neonatologists and with our geographically representative sample of hospitals our findings are more generalizable for China as a whole. Some reports of KMC experience in other country settings indicated that KMC is commonly provided to infants with GA>32 weeks or with a birth weight above 1500 g after becoming clinically stable [18,19]. Our study found relatively greater KMC use for smaller and younger GA infants, including many receiving non-invasive and invasive respiratory support. Preterm infants born below 28 weeks GA had a significantly longer average KMC exposure hours compared with those born with a GA above 34 weeks. As tiny babies had more complications, longer stay in hospital, more anxious of their parents, the medical staff prefer providing some additional help. KMC is believed to be able to provide support to preterm infants by medical staffs, so in the situation of limited resource, smaller and sicker infants are more often the beneficiaries of KMC. The training for medical/nursing staff under the Premature Birth and Preterm Infants Intervention Program in fact emphasized the specific benefits for these more vulnerable babies as long as KMC was carefully used so as to ensure patient safety. In addition to our reported findings, our interviews with medical and nursing staff (not included in the current analysis) consistently found positive views of KMC benefit and safety, with common reports from staff that length of hospitalization among preterm infants was reduced following KMC introduction and increasing implementation. Our speculation appears to be in line with a recently reported national survey of NICU nurses finding increasing KMC implementation experience was associated with substantially greater nurse acceptance and perceived benefits of KMC [20]. Our analysis of the views of parents providing KMC also indicated that Chinese parents have a high level of acceptance of KMC for preterm infants. KMC was recognized as having positive influence over reducing anxiety and improving communication between parents and medical staff, which was consistent with previous studies e.g. in India [21]. It should be noted that sources of KMC information for parents in China were limited, with most parents receiving their first information on KMC from medical and nursing staff only during NICU hospitalization. While hospital-level promotion should be continued to expose more parents to the concept of KMC, additional advocacy through social media and other channels is needed to promote parental knowledge and increase “demand” for KMC in China. Several limitations should be noted for the current study. To start with, this study is a cross-sectional study which presents the current status of KMC utilization in China’s NICUs, thus no casual inference could be made; Secondly, there might be inconsistency among hospitals regarding KMC inclusion, implementation and reporting, as KMC decision-making was largely influenced by hospital’s prior experience with KMC, and the perceived advantage and risk of KMC among individual medical staff. Nonetheless, we believe that by aggregating the data across hospitals we have the best-available evidence on KMC utilization in China’s NICUs; Thirdly, despite that one of detailed information on the discharge diagnosis which is serious infection collected, we cannot specify whether it occurred during or before the KMC sessions, which is another limitation for the current analysis. Conclusion In this cross-sectional study, we analyzed and reported on the current status of intermittent KMC use in selected Chinese NICUs after prior staff exposure to advocacy and training, and the sharing of experiences among participating hospital staff. Preterm infants selected by neonatologists as eligible for KMC were found to be those who were more premature. KMC was highly accepted by parents of preterm infants. Considering safety issues like the low risk of infections, we recommend that KMC guidelines and protocols appropriate for China’s NICU settings should be developed, endorsed and implemented to enable nation-wide scale up of KMC. Declarations Ethics approval and consent to participate Ethical approval was obtained from Peking University First Hospital Biomedical Research Ethics Committee [(2018) scientific research no. (13)]. Written consent was obtained from the parents of newborns who received KMC. Consent to publication Not applicable; no individual person’s personal information is included in this study. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no conflict of interest. Funding This study was funded by Infants Program of China (No. 34400038) from the Save the Children International. The funding body has role in designing the study, analysis, and interpretation of data and in writing the manuscript. Authors' Contributions QF and GZ conceived of and led the study design; QF and XL coordinated data collection, analysis and wrote the first draft of the manuscript; ZL, XC, BC, SJ, CYY, QL and CZY contributed to data collection, training and program implementation. All authors have read and approved the manuscript. Acknowledgements We thank all parents and infants, all participants in KMC delivery and data collection, all international and national professional experts for technical support. Special thanks to program support from Save the Children. Also cordially thank Sarah Williams, Steve Wall, Greta Wetzel, Zhao Li, Lin Zhang, Ying Cao, and Yingxi Zhao, for their insightful discussions in this work. Abbreviations CGA: Corrected gestational age; GA: Gestational age; KMC: Kangaroo mother care; NICU: Neonatal intensive care unit References World Bank. Mortality rate, under-5 (per 1,000 live-births) – China. Retrievd from https://data.worldbank.org/indicator/SH.DYN.MORT?locations=CN&view=chart HNN. China – Health Newborn Network. Retrieved from https://www.healthynewbornnetwork.org/country/china Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37-e46. Bergman NJ, Jurisoo LA. The 'kangaroo-method' for treating low birth weight babies in a developing country. Tropical doctor. 1994;24(2):57-60. WHO Guidelines Approved by the Guidelines Review Committee. WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. World Health Organization Copyright (c) World Health Organization 2015.: Geneva,2015. Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. 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Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Trop Doct. 2010;40(4):199-202. Tables Table 1. Basic characteristics of KMC and no KMC infants KMC group (N=135) No KMC group (N=503) T / c 2 P Gestational age at birth (week, mean ± SD ) 31.2 ± 2.3 33.9 ± 2.4 10.5 < 0.01 Gestational age <34 weeks (%) 87.5 38.9 74.4 <0.01 Birth weight<2000g (%) 86.5 39.1 70.6 14d (%) 89.6 32.3 105.9 28d (%) 57.3 15.3 78.5 <0.01 Corrected gestational age at discharge (week, mean ± SD ) 34.8 ± 2.4 36.3 ± 2.1 6.0 <0.01 Weight at discharge (g, mean ± SD ) 1809.4 ± 436.1 2266.2 ± 459.5 9.2 < 0.01 K MC, Kangaroo mother care; SD, Standard Deviatio n; P, p-value # include twins and above, 100% minus percentage of single births. Table 2. Gestational age , Birth weight distribution of KMC infants Variable Preterm infant discharged Premature discharged that performed KMC, N(%) Compared with gestational age ＜ 28 week or birth weight ＜ 1000g c 2 P Total 638 135 (21.2%) Gestational age (week) < 28 24 12 (50.0%) - - 28 - < 32 135 76 (56.3%) 0.3 0.6 32-< 34 155 35 (22.6%) 8.1 <0.01 34 - < 37 324 12 (3.7%) 67.6 <0.01 c 2 171.2 P ＜ 0.01 Birth weight (g) < 1000 27 13 (48.1%) - - 1000-<1500 117 69 (59.0%) 1.0 0.3 1500-<2000 166 41 (24.7%) 6.3 0.01 2000-<2500 191 10 (5.2%) 41.7 <0.01 ≥ 2500 137 3 (2.2%) 49.0 <0.01 c 2 171.0 P ＜ 0.01 K MC, Kangaroo mother care; %, KMC premature/preterm infant discharged; c 2 , Chi-squared test Table 3. KMC initiation and practice by different gestational age group GA (week) KMC Number KMC initiation KMC practice Age (d)* CGA (week) Weight (g) Frequency (n)* Duration per session (h) Total 135 17.0 (11.0,29.0) 34.5±2.0 1809.4±437.8 5.0 (5.0,7.3) 1.7±1.0 < 28 12 28.0 (17.0,29.5) # 33.9±3.8 1423.3±226.8 13.0 (7.5,15.0) 1.7±0.3 28 ~ < 32 76 23.0 (16.0,32.0) # 33.7±1.5 # 1768.1±459.2 5.0 (5.0,8.0) 1.8±1.3 32 ~ < 34 35 14.0 (9.0,17.0) 34.9±1.1 1852.8±333.6 5.0 (4.0,5.0) 1.5±0.7 34 ~ < 37 12 7.0 (5.0,16.5) # 37.2±2.3 # 1995.5 ±541.4 5.0 (5.0,6.0) 1.5±0.5 F/ c 2 9.1 16.9 1.8 1.5 1.6 P ＜ 0.01 ＜ 0.01 0.2 0.2 0.2 K MC, Kangaroo mother care; GA, Gestational age; d, day; CGA, Corrected gestational age; n, number; h, hour; Values are mean ± SD or median (first quartile, third quartile) (*) ; # denotes p <0.05 while compared with 32 ~ < 34 weeks; Supplementary Files STROBEchecklistcrosssectional.doc Appendix.docx Cite Share Download PDF Status: Published Journal Publication published 29 May, 2020 Read the published version in