Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods 

Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods Viviane Saile do Nascimento Pereira, Luana Teixeira Ghiggino, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5611270/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2025 Read the published version in Discover Public Health → Version 1 posted 7 You are reading this latest preprint version Abstract Objective To compare the evolution of anthropometric indicators in preterm newborns (NB) submitted to the Kangaroo Mother Care (KMC) method and the Conventional Hospitalization Method (CHM), through the construction of growth curves, in a neonatal intensive care complex of a high-risk maternity hospital in Rio de Janeiro, Brazil. Methods: A retrospective longitudinal study using medical record data of preterm newborns born between January 2018 and December 2019. Data collected included weight, length, head circumference, and Intergrowth-21st growth curve classification, according to sex and age. Maternal sociodemographic data were also collected. Means and standard deviations of continuous variables were calculated after normality testing. For categorical variables, significant differences were evaluated using the chi-square test (p-value < 0.05). Growth curves were constructed based on the hospitalization method, differentiated by sex, using generalized additive mixed models. Results: The CHM group had a higher proportion of single pregnancies (61.7%, p = 0.017) and single mothers (50.8%, p = 0.025). The length of hospital stay was significantly shorter in the KMC group (26.7 days, SD = 14.5), while discharge length was higher in the CHM group (45.5 cm, SD = 4.1). Growth curves for weight, length, and head circumference in the KMC group were more homogeneous compared to the CHM group. Conclusion: The results indicate better growth patterns in the KMC group than in the CHM group, suggesting the importance of public policies promoting humanized care in neonatal health. Premature Extremely Low Birth Weight Growth and Development Kangaroo-Mother Care Method Weight Gain Humanization of Assistance Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction According to the World Health Organization, 152 million babies were born preterm in the last decade [ 1 ]. A preterm (or premature) baby is defined as any child born before 37 weeks of gestation (< 259 days), counted from the first day of the mother’s last menstrual period [ 2 ]. In Brazil, the prematurity rate is estimated at 12.2% [ 3 ], with the most common being late preterm infants, born between 34 and 36 weeks of gestational age. This rate is highly associated with cesarean sections performed in women of advanced age and higher educational levels [ 4 , 5 ]. Prematurity brings consequences for neonates, such as an increased likelihood of illnesses and complications in the first days of life, longer hospital stays, and higher neonatal mortality rates, with significant impacts on public health [ 2 , 6 ]. To assess and monitor the nutritional status of neonates, anthropometric parameters are used, typically weight, length, and head circumference. However, these parameters can be influenced by factors such as early nutrition, the newborn's stay in the hospital environment, and limitations on maternal presence [ 7 , 8 ]. Nutritional care provided to preterm infants aims to minimize potential health risks to the neonate [ 9 ]. In 2000, Brazil's Ministry of Health adopted the Kangaroo Mother Care (KMC) as a public policy through the Standard for Humanization of Assistance for Low Birth Weight Newborns. KMC is a model of care for preterm newborns and their families, hospitalized in the Neonatal Intensive Care Unit (NICU), focused on providing humanized and safe care, which is highly important in public health initiatives [ 2 ]. The KMC is designed for newborns classified as medium-risk and requiring continuous care but with less complexity than that provided in intensive care units [ 2 , 10 ]. This policy constitutes a perinatal care model, developed in three stages, aiming to improve the quality of support provided to pregnant women, newborns, and their families through a comprehensive and safe approach [ 11 ]. Literature has highlighted the advantages of KMC over the conventional hospitalization method (CHM), such as strengthening the bond between the mother and the infant, encouraging breastfeeding, improving weight gain, enhancing growth and development, reducing hospital infections, and enabling earlier discharge [ 12 , 13 ]. Although studies describe the benefits of KMC, few investigations assess the physical development of neonates during hospitalization and compare growth between KMC and CHM. Thus, this study aimed to evaluate the physical growth of hospitalized neonates under both methods in a maternity hospital of great reference in the city of Rio de Janeiro, Brazil. Materials and methods Study design and target audience This is a retrospective longitudinal study, using secondary data obtained from medical records of the neonatal intensive care complex at a public health reference unit linked to the Unified Health System (SUS) in the city of Rio de Janeiro, Brazil. The Maternity is a specialized unit providing both outpatient and inpatient care, offering specific care units for high-risk pregnant women and newborns. Additionally, the unit is equipped with technological resources for care and a multidisciplinary team, including an active nutritionist on staff [ 14 ]. The study included all preterm neonates born between January 1, 2018, and December 31, 2019, with a gestational age of less than 37 weeks who, after discharge from the Neonatal Intensive Care Unit (NICU), were transferred to KMC or CHM according to the criteria described in Fig. 1 . No sampling criteria were applied, aiming to evaluate all neonates monitored during the study period. For inclusion in the KMC, neonates had to meet the following criteria: minimum weight of 1250 grams, clinical stability (no life-threatening conditions), full enteral nutrition, and a mother willing to stay in the unit environment 24 hours a day until hospital discharge. Additionally, the mother needed to express an interest in actively participating in her child’s care in the Kangaroo Mother Care Unit, with guidance and support from the team, and be able to maintain the kangaroo position for as long as possible. Neonates assigned to CHM were those who, after discharge from the NICU, still required complementary care and met the following criteria: clinical stability (no life-threatening conditions), the ability to breathe in ambient air, a weight between 1000g and 1500g, full enteral nutrition, and in treatment for nonspecific infections. Neonates with malformations that prevented shared accommodations, those undergoing phototherapy, or those who had undergone medium-complexity surgeries, provided they were clinically stable, were also considered eligible under the guidelines for comprehensive and humanized care for critically ill or potentially critically ill newborns [ 15 ]. The exclusion criteria were neonates with clinical instability, characterized by fluctuations in respiratory or cardiac parameters, as well as those requiring continuous cardiorespiratory or hemodynamic monitoring, such as neonates with neurological or chronic pulmonary conditions, congenital heart disease, craniofacial malformations, and those with seropositivity for the human immunodeficiency virus (HIV). Data collection All data were collected from physical records organized and stored at the Health Unit and later digitized into an Excel® spreadsheet, ensuring the confidentiality of participants' information. The data collected on the neonates covered the period from admission to the neonatal complex until hospital discharge. The collected data included information on sex, gestational age, corrected age, and anthropometric measurements such as weight in grams, length in centimeters, and head circumference in centimeters. These were based on specific Unit protocols adapted from the guidelines of Lohman et al. (1988) and the Ministry of Health [ 16 ]. For the classification of anthropometric measurements, the Intergrowth-21st growth curves were used, providing international prescriptive standards for preterm neonates [ 17 ]. Measurements were taken at birth, upon transfer to intermediate units, weekly during hospitalization, and at hospital discharge. The collection of this information was part of the routine practice of the Nutrition and Nursing teams throughout the hospitalization period. Besides the anthropometric measurements, the study also collected data related to the mother's age (in years), race/skin color, type of employment, marital status, and gestational age at birth. Data analysis The population was divided into two groups: the KMC group and the CHM group (Fig. 1 ). Initially, the normality of the data was verified using the Kolmogorov-Smirnov test and graphical analysis. Due to the parametric nature of the data, descriptive analyses of central tendency and