BMC Pediatrics → Version 3 posted Submission checks completed at journal 19 May, 2020 Editorial decision: Accept 18 May, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-12166","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":590263,"identity":"7dd3df7b-c67b-4176-ab4f-242b97322a87","order_by":1,"name":"Xin Liu","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Liu","suffix":""},{"id":590264,"identity":"f104e19d-29cc-45a8-b681-2c09eb614ff1","order_by":2,"name":"Zhankui Li","email":"","orcid":"","institution":"Shanxi Northwest Women and Children Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhankui","middleName":"","lastName":"Li","suffix":""},{"id":590265,"identity":"d569dc4a-22a4-4fde-a24d-e5d31e6db86e","order_by":3,"name":"Xiaohui Chen","email":"","orcid":"","institution":"Nanjing Maternity and Child Health Care Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaohui","middleName":"","lastName":"Chen","suffix":""},{"id":590266,"identity":"4317bb8f-7b4a-4c3a-8532-97045432d701","order_by":4,"name":"Bei Cao","email":"","orcid":"","institution":"The Maternal and Child health care hospital of Hunan province","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bei","middleName":"","lastName":"Cao","suffix":""},{"id":590267,"identity":"aa90c117-d383-49d3-9291-33bdcd1794dc","order_by":5,"name":"Shaojie Yue","email":"","orcid":"","institution":"Xiangyang Hospital Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shaojie","middleName":"","lastName":"Yue","suffix":""},{"id":590268,"identity":"d887ab18-01f7-47ef-802f-8badd30d92b9","order_by":6,"name":"Changyi Yang","email":"","orcid":"","institution":"Fujian provice Maternity and Children Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Changyi","middleName":"","lastName":"Yang","suffix":""},{"id":590269,"identity":"37d0274a-49f2-488b-972f-9af4ae8dfd24","order_by":7,"name":"QiongYu Liu","email":"","orcid":"","institution":"Women and Children's Health care Hospital of Linyi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"QiongYu","middleName":"","lastName":"Liu","suffix":""},{"id":590270,"identity":"cee597bb-9289-46f8-962f-4aaa04690826","order_by":8,"name":"Chuanzhong Yang","email":"","orcid":"","institution":"Shenzhen Maternity and Child Healthcare Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chuanzhong","middleName":"","lastName":"Yang","suffix":""},{"id":590271,"identity":"3adc0503-26e9-4837-be95-6399a66f437f","order_by":9,"name":"Gengli Zhao","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gengli","middleName":"","lastName":"Zhao","suffix":""},{"id":590272,"identity":"71559f62-c108-496d-9468-7f89e2bf3335","order_by":10,"name":"Qi Feng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIie3PMQrCQBBA0QkLm2YglpPKKwwsLAiCB7EJCKkieIAQAoJWYi14CI+gLGgj5goBG4sUsbfQINa7doL7i2GKecUA+Hw/WFh2kyGKhDjUTgT3bxJvlnLCXxCAeFeh7rmRcGVuzawgZUAD5MOxneAlHWxZkjaQ1nBMp6WNjCjTChmLFzlxUBo7wX7TESI1DxbkRgjVFZmJhZCOBDMdbDkhMlJw4vILhmfVNo+ConV1r9t8aCevJOFnTRzOu0SL9iOfz+f7555GWzaAnpF+lwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-7321-6134","institution":"Peking University First Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Feng","suffix":""}],"badges":[],"createdAt":"2020-01-21 12:38:59","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.2.21580/v3","doiUrl":"https://doi.org/10.21203/rs.2.21580/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-020-02153-2","type":"published","date":"2020-05-29T20:24:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":1196056,"identity":"88bf31b0-d372-4c7c-b8f9-f76a0368aef3","added_by":"auto","created_at":"2020-05-28 14:25:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1037378,"visible":true,"origin":"","legend":"Decision support flow chart of KMC implementation","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/Fig.1.png"},{"id":1196057,"identity":"6e161487-e459-48ff-b7fc-4e7bf70dfac0","added_by":"auto","created_at":"2020-05-28 14:25:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":827405,"visible":true,"origin":"","legend":"The flow diagram on the process of enrolment","description":"","filename":"Fig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/Fig.2.png"},{"id":1196058,"identity":"6d466006-18cd-4947-8398-49b1dbc0b12c","added_by":"auto","created_at":"2020-05-28 14:25:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":84938,"visible":true,"origin":"","legend":"Total KMC exposure in hours per gestational age preterm infants with GA \u003c 28wk being the longest (Median, IQR, P\u003c0.05)","description":"","filename":"Fig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/Fig.3.png"},{"id":1196059,"identity":"cccd4985-7b26-4459-9796-ae7c9a20d70c","added_by":"auto","created_at":"2020-05-28 14:25:33","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":121299,"visible":true,"origin":"","legend":"Parental experience. The bars the represent the proportion of parents who perceived that KMC had a positive effect；","description":"","filename":"Fig.4.png","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/Fig.4.png"},{"id":13533109,"identity":"1b479a0b-f6ed-4460-b37b-7d84b261c5ce","added_by":"auto","created_at":"2021-09-17 01:19:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":904179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/02919bc4-1338-421e-806c-eddc76f1ea89.pdf"},{"id":1196060,"identity":"eeacb4bd-17b9-47e5-b475-1e813401fe31","added_by":"auto","created_at":"2020-05-28 14:25:34","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":88576,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistcrosssectional.doc","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/STROBEchecklistcrosssectional.doc"},{"id":1196061,"identity":"216a891c-9ba2-43c6-8981-b64688ea0e33","added_by":"auto","created_at":"2020-05-28 14:25:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":22173,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-12166/v3/Appendix.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eUtilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eChina has sustained significant improvements in reducing child mortality, with deaths in children under the age of five falling from an estimated 18.5 per 1000 live births in 2008 to 8.6 per 1000 live births in 2018 [1]. Half of deaths in children under the age of five in China occur in the neonatal period (\u0026lt;28 days) and 31% of these are due to complications of prematurity [2]. China had a preterm birth rate of 6.9 per 100 live births in 2014, equating to approximately 1.2 million preterm newborns, the second highest annual number in the world [3]. These statistics show that an intervention proven to reduce mortality and morbidity in preterm newborns if adopted across China has the potential for huge beneficial impact. Kangaroo mother care (KMC) is such an intervention.\u003c/p\u003e\n\u003cp\u003eKMC originated in Bogota, Colombia in the 1970s [4]. The World Health Organization defines KMC as \u0026ldquo;care of preterm infants carried skin to skin with the mother. Its key features include continuous and prolonged skin to skin contact between the mother and the baby, and exclusive breastfeeding (ideally) or feeding with breast milk\u0026rdquo; [5]. KMC is an evidence-based and cost-effective intervention that has been demonstrated to increase newborn survival, exclusive breastfeeding, weight gain and reduce the risk of hypothermia, apnea, and serious newborn infections such as sepsis and pneumonia [6,7]. Evidence showed that KMC increases parent-infant bonding and improves long-term psychological and intellectual development [8.9]. WHO recommends newborns weighing less than 2000g receive continuous KMC when possible; and that when continuous KMC is not feasible, intermittent KMC should be provided based on evidence of decreased morbidity when compared to conventional care [10].\u003c/p\u003e\n\u003cp\u003eBefore China\u0026rsquo;s Premature Birth and Preterm Infants Intervention Program started to actively promote KMC in 2014, the policy of most neonatal intensive care units (NICUs) in China was not to allow parents into the NICUs and those that permitted parental access tended to prohibit physical contact between parent and the child [11], a practice largely in place to prevent newborn infections. A few hospitals implemented KMC to varying degrees [12-14], however it was not established as part of routine care in China and there was no standardized guideline or training. Chinese doctors and nurses had few opportunities to witness or experience the provision of KMC which hindered uptake and the development of KMC implementation strategies [15]. KMC was widely perceived by clinical staff to pose an infection risk and place an additional burden on the workload of already stretched medical staff. In addition, the space available on NICUs for KMC implementation was limited and commonly cited as a major barrier for successful initiation of KMC [16].\u003c/p\u003e\n\u003cp\u003eIn 2014, the Department of Maternal and Child Health of the National Health Commission of China established the Premature Birth and Preterm Infants Intervention. The Intervention Program has worked to raise awareness and promote the implementation of KMC amongst its network of 50 hospitals through the use of lectures, training in the approach, and exchange experience. Ten of these hospitals volunteered to take part in a structured pilot of KMC implementation. In 2015 the hospitals were provided with three days theoretical and practical training in Beijing, China. In 2016 a meeting was held between representatives of these hospitals, the Premature Birth and Preterm Infants Intervention Program and external experts to draft a KMC implementation protocol for use in the pilot. Eight of these hospitals agreed to participate in implementation research to understand the feasibility and method of adoption of KMC in the context of China\u0026rsquo;s NICUs. This would inform national KMC guidelines and create \u0026lsquo;centers of excellence\u0026rsquo; to promote implementation and scale up of KMC across China. In 2017 the study design and data capture tools were developed, piloted and finalized. This cross-sectional study of KMC practice was conducted for preterm infants discharged from NICUs during the month of April 2018, it provides a snapshot of KMC implementation in participating NICU\u0026rsquo;s a couple of years after the protocol had been agreed.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study of infants discharged from eight NICUs in April 2018. The protocol and standard operating procedures were designed by the academic study group along with international experts, with contributions from each hospital\u0026rsquo;s NICU medical and nursing staff.\u003c/p\u003e\n\u003cp\u003eThe eight NICUs were self-selected from a network established under China\u0026rsquo;s Premature Birth and Preterm Infants Intervention Program, these hospitals were promoting KMC and had incorporated it into their routine practice. The hospitals from seven different provinces are located in major urban cities, two are teaching hospitals and six are specialized maternal and child-health care hospitals. All are tertiary level hospitals, the number of beds in eight NICUs rang from 22 to 60 (on average 33).\u003c/p\u003e\n\u003cp\u003eOver a two-year period, staff from the eight hospitals participated in training sessions on KMC practice and management, these trainings were delivered by international and domestic experts, in addition twice yearly workshops were held to enable staffs from participating hospitals to share their experiences of KMC implementation.\u003c/p\u003e\n\u003cp\u003eOur study population was all preterm infants (GA\u0026lt;37 weeks at birth) cared for in the eight NICUs. All preterm infants were discharged in April 2018, but their date of birth varied with the earliest born in January 2018. GA was determined by both early antenatal ultrasound records and clinical examination on admission to the NICU. Hospital neonatologists decided which newborns were eligible for KMC (Figure 1). This was based on the neonatologist\u0026rsquo;s perception of the balance of benefit and risk KMC posed for each newborn, dependent on their clinical condition. Provided a newborn\u0026rsquo;s parents were willing, intermittent KMC could then be provided. Due to the limited availability of space and staff in all eight units, it was not possible for all eligible newborns to receive KMC at the same time, therefore an appointment system was implemented, with parents booking time slots for KMC provision. Newborns receiving one or more sessions of intermittent KMC during the entire hospital stay were defined as the \u0026ldquo;KMC group\u0026rdquo;, others were defined as the \u0026ldquo;non KMC group\u0026rdquo;. Babies not considered eligible for KMC were those deemed by physicians to have very unstable vital signs, catheters in place preventing prone KMC position, and those whose parents refused to sign informed consent; NICU preterm babies considered by clinicians to be less benefited by KMC (ie, \u0026ldquo;low risk\u0026rdquo; infants) were not offered KMC given the limited available NICU space for KMC beds and the aim to provide babies who would experience greater KMC benefit if safely provided. Babies who never received KMC during the entire hospital stay for mainly these reasons were defined as the non-KMC group. In brief, the non-KMC group was largely comprised of two different groups \u0026ndash; those considered too unstable for safe KMC; and those considered by medical staffs as \u0026ldquo;low risk\u0026rdquo; and less likely to benefit from KMC than smaller and/or sicker babies.\u003c/p\u003e\n\u003cp\u003eKMC was practiced using a standard protocol and flow chart (Figure 2) developed for this KMC project, mostly adapted from international KMC practice guidance [14]. Each pilot hospital took part in the development and training of the protocol and KMC flow chart.\u003c/p\u003e\n\u003cp\u003eIntermittent KMC was conducted in the NICUs on a lounge chair next to the baby\u0026rsquo;s incubator or bed. The baby was placed in the kangaroo position, skin to skin on the chest of its mother or father. Each KMC session last from 30 minutes to two hours, there\u0026rsquo;s usually 30 time slots available per day and NICU (usually from 8:00 to 20:00). The duration of each KMC session was determined by the availability of staff and space on the NICU, the infants\u0026rsquo; condition and the parent\u0026rsquo;s availability. Likewise, the number of lounge chair next to the baby\u0026rsquo;s incubator or bed usually determine the number of slots available. NICUs and families were encouraged to practice KMC for longer duration and more sessions (\u0026gt;5) during the entire hospital stay as the project progressed, based on increasing confidence of clinical staff and adaptions made in NICU environment and practice routines. During KMC, nursing staff were available to help and support the parents, they monitored the infants heart rate, respiratory rate and oxygen saturation levels. If the newborns condition deteriorated or emergency intervention was required, KMC was discontinued immediately.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMeasures and variables\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneral information was collected from the hospital records of all discharged preterm infants whether they received KMC or not. This included GA at birth, weight on admission and discharge, and length of hospital stay. For newborns who received KMC, each KMC session was documented by a nurse using a daily recording sheet that included information on the length of the KMC session, the infant\u0026rsquo;s age, gestational age (CGA), daily weight, vital signs and details of any respiratory support needed. The sheet also included the nurses name and the name of the parent providing KMC.\u003c/p\u003e\n\u003cp\u003eParents providing KMC were surveyed after two or three KMC sessions. The survey questionnaire was administered by NICU nurses with the intention of collecting information on parents\u0026rsquo; knowledge and experience of KMC provision (See supplementary appendix). Questionnaire included closed-ended questions on KMC information (source of information), KMC experience (any assistance from medical staff, perceived benefits of KMC, intention to continue KMC after discharge) and KMC preference (best time period, duration and frequency of KMC). We also included the following questions in the questionnaire: \u0026ldquo;Did you receive family member accept?\u0026rdquo;, \u0026ldquo;How did medical staff help you during KMC?\u0026rdquo;, \u0026ldquo;What are the benefits of KMC for you?\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAll data was entered onto a specially designed Epidata database. A nurse from each participating NICU was identified and assumed responsibility for data entry after receiving training on data collection. Epidata data from each hospital was compiled in a central location (Peking University First Hospital) for review, reconfirmation and analysis by the authors.\u003c/p\u003e\n\u003cp\u003eBirth weight was measured using the scales available in each NICU. Respiratory support was defined as persistent oxygen via nasal cannula, invasive or non-invasive ventilation therapy. KMC exposure hours was the sum of each child's total exposure time over the course of his/her hospital stay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using SPSS for Windows version 20 (IBM Inc., Chicago, IL). The test level was set at \u0026alpha;=0.05, and \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant. Outcomes were presented for the full study population and separately for the KMC and non KMC groups. Percentage and chi-square were used to analyze subject questionnaires. Statistical significance was determined by chi-square, t-test or by Wilcoxon rank sum test based on the outcome of interest.