dispersion were presented using means, standard deviation, and minimum and maximum values. Categorical variables were presented in absolute numbers and frequencies, and the differences between the proportions of the KMC and CHM groups were evaluated using the chi-square test. It was adopted a significance level of 5% (p < 0.05). Data analysis was performed using the SPSS statistical software for Windows, version 21.0 (IBM SPSS Inc., CHICAGO, IL, USA). Afterward, longitudinal analyses were performed, taking into account the specificities of the outcome variables (weight, length, and head circumference), which are subject to continuous changes (not necessarily gradual and constant) and tend to increase over time, with inter- and intra-individual variability. Thus, it is assumed that anthropometric measurements between individuals are independent, while measurements taken on the same individual are dependent, having a correlation structure [ 18 ]. For the construction of growth curves during the hospitalization period, mixed generalized additive models (GAMMs) were used, developed by [ 19 ]. GAMMs account for the relationship between measurements from the same individual over time and do not require measurements between individuals to be equally spaced in time or balanced (the same number of measurements). Furthermore, these can be used when there is no linear relationship between the variables [ 19 , 20 ]. Mixed models are necessary for longitudinal analyses because a statistical technique is needed to account for the existing inter- and intra-variable correlations, with a spline adjustment function used in the construction of the curves. For this purpose, the statistical software R 3.6.3 ( https://www.r-project.org/ ) was used, along with the ggplot [ 21 ] and gamm4 [ 22 ] libraries. Ethical aspects The project was planned and conducted according to the ethical principles outlined in Resolution nº. 466/2012 of the National Health Council (Conselho Nacional de Saúde). It was approved by the Research Ethics Committee (CEP) of the Maternidade Escola – ME/UFRJ (nº CAAE 49243121.50000.5275 / opinion nº. 4.859.371). Informed consent was obtained from all subjects and/or their legal guardians included in the manuscript. Results In the studied period (2018–2019), a total of 250 preterm neonates were admitted to the NICU. Of these, 218 were transferred to the Intermediate Units (KMC and CHM), making them eligible for data collection. However, only 180 (82.5%) participated in the study. The losses occurred due to missing data in the medical records, inconsistencies in the records from measurement or data collection errors, and the loss of medical records (Fig. 2 ). The anthropometric data of the newborns and maternal age are described in Table 1 , according to the method of hospitalization. In the KMC group, the length of stay in the NICU and the intermediate unit was shorter than in the CHM group. The age and weight in the KMC group at the time of transfer to the KMC unit were lower (16.2 ± 13.4 and 1808.0 ± 255.4), with less variation in the neonate's age. Table 1 Means and standard deviations of the participants' characteristics, according to the method of admission to a neonatal intensive care unit of a reference maternity hospital in the city of Rio de Janeiro, 2018–2019. Mean (SD) Min-max MCM CoM Mean (SD) Min-max Mean (SD) Min-max Mother’s age (years) 29,1(7,6) 15,0–50,0 28,2(7,1) 15,0–43,0 30,6(8,4) 15,0–50,0 Gestational age at birth (weeks) 32,3(2,6) 26,0–36,8 32,6(2,2) 27,0–38,0 32,3(3,1) 26,0–36,8 Weight at birth (g) 1691,0(536,7) 550,0-3760,0 1605,3(351,5) 755,0-2385,0 1731,8(661,8) 550,0-3330,0 Lenght at birth (cm) 40,3(3,5) 30,8–40,0 39,5(2,7) 34,0–47,0 40,5(4,3) 30,8–49,0 Head circumference at birth (cm) 29,3(2,5) 23,0–36,0 29,1(2,0) 23,0–33,0 29,4(3,0) 23,0–36,0 Age during transference (days) 23,9(34,6) 0,0-333,0 16,2(13,4) 3,0–66,0 27,7(33,6) 1,0-165,0 Lenght of stay in NICU(days) 23,9(34,5) 0,0-333,0 16,1(13,5) 3,0–66,0 33,6(43,3) 1,0-165,0 Weight during transference* (g) 2087,2(568,4) 1280,0-4655,0 1808,0(255,4) 1315,0-2545,0 2373,4(606,2) 1280,0-4210,0 Lenght during transference* 43,1 (3,5) 29,0–54,0 43,8(2,3) 35,0–47,0 43,8(4,2) 29,0-(54,0) Head circumference during transference* 30,9(2,2) 24–39 30,3(1,2) 28,0–33,0 31,9(2,5) 24,0–39,0 Age during first week in Intermediate Unit (days) 29,1(3,5) 5,0-338,0 18,7(8,8) 8,0–44,0 27,1(17,0) 8,0–76,0 Weight during first week in Intermediate Unit (g) 2072,8(491,2) 1360,0-4950,0 1884,3(240,3) 1540,0-2355,0 2152,8(601,0) 1475,0-3850,0 