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eKMC implementation in NICUs \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKMC was conducted in NICUs of all eight pilot hospitals. Table 1 shows the characteristics of preterm infants who received and did not receive KMC. Infants born at a lower gestational age (GA\u0026lt;32weeks), with a lower birth weight (BW\u0026lt;1500g), and longer stay in hospital (\u0026gt;14d) received more KMC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eKMC \u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003epractice\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 stratified infants who received KMC by GA and birth weight. 55.3% of infants below 32 weeks at birth were received KMC, and 56.9% had a birth weight of \u0026lt;1500g More infants that were immature and with less BW received KMC.\u003c/p\u003e\n\u003cp\u003eTable 3 presents detailed information of KMC practice by infant\u0026rsquo;s GA at birth. Although babies born at a lower GA and with lower birth weight were more likely to receive KMC than premature newborns born at a greater GA and heavier birth weight, they were initiated on KMC later and once they had gained weight. Newborns with a lower gestational age at birth started KMC later compared with those whose GA \u0026sup3; 32 weeks at birth. Infants GA\u0026lt; 32 weeks were initiated KMC later, at day 28.0 median (IQR: 17.0,29.5) and day 23.0 (16.0,32.0) for infants with GA \u0026lt; 28 weeks and GA 28 - \u0026lt;32 weeks respectively, compared to day 13.5 (8.8,17.3) for infants with GA \u0026sup3; 32 weeks. The weight of smaller GA infants at the time of KMC was still lower: the average weight of all KMC infants were 1809.4\u0026plusmn;437.8g, while infants GA\u0026lt;28 weeks had an average weight of 1423.3\u0026plusmn;226.8g, lower than infants in other GA groups (GA 28-\u0026lt;32 weeks 1768.1\u0026plusmn;459.2g( mean \u0026plusmn; SD), GA 32-\u0026lt;34 weeks 1852.8\u0026plusmn;333.6g, and GA \u0026sup3;34 weeks 1995.5 \u0026plusmn;541.4 g). KMC duration per session (average hours of KMC received) was 1.7\u0026plusmn;1.0 hours on average. The duration per session and frequency of KMC did not vary by gestational age and birth weight groups, although there was a trend toward more frequent KMC in GA\u0026lt;28 weeks infants.\u003c/p\u003e\n\u003cp\u003eFigure 3 describes the distribution of accumulated KMC hours for each baby (median, quartile) differed by GA category, with significantly increased greater exposure for infants born at a lower GA (19h for GA\u0026lt;28 weeks, and 10h, 6h, and 8.8h for GA 28-32 weeks, 32-34 weeks, and 34-37 weeks).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcceptability of KMC by parents\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 135 questionnaires were sent out to parents providing KMC and 135 parents responded. Parents performed KMC are invited to the survey. Questionnaire respondents could either be the father or mother, though mothers will be selected if both provided KMC. 94.8% of the parents who participated in the survey stated that KMC was positively accepted by their family members (Figure 4). Over half of the participants indicated that KMC played a role in relieving anxiety (60.4%), increasing parental communication with doctors and nurses (57.3%), and assisted in increasing parental confidence in caring for their preterm babies (69.8%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThrough the analysis of cross-sectional data collected from eight NICUs in China, we found that, under current circumstances, infants born at a lower gestational age and with a lower birth weight were more likely to receive KMC than premature infants born at a greater gestational age and with a higher birth weight. First, this potentially is due to more and more tiny and sicker preterm infants to be treated in NICU and they need more extra helps besides current standard therapy. Second, medical staff\u0026rsquo;s growing confidence in KMC as a safe and beneficial intervention is important for it could be feasibly provided in NICU. The results of our program emphasis to provide KMC to small/sick babies. Preterm infants born at a GA under 28 weeks had more KMC exposure hours during hospitalization than infants born at a higher GA. KMC was well accepted by parents and was perceived as beneficial to reduce anxiety and improve communications between parents and medical staff.\u003c/p\u003e\n\u003cp\u003eOur study is one of the first to report on the implementation of KMC in China\u0026rsquo;s NICUs following its introduction in selected pilot hospitals. All eight research units included in this study are in tertiary hospitals - including both general teaching hospitals and maternal and child health care hospitals - located in major urban cities across seven different provinces in North, South, West and East China. The number of preterm infants in those NICUs are also relatively large. Our results show that intermittent KMC is both feasible and acceptable in typical NICU settings across China, and that use of KMC for relatively small and sick babies was observed. This suggests that our approach of systematic introduction, training and support for implementation may accelerate the use and scale-up of this high impact intervention across China. Despite observed differences in NICU location, bed capacity, patient population and relative differences in KMC implementation, our findings across NICUs showed largely consistent patterns of KMC use, feasibility and acceptability. We believe that combining data across these hospitals provides a valid snapshot of KMC use after introduction and establishment in China\u0026rsquo;s NICUs. Our study differs from previous studies in China that focused on very or extremely low birth weight infants admitted to NICUs in specific hospitals [17]. We looked at KMC use for all newborns admitted to eight participating NICU\u0026rsquo;s, allowing us to identify the newborns. Infants would be prioritized for KMC by neonatologists and with our geographically representative sample of hospitals our findings are more generalizable for China as a whole.\u003c/p\u003e\n\u003cp\u003eSome reports of KMC experience in other country settings indicated that KMC is commonly provided to infants with GA\u0026gt;32 weeks or with a birth weight above 1500 g after becoming clinically stable [18,19]. Our study found relatively greater KMC use for smaller and younger GA infants, including many receiving non-invasive and invasive respiratory support. Preterm infants born below 28 weeks GA had a significantly longer average KMC exposure hours compared with those born with a GA above 34 weeks. As tiny babies had more complications, longer stay in hospital, more anxious of their parents, the medical staff prefer providing some additional help. KMC is believed to be able to provide support to preterm infants by medical staffs, so in the situation of limited resource, smaller and sicker infants are more often the beneficiaries of KMC. The training for medical/nursing staff under the Premature Birth and Preterm Infants Intervention Program in fact emphasized the specific benefits for these more vulnerable babies as long as KMC was carefully used so as to ensure patient safety. In addition to our reported findings, our interviews with medical and nursing staff (not included in the current analysis) consistently found positive views of KMC benefit and safety, with common reports from staff that length of hospitalization among preterm infants was reduced following KMC introduction and increasing implementation. Our speculation appears to be in line with a recently reported national survey of NICU nurses finding increasing KMC implementation experience was associated with substantially greater nurse acceptance and perceived benefits of KMC [20].\u003c/p\u003e\n\u003cp\u003eOur analysis of the views of parents providing KMC also indicated that Chinese parents have a high level of acceptance of KMC for preterm infants. KMC was recognized as having positive influence over reducing anxiety and improving communication between parents and medical staff, which was consistent with previous studies e.g. in India [21]. It should be noted that sources of KMC information for parents in China were limited, with most parents receiving their first information on KMC from medical and nursing staff only during NICU hospitalization. While hospital-level promotion should be continued to expose more parents to the concept of KMC, additional advocacy through social media and other channels is needed to promote parental knowledge and increase \u0026ldquo;demand\u0026rdquo; for KMC in China.\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be noted for the current study. To start with, this study is a cross-sectional study which presents the current status of KMC utilization in China\u0026rsquo;s NICUs, thus no casual inference could be made; Secondly, there might be inconsistency among hospitals regarding KMC inclusion, implementation and reporting, as KMC decision-making was largely influenced by hospital\u0026rsquo;s prior experience with KMC, and the perceived advantage and risk of KMC among individual medical staff. Nonetheless, we believe that by aggregating the data across hospitals we have the best-available evidence on KMC utilization in China\u0026rsquo;s NICUs; Thirdly, despite that one of detailed information on the discharge diagnosis which is serious infection collected, we cannot specify whether it occurred during or before the KMC sessions, which is another limitation for the current analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this cross-sectional study, we analyzed and reported on the current status of intermittent KMC use in selected Chinese NICUs after prior staff exposure to advocacy and training, and the sharing of experiences among participating hospital staff. Preterm infants selected by neonatologists as eligible for KMC were found to be those who were more premature. KMC was highly accepted by parents of preterm infants. Considering safety issues like the low risk of infections, we recommend that KMC guidelines and protocols appropriate for China\u0026rsquo;s NICU settings should be developed, endorsed and implemented to enable nation-wide scale up of KMC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Peking University First Hospital Biomedical Research Ethics Committee [(2018) scientific research no. (13)]. Written consent was obtained from the parents of newborns who received KMC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable; no individual person\u0026rsquo;s personal information is included in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Infants Program of China (No. 34400038) from the Save the Children International. The funding body has role in designing the study, analysis, and interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQF and GZ conceived of and led the study design; QF and XL coordinated data collection, analysis and wrote the first draft of the manuscript; ZL, XC, BC, SJ, CYY, QL and CZY contributed to data collection, training and program implementation. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all parents and infants, all participants in KMC delivery and data collection, all international and national professional experts for technical support. Special thanks to program support from Save the Children. Also cordially thank Sarah Williams, Steve Wall, Greta Wetzel, Zhao Li, Lin Zhang, Ying Cao, and Yingxi Zhao, for their insightful discussions in this work.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCGA: Corrected gestational age; GA: Gestational age; KMC: Kangaroo mother care; NICU: Neonatal intensive care unit\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Bank. Mortality rate, under-5 (per 1,000 live-births) \u0026ndash; China. Retrievd from https://data.worldbank.org/indicator/SH.DYN.MORT?locations=CN\u0026amp;view=chart\u003c/li\u003e\n\u003cli\u003eHNN. China \u0026ndash; Health Newborn Network. Retrieved from https://www.healthynewbornnetwork.org/country/china\u003c/li\u003e\n\u003cli\u003eChawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7(1):e37-e46.\u003c/li\u003e\n\u003cli\u003eBergman NJ, Jurisoo LA. The 'kangaroo-method' for treating low birth weight babies in a developing country. Tropical doctor. 1994;24(2):57-60.\u003c/li\u003e\n\u003cli\u003eWHO Guidelines Approved by the Guidelines Review Committee. WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. World Health Organization Copyright (c) World Health Organization 2015.: Geneva,2015.\u003c/li\u003e\n\u003cli\u003eCharpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants \u0026lt;/=2000 grams: a randomized, controlled trial. Pediatr. 1997;100(4): 682-688.\u003c/li\u003e\n\u003cli\u003eParmar VR, Kumar A, Kaur R, Parmar S, Kaur D, Basu S, et al. Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India. Indian J Pediatr. 2009;76(1):25-28.\u003c/li\u003e\n\u003cli\u003eMorelius E, Ortenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev. 2015;91(1):63-70.\u003c/li\u003e\n\u003cli\u003eParsa P, Karimi S, Basiri B, Roshanaei G. The effect of kangaroo mother care on physiological parameters of premature infants in Hamadan City, Iran. Pan Afr Med J. 2018;30:89.\u003c/li\u003e\n\u003cli\u003eFeldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014;75(1):56-64.\u003c/li\u003e\n\u003cli\u003eHe L, TAN YJ, HEI MY. Effect of family integrated care in neonatal intensive care unit on maternal stressfulness of hospitalized preterm infants: a self comparison study. Chin J Evid Based Pediatr. 2015;10(6):409-13.\u003c/li\u003e\n\u003cli\u003eDeng Q, Li Q, Wang H, Sun H, Xu X. Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial. Trials. 2018;19(1):701.\u003c/li\u003e\n\u003cli\u003eMellis C. Kangaroo Mother Care and neonatal outcomes: A meta-analysis. J Paediatr Child Health. 2016;52(5):579.\u003c/li\u003e\n\u003cli\u003eCasper C, Sarapuk I, Pavlyshyn H. Regular and prolonged skin-to-skin contact improves short-term outcomes for very preterm infants: A dose-dependent intervention. Arch Pediatr.2018;25(8):469-475.\u003c/li\u003e\n\u003cli\u003eDeng Q, Zhang Y, Li Q, Wang H, Xu X. Factors that have an impact on knowledge, attitude and practice related to kangaroo care: National survey study among neonatal nurses. J Clin Nurs. 2018; 27(21-22):4100-4111.\u003c/li\u003e\n\u003cli\u003eChan G, Bergelson I, Smith ER, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health Policy Plan. 2017; 1;32(10):1466-1475.\u003c/li\u003e\n\u003cli\u003eHei MY, Gao XY, Li ZK, Zhang QS, Li J, Xia SW, et al. Breastfeeding outcomes in family integrated care model in neonatal intensive care units. Chin J Neonatol. 2018;33(1):27-33.\u003c/li\u003e\n\u003cli\u003eSamra NM, Taweel AE, Cadwell K. Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain. J Perinat Educ. 2013; 22(4):194-200.\u003c/li\u003e\n\u003cli\u003eCharpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Pediatrics. 2001;108(5): 1072-1079.\u003c/li\u003e\n\u003cli\u003eZhang Y, Deng Q, Zhu B, Li Q, Wang F, Wang H, et al. Neonatal intensive care nurses' knowledge and beliefs regarding kangaroo care in China: a national survey. BMJ open. 2018; 8(8):e021740.\u003c/li\u003e\n\u003cli\u003eGathwala G, Singh B, Singh J. Effect of Kangaroo Mother Care on physical growth, breastfeeding and its acceptability. Trop Doct. 2010;40(4):199-202.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 16px; color: rgb(0, 0, 0);\"\u003eTable 1. Basic characteristics of KMC and no KMC infants\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.3e+2pt;border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eKMC group (N=135)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eNo KMC group (N=503)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.0pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eT /\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: Symbol;\"\u003ec\u003c/span\u003e\u003csup\u003e\u003cspan style=\"font-size: 13px;\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:40.5pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eP\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eGestational age at birth (week,\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003emean\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003eSD\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e31.2\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e2.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e33.9\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e2.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e10.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt; 0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eGestational age \u0026lt;34 weeks (%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e87.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e38.9\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e74.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eBirth weight\u0026lt;2000g (%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e86.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e39.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e70.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMultiple Births\u003csup\u003e#\u003c/sup\u003e\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family: SimHei;\"\u003e（\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e%\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family: SimHei;\"\u003e）\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e38.