Lenght during first week in Intermediate Unit (cm) 43,2(2,8) 30,0–52,0 42,6(1,4) 39,0–45,0 44,9(2,9) 42,0–51,0 Head circumference during first week in Intermediate Unit (cm) 31,2(1,8) 25–38,5 30,6(1,0) 29,0–32,5 30,8(2,1) 28,0–36,0 Age during neonatal discharge 34,2(35,6) 2,0-344,0 26,8(24,0) 7,0–75,0 36,8(35,3) 2,0-168,0 Days of hospitalization in the Intermediate Unit 10,2(7,7) 0,0–48,0 10,6(5,6) 1,0–24,0 9,1(8,9) 0,0–46,0 Weight in neonatal discharge (g) 2354,7(584,3) 1550,0-5190,0 2062,7(246,6) 1550,0-2780,0 2513,7(610,1) 1640,0-4270,0 Lenght in neonatal discharge (cm) 44,2(4,1) 30,0–55,0 42,3(3,0) 32,0–47,0 45,5(4,1) 30,0–55,0 Head circumference in neonatal discharge (cm) 32,4(2,5) 28,0–47,5 32,0(3,2) 28,0–47,5 32,7(2,2) 28,0-(44,0) Total length of stay for newborns 34,2(34,2) 2,0-344,0 26,7(14,5) 7,0–75,0 36,8(35,4) 2,0-168,0 Notes: Caption: SD = standard deviation; MCM Kangaroo Method; CoM = Conventional Method. NICU = Neonatal Intensive Care Unit *Age during transference (days) in NICU to MCM or CoM/ Weight during transference*(g) in NICU to MCM or CoM/ Lenght during transference* (cm) in NICU to MCM or CoM Head circumference during transference* (cm) in NICU to MCM or CoM. When comparing KMC and CHM, there was a significant difference in gestation type, maternal employment, and marital status. Most of the conventional hospitalizations were among neonates from single pregnancies, with mothers who self-identified as non-Black, and who worked outside their home (Table 2 ). Table 2 Characteristics of the newborns’ mothers, according to the method of admission, in a neonatal intensive care unit of a reference maternity hospital in the city of Rio de Janeiro, 2018–2019. MMC MCo p-valor n (%) % IC95% n (%) n (%) Pregnancy Singleton 115 63,8 58,1–71,2 44(38,3) 71 (61,7) 0,017 Twin 59 32,7 25,7–38,7 36,0(61,0) 23 (39,0) Triplet 6 3,4 1,0–5,8 3 (50,0) 3 (50,0) Number of prenatal visits 5 visits 119 66,1 1,9 − 1,6 52(43,7) 67(56,3) Mode of delivery Vaginal 43 23,8 18,3–30,9 16 (37,2) 27 (62,8) 0,121 C-section 137 76,1 69,1–81,7 67 (48,9) 70 (51,1) Pre-gestational nutritional status (kg/m-2) Underweight ( 30 Kg/m2) 39 20,4 15,2–26,7 15(38,5) 24(61,5) Maternal education Primary education 3 1,6 0,0–3,7 0(0,0) 3(100,0) 0,422 Incomplete elementary education 16 8,9 5,2–13,1 6(37,5) 10(62,5) Completed elementary education 18 10 6,8–15,7 9(50,0) 9(50,0) Incomplete high school 28 15,5 9,9–20,4 12(42,9) 16(57,1) Complete high school 87 48,3 41,4–56,0 43(49,4) 44(50,6) Complete higher education 22 12,2 7,3–16,8 9 (40,9) 13(59,1) Incomplete higher education 5 2,7 0,5 − 4,7 4(80,0) 1(20,0) No information 1 0,5 0,0–2,1 0(0,0) 1(100,0) Marital status Single 118 65,5 58,1–71,7 58(49,2) 60 (50,8) 0,025 Married 50 27,8 22,0–35,1 24 (48,0) 26 (52,0) Mora com o companheiro 13 6,8 3,1–11,0 1 (8,3) 11 (91,7) Ocupation Stay-at-home 77 42,7 35,1–49,2 37 (48,1) 40 (51,9) 0,602 Employed 103 57,2 50,3–64,4 47 (45, 6) 56 (54,9) Race/Skin color White 46 25,5 19,4–31,9 20 (43,5) 26 (56,5) 0,03 Brown 84 46,6 40,8–54,5 32 (38,1) 52 (61,9) Black 49 27,2 20,4–32,5 31 (63,3) 18 (36, 7) Notes: p-value < 0,05 (chi-square test). MCM Kangaroo Method; CoM = Conventional Method. BMI = Body Mass Index The longitudinal analysis of the 180 neonates included a total of 701 repeated measurements throughout their stay in the neonatal complex. In the weight gain progression over time, the weight curve of the KMC group was more homogeneous, consistently showing an upward trend. In contrast, the CHM group exhibited a more fluctuating pattern, including a decline between approximately 10 and 30 days of hospitalization. After this period, although the trend was still upward, the curve presented more heterogeneous inclines, indicating potential growth failures (Fig. 3 ). For both groups, there was no regression in length increase over time, but rather stagnation. When separated by outcomes (KMC and CHM), the patterns were quite heterogeneous, with oscillations in the slopes of the curves. However, the KMC group tended to be more homogeneous throughout the days of hospitalization, with more continuous splines (Fig. 4 ). The growth curve of head circumference gain showed the KMC group with more continuous lines, consistently presenting an upward trend. Neonates admitted to the CHM group exhibited a more heterogeneous pattern of curves, with a retraction of the spline between approximately 15 and 30 days of hospitalization. After this period, the curve continued to increase, but with more heterogeneous slopes compared to the KMC