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e37.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e0.92\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eAny breast feeding at discharge (%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e78.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e72.0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e2.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e0.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eLength of hospital stay \u0026gt;14d (%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e89.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e32.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e105.9\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eLength of hospital stay \u0026gt;28d (%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e57.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e15.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e78.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eCorrected gestational age at discharge (week,\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003emean\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003eSD\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e34.8\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e2.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e36.3\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e2.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:45.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e6.0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:40.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eWeight at discharge (g,\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003emean\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003eSD\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e1809.4\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e436.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e2266.2\u003c/span\u003e\u003cspan style=\"font-size: 13px; font-family: SimSun;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style=\"font-size: 13px;\"\u003e459.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e9.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026lt; 0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:justify;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 13px;\"\u003eK\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eMC, Kangaroo mother care; SD, Standard Deviatio\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003en;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size: 13px; font-family: \"Times New Roman\", serif; background: white;'\u003e\u0026nbsp;\u003cstrong\u003eP, p-value\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:justify;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e#\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;include twins and above, 100% minus percentage of single births.\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:justify;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:justify;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eTable 2.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eGestational age\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e,\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eBirth weight distribution of KMC infants\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.3e+2pt;border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width:139.5pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:41.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:12px;\"\u003eVariable\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:58.5pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:41.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003ePreterm infant\u003c/span\u003e\u003cspan style=\"font-size: 12px;\"\u003e\u0026nbsp;discharged\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:99.0pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:41.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003ePremature discharged that performed KMC, N(%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:133.65pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:41.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003eCompared with gestational age\u003c/span\u003e\u003cspan style=\"font-size: 12px; font-family: SimHei;\"\u003e＜\u003c/span\u003e\u003cspan style=\"font-size: 12px;\"\u003e28 week or birth weight\u003c/span\u003e\u003cspan style=\"font-size: 12px; font-family: SimHei;\"\u003e＜\u003c/span\u003e\u003cspan style=\"font-size: 12px;\"\u003e1000g\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:81.0pt;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:13.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px; font-family: Symbol;\"\u003ec\u003c/span\u003e\u003csup\u003e\u003cspan style=\"font-size: 12px;\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:13.55pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style=\"font-size: 12px;\"\u003eP\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:139.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003eTotal\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e638\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e135 (21.2%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width:76.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003eGestational age\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e(week)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026lt; 28\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e24\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e12 (50.0%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e28 - \u0026lt; 32\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e135\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e76 (56.3%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e0.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e0.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e32-\u0026lt; 34\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e155\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e35 (22.6%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e8.1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e34 - \u0026lt; 37\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e324\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e12 (3.7%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e67.6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026lt;0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:76.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;\"\u003ec\u003c/span\u003e\u003c/em\u003e\u003csup\u003e\u003cspan style=\"font-size:13px;\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e171.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:76.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;\"\u003eP\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e13 (48.1%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:63.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1000-\u0026lt;1500\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e117\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e69 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style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1500-\u0026lt;2000\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e166\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e41 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style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e2000-\u0026lt;2500\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e191\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e10 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style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e2500\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e137\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan 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style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e171.0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:76.5pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;\"\u003eP\u003c/span\u003e\u003c/em\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:63.0pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:58.5pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.0pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e＜\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:52.65pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 13px;\"\u003eK\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eMC, Kangaroo mother care;\u003c/span\u003e\u003c/strong\u003e\u003cspan style=\"font-size:12px;\"\u003e\u0026nbsp;\u003cstrong\u003e%, KMC premature/preterm infant discharged;\u003c/strong\u003e\u003c/span\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;\"\u003ec\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e\u003cspan style=\"font-size:13px;\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/strong\u003e\u003cspan style=\"font-size:13px;\"\u003e,\u0026nbsp;\u003c/span\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eChi-squared test\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eTable 3. KMC initiation and practice by different gestational age group\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.5e+2pt;border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:55.35pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003eGA (week)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:42.5pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 12px;\"\u003eKMC Number\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 207.65pt;border-top: 1.5pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eKMC initiation\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1.5pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:134.65pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eKMC practice\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:84.3pt;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eAge (d)*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:51.35pt;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eCGA (week)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eWeight (g)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: rgb(217, 217, 217);padding: 0in 5.4pt;height: 0.2in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;border-bottom:solid windowtext 1.0pt;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eFrequency\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e(n)*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;background:#D9D9D9;padding:0in 5.4pt 0in 5.4pt;height:.2in;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003eDuration per session\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e(h)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003eTotal\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:42.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e135\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:84.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e17.0 (11.0,29.0)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:51.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e34.5\u0026plusmn;2.0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1809.4\u0026plusmn;437.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e5.0 (5.0,7.3)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1.7\u0026plusmn;1.0\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:55.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026lt; 28\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:42.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e12\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:84.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e28.0 (17.0,29.5)\u003csup\u003e#\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:51.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e33.9\u0026plusmn;3.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1423.3\u0026plusmn;226.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 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5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e33.7\u0026plusmn;1.5\u003csup\u003e#\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1768.1\u0026plusmn;459.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e5.0 (5.0,8.0)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1.8\u0026plusmn;1.3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:55.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e32 ~ \u0026lt; 34\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:42.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e35\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:84.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 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19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e5.0 (4.0,5.0)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1.5\u0026plusmn;0.7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:55.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:left;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e34 ~ \u0026lt; 37\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:42.5pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e12\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:84.3pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e7.0 (5.0,16.5)\u003csup\u003e#\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:51.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e37.2\u0026plusmn;2.3\u003csup\u003e#\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1995.5 \u0026plusmn;541.4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border: none;padding: 0in 5.4pt;height: 19.85pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e5.0 (5.0,6.0)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:19.85pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1.5\u0026plusmn;0.5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:55.35pt;border:none;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;\"\u003eF/\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;\"\u003ec\u003c/span\u003e\u003c/em\u003e\u003csup\u003e\u003cspan style=\"font-size:13px;\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n 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style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e16.9\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e1.8\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border: none;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;padding:0in 5.4pt 0in 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13px;\"\u003e0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:51.35pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e＜\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e0.01\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e0.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;height: 13.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:77.95pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 13px;\"\u003e0.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:56.7pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:13.95pt;\"\u003e\n \u003cp style='margin:0in;margin-bottom:.0001pt;text-align:center;font-size:14px;font-family:\"Times\",serif;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:13px;\"\u003e0.2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;margin-bottom:.0001pt;text-align:justify;font-size:14px;font-family:\"Times\",serif;line-height:12.0pt;'\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 13px;\"\u003eK\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003eMC, Kangaroo mother care; GA, Gestational age; d, day; CGA, Corrected gestational age; n, number; h, hour; Values are mean\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026plusmn; SD or\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;median (first quartile, third quartile)\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e(*)\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e; #\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;denotes p\u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 13px; color: rgb(0, 0, 0);\"\u003e\u0026lt;0.05 while compared with 32 ~ \u0026lt; 34 weeks; \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Preterm infants, Kangaroo mother care, Neonatal intensive care unit","lastPublishedDoi":"10.21203/rs.2.21580/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.21580/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eKangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA \u0026lt;28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAfter advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.\u003c/p\u003e","manuscriptTitle":"Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-05-28 14:18:13","doi":"10.21203/rs.2.21580/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-05-19T12:00:00+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-05-18T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-03-31 17:54:58","doi":"10.21203/rs.2.21580/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2020-04-21T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe authors made the requested changes in the manuscript.\nI would only like to make a small comment:\nIn page 10, lines 189-191: This information is not clear: Are these all the questions included in the questionnaire? Are they open-ended? If authors wanted to show that those questions were the ones analysed for the purpose of this paper, they should be clearer on that.