group (Fig. 5 ). Discussion The preterm neonates included in this study were primarily born to single women, of brown and black skin color, with low educational levels, similar to findings in the literature [ 23 , 24 ]. This is generally the profile of women with lower family income, who, consequently, are more likely to use public healthcare services in the country [ 25 ]. Although the most common type of gestation in preterm neonates is multiple births [ 26 ], in the present study, the majority of pregnancies were single fetuses. Preterm birth could be related to lower attendance of prenatal consultations and high-risk pregnancies. Another factor that may partially explain the preterm profile in this study is maternal overweight (overweight and obesity) during the pregestational period. Excess maternal weight exposes the fetus to the risk of prematurity and complications for the mother, such as the likelihood of developing diseases, of having a life-threatening delivery, among others, emphasizing the importance of prenatal care to ensure the healthy development of the baby and reduce risks for the mother [ 27 ]. In the analysis of the evolution of anthropometric indicators, neonates admitted to KMC had less variability in weight throughout their hospitalization and shorter lengths of stay. Thus, this method appears to be the most effective during the neonatal hospitalization phase, which may be associated with skin-to-skin contact, frequent breastfeeding, an environment closer to natural conditions, and the promotion of greater emotional stability and security for the baby [ 28 ]. A relevant finding of the present study was that the average anthropometric data at birth were lower in the group of preterm neonates admitted to KMC. Some studies have found similar results [ 29 ], while others did not show significant differences between the groups [ 30 , 31 ]. This difference may reflect the initial health condition of the preterm neonates. Therefore, it is important to highlight that weight gain should not be analyzed in isolation as a promoter of health, as it is just one factor to be considered in the overall benefits of KMC. Regarding the increase in length during hospitalization, the KMC group showed consistent and upward growth. However, some neonates who were born AGA (Appropriate for Gestational Age) length were classified as SGA (Small for Gestational Age) at discharge, likely due to complications during hospitalization. It is important to note that the nutritional status classification was performed at birth and before admission to the KMC and CHM groups. As observed in this study, the literature [ 7 , 32 , 34 ] mentions an increase in length during hospitalization, but the studies do not perform anthropometric classification to assess the suitability of this growth. In this study, the difference in classification found at birth and discharge may be related to a slower length gain, which is not observed in HC and weight. Another important factor was the nutritional care routine adopted in the unit: the KMC group received breast milk on demand, while the conventional hospitalization group primarily received infant formula. Studies suggest that breast milk may have contributed to the more homogeneous growth in the KMC group [ 32 ]. However, to assess the impact of this practice, it would be necessary to follow up on growth after hospital discharge [ 7 , 33 , 34 ]. Regarding weight, there was greater weight gain in the CHM group, as also indicated in the study by Silva et al. (2019). However, the literature remains controversial, with some studies finding no differences [ 35 , 36 ], while others observed greater weight gain in the KMC group [ 37 , 38 ]. It is worth highlighting that, although in the present study weight gain was greater in the neonates hospitalized in the CHM group, the weight gain in the KMC group was more homogeneous. This can be considered a positive indicator of the beneficial impact of the method on the development of these children, through favorable conditions for stable and continuous growth. The Intergrowth-21st curve for preterm neonates [ 39 , 40 ] recommends a growth pattern that is always ascending [ 17 ]. Stability in growth throughout the entire hospitalization period indicates that KMC may help minimize fluctuations and decelerations in weight gain that can occur in preterm neonates subjected to other hospitalization methods [ 41 ]. Another factor that can impact weight gain is the length of hospitalization. The higher weight gain in the