\n\nI recommend this paper for publication after discretionary review.* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Unable to assess**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"decision","content":"Major revision","date":"2020-04-21T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-04-12T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThank you for your first revision. I still believe the study is important but the manuscript needs further editing. Please review my comments (Track changes) in your submitted word document.* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-03-30T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-03-30T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-03-27T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-03-27T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-03-26T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-03-26T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-01-22 20:52:10","doi":"10.21203/rs.2.21580/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-02-27T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-02-26T12:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n\nComments to Author:\n---\nThe paper \"Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China\" is an interest and relevant study in the neonatal field. There are some confusing parts that authors should improve to make the paper easier to read.\n\nAbstract:\n- The background section starts with the aim of the study. Authors should consider to present a very brief introduction to the theme.\n- The methods section is confusing. It is missing the number of infants involved and information on parents' survey.\n- The conclusion includes information not mention in the results section - KMC was well-accepted by medical staff and parents.\n\nIntroduction:\n- The problem is well-described as well as the arguments for studying it.\n- Page 5, Lines 89-95: Authors should consider to include some references. Readers do not know if these statements came from authors' empirical knowledge or from studies on healthcare professionals' views about KMC in China. There are several international studies on barriers and enablers of the implementation of KMC.\n- Page 5, lines 97-100: It would be helpful to know more about the Program - Who have created it? Which are the characteristics of those 50 hospitals who take part of the network?\n- Page 5 and 6, lines 100-101: Authors should consider to give a brief description of the 10 volunteer hospitals, because their characteristics can influence the success of the KMC implementation.\n\nMaterials and methods:\nStudy design and population\n- Page 6, lines 121-122: Authors should consider to explain if the 8 NICUs are the same of those described in lines 100-101. And why two of them were not consider for this study.\n- Page 8, lines 151-152: It is not clear how clinicians assess the \"low risk\" of infants. Do they have specific guidelines for that, equal for all the eight hospitals, or it depends on doctors' subjective evaluation?\n- Did study population include twins?\nMeasures and variables\n- Page 9, lines 186-188: This sentence is a little confusing.\n\nResults:\n- Page 10, line 208: The sentence is not correctly written - \"below 34 weeks GA weeks at birth\".\n- Page 11, line 216: It should be \"GA \u003c32 weeks\" instead of \"GA\u003c 32 week\".\n- Page 11, lines 214-218: Authors should reformulate the sentence. The values for days are Mean, SD or Median, IQR?\n- Page 12, lines 234-239: Authors should consider to give information on who are those parents (mothers, fathers?), who was invited to answer the survey, the parent who performed KMC? And what if the two of them did it? Readers expect to have a brief characterization of participant parents.\n\nDiscussion:\n- Page 12, lines 242-249: Authors should consider to divide these sentence, it is too long to be understandable.\n- Page 13, lines 269-275: These sentence is too long. Moreover, readers can expect to see the comparison of these results with those from the other studies in China.\n- Page 14, lines 283-284: These sentence is not well-written.\n\nConclusion:\n- Page 16, line 232: Not sure if the expression \"even preferred\" can be used in this case, since the survey was only administered to those who performed KMC. We do not know what parents who did not do KMC think about it.\nTable 1:\n- A legend is needed for information on table 1 (e.g., SD, KMC).\n\nTable 2:\n- A legend is needed for information on table 2.\n\nTable 3:\n- Some information is missing in the legend (e.g., KMC, d).\n\nFigures:\n- The figures do not have titles and legends."},{"type":"editorInvitedReview","content":"","date":"2020-02-19T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n* Are the methods appropriate and well described?: **No**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **No**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Needs some language corrections before being published**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n\nComments to Author:\n---\nI commend the research group taking this initiative, which can play a major role in advocacy and initiation of creating national KMC guidelines and its later implementation.\nHowever I have a few comments I would like the authors respond to before recommending publication\n\nAIM: to understand the feasibility and method of adoption of KMC in the context of China's NICUs\n\nCONCLUSION: - The conclusions in the text and abstract are not congruent. This report does not support that \"KMC is well-accepted by medical staff\" - that information is anecdotal. Int fa the background, the safety issues were mentioned (especially risk of infections) as an important factor inhibiting use of KMC.\n\nMETHODS:\n- When did recruitment start? When did the study stop, all infants discharged in April?\n- only single births?\n- Explain the \"signing up for KMC\" procedure. How long time slots? How many KMC slots for an infant were available per day?\n- It would be very helpful to have a flow chart of the recruitment process. How many infants were born during the time of the study? What was the proportion of non-recruited infants due to not medical stable, considered not prioritized, lack of space, no consent? Number of infants stopping KMC due to clinical deterioration.\n- What was the mortality in the KMC group per GA category vs non-enrolled infants? If any, what was the cause of death?\n- What was the incidence of clinical diagnosed severe bacterial infection in the KMC group per GA category vs non-enrolled infants?\n- Describe the parent survey in detail. VAS, categorical variables, open questions? Statistical method used for analyzing. Only descriptive statistics?\n-\n\nSTATISTICS: Adequate except for questionnaire. See above\n\nRESULTS:\n-\n- Accumulated KMC hours: I agree that descriptive statistics is satisfactory but Figure 2 is blurry and needs a figure legend.\n- Questionnaire: See above regarding description needed. Power enough for statistical analyses? IF not one could consider a Figure 3 for descriptive statistics depending of the method used. Are the reported effects due to KMC or increased presence per se in the NICU?\n\nI recommend publication after revisions. Are the authors intending to publish the staff questionnaire? If so I think one could consider to do this together with the parent questionnaire instead, as the latter probably needs some extensive work. A joint publication of the surveys would add value to both."},{"type":"reviewersInvited","content":"","date":"2020-02-12T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-02-12T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-02-12T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-01-21T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-01-20T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-01-20T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-01-19T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"53200820-ca97-41d9-bccc-5426bafbecac","owner":[],"postedDate":"May 28th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":77149,"name":"Pediatrics"}],"tags":[],"updatedAt":"2021-07-22T20:24:23+00:00","versionOfRecord":{"articleIdentity":"rs-12166","link":"https://doi.org/10.1186/s12887-020-02153-2","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2020-05-29 20:24:23","publishedOnDateReadable":"May 29th, 2020"},"versionCreatedAt":"2020-05-28 14:18:13","video":"","vorDoi":"10.1186/s12887-020-02153-2","vorDoiUrl":"https://doi.org/10.1186/s12887-020-02153-2","workflowStages":[]},"version":"v3","identity":"rs-12166","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-12166","version":["v3"]},"buildId":"uzvnyPIH0yfUW73ClG4p1","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}