conventional method may be related to the longer hospitalization time. In the Kangaroo Care method, although studies point to greater weight gain and better growth [ 44 ], in the present study, the babies had a shorter hospitalization period, as found by Ornelas et al. [ 13 ]. Consequently, a shorter hospitalization period leads to a lower total weight gain. A systematic review and meta-analysis showed a reduction in the length of hospitalization in days in the ward with the Kangaroo method, and that this method is a safe, low-cost intervention that has been effective in reducing the hospitalization time of preterm and/or low birth weight newborns [ 42 ]. One possible explanation for this difference in hospitalization time is related to the skin-to-skin contact provided by the KMC. This contact promotes greater physiological stability in preterm neonates, which may accelerate the recovery process and contribute to a faster improvement in their health status [ 45 ]. The reduction in hospitalization time is a clinically relevant outcome, as the shorter the preterm neonate's stay in the hospital environment, the lower the exposure to potential infections and associated complications [ 39 , 12 , 40 ]. Although the study analyzed data from one of the largest and primary public maternity hospitals in the city, dedicated to high-risk pregnancies in Rio de Janeiro, the results cannot be extrapolated to other units. However, it is important to note that the studied maternity hospital is linked to the Unified Health System (SUS) and receives pregnant women through the System of Regulation (SISREG) and the Carioca Stork Network, meaning that it is part of the same system used by other health units in the municipality of Rio de Janeiro. In addition to this limitation, it was also not possible to evaluate data prior to 2018 due to issues related to the availability of data provided by management and institutional access, nor from the year 2020 onward due to the COVID-19 pandemic, which altered the routine of care practices promoting KMC and the analysis of the evolution of preterm infants after hospital discharge. However, the results emphasize the importance of considering not only the anthropometric data at birth but also other parameters for evaluating growth and continuous development throughout hospitalization, as well as after discharge. Additionally, it highlights the importance of implementing and enabling the Kangaroo Mother Care (KMC) method in other health units, aiming for better outcomes for neonates born prematurely. Conclusion The results showed more homogeneous growth for the neonates subjected to the Kangaroo Mother Care (KMC), highlighting the physical benefits for the child resulting from the baby-mother-family bond and the importance of public policies that enable this condition for neonates. They also indicate a shorter hospital stay in the KMC, leading to lower risks of complications associated with prolonged hospitalizations in neonates. The results support the strengthening of public policies aimed at the humanization of assistance and maternal-infant health, as well as the importance of healthcare professionals in monitoring the anthropometric growth of neonates. It is also crucial to invest in the implementation and viability of KMC in hospitals across Brazil and Latin America, both in the public and private healthcare sectors, strengthening and training professionals specialized in this method. Declarations Author Contributions Statement VSBPN participated in the concept, writing, data analysis, and final revision of the article. LTG participated in manuscript writing, figure formulation, and final manuscript revision. MLBMS contributed to manuscript writing, figure formulation, and final manuscript revision. LBNR participated in manuscript writing, figure formulation, and final manuscript revision. USB participated in the manuscript revision. CS contributed to the manuscript revision. AAF contributed to the concept, writing, data analysis, and final revision of the article. Data Availability Statement The data that support the findings of the article “Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods” are not publicly available due to the need to protect the privacy of the study participants. Access to the data is therefore restricted and governed by institutional ethical guidelines. References United Nations. Relatório aponta que 152 milhões de bebês nasceram prematuros na última década | ONU News [Internet]. 2023 [cited 2024 Sep 27]. Available from: https://news.un.org/pt/story/2023/05/1814187. Brasil. Atenção humanizada ao recém-nascido : Método Canguru : manual técnico / Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. 3rd ed. Brasília, DF: Ministério da Saúde; 2016. 340 p. Brasil. TabNet Win32 3.2: Nascidos vivos - Brasil [Internet]. 2021 [cited 2024 Sep 25]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def. Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, Moller AB, Say L, Hosseinpoor AR, Yi M, de Lyra Rabello Neto D, Temmerman M. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018 Oct 13;392(10155):1341–8. Bischof AY, Geissler A. Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth - PubMed [Internet]. 2023 [cited 2024 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/37891505/. Pan Y, Wang H, Xu Y, Zhang X, Chen X, Liu X, Liu S, Gao Y, Hou W, Pan Z, Wu X, Xue M, Wu M, Ju H, Wu W, Han S. Short-time mortality and severe complications of very premature infants—a multicenter retrospective cohort study from Jiangsu Province during 2019–2021. Transl Pediatr. 2023 Apr 29;12(4):608–17. Wang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med. 2021 Apr;16(4):282–91. Raman SB, Muthusamy SK, Mohideen AK. Hemodynamically stable very low birth neonates weight gain is affected by the early initiation of full enteral feedings compared to standard feeding. J Educ Health Promot. 2023;12:86. Klossoswski DG, Godói VC de, Xavier CR, Fujinaga CI. Assistência integral ao recém-nascido prematuro: implicações das práticas e da política pública. Rev CEFAC. 2016 Feb;18:137–50. Pinheiro MR, Carr AMG. A eficácia do método mãe canguru em comparação aos cuidados convencionais em uma UTI Neonatal / The effectiveness of the kangaroo mother method in comparison of conventional care in a Neonatal UTI. Brazilian Journal of Health Review. 2019 Feb 14;2(2):1039–48. Brasil. Atenção ao pré-natal de baixo risco / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Brasília, DF: Ministério da Saúde; 2011. (Caderno de atenção básica, 32). Silva LJ da, Leite JL, Scochi CGS, Silva LR da, Silva TP da. Nurses’ adherence to the Kangaroo Care Method: support for nursing care management. Rev Latino-Am Enfermagem. 2015 Jul 3;23:483–90. Ornelas SL, Guimarães RP, Silva LA, Romanelli RM de C. Third stage of the kangaroo method: exclusive breastfeeding and growth of preterm and/or low birth weight newborns. ResearchGate [Internet]. 2024 May 10 [cited 2024 Sep 26]; Available from: https://www.researchgate.net/publication/380267072_Third_stage_of_the_kangaroo_method_exclusive _breastfeeding_and_growth_of_preterm_andor_low_birth_weight_newborns. Maternidade Escola. l Maternidade-Escola da Universidade Federal do Rio de Janeiro (UFRJ) [Internet]. 2024 [cited 2024 Nov 12]. Available from: https://www.me.ufrj.br/index.php/instituicao.html. Brasil. PORTARIA N o 930, DE 10 DE MAIO DE 2012 Define as diretrizes e objetivos para a organização da atenção integral e humanizada ao recém-nascido grave ou potencialmente grave e os critérios de classificação e habilitação de leitos de Unidade Neonatal noâmbito do Sistema Único de Saúde (SUS). [Internet]. 2012 [cited 2024 Sep 25]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2012/prt0930_10_05_2012.html. Brasil. Orientações para coleta e análise de dados antropométricos em serviços de saúde: Norma Técnica do Sistema de Vigilância Alimentar e Nutricional - SISVANS. Ms; 2011. (G. Estatística e Informação em Saúde). Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):857–68. Singer JD, Willett JB. Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY, US: Oxford University Press; 2003. xx, 644 p. (Applied longitudinal data analysis: Modeling change and event occurrence). Breslow NE, Clayton DG. Approximate Inference in Generalized Linear Mixed Models. Journal of the American Statistical Association. 1993;88(421):9–25. Pinheiro JC, Bates D. Mixed-Effects Models in S and S-PLUS. Springer Science & Business Media; 2009. 538 p. Wickham H. ggplot2 [Internet]. Cham: Springer International Publishing; 2016 [cited 2024 Sep 27]. (Use R!). Available from: http://link.springer.com/10.1007/978-3-319-24277-4. Wood S, Scheipl F. gamm4: Generalized Additive Mixed Models using “mgcv” and “lme4” [Internet]. 2020 [cited 2024 Nov 12]. Available from: https://cran.r-project.org/web/packages/gamm4/index.html. Menetrier JV, Almeida G de. Perfil epidemiológico de gestantes de alto risco com parto prematuro em um hospital de referência. Saúde e Pesquisa. 2016;9(3):433–41. Oliveira AA de, Almeida MF de, Silva ZP da, Assunção PL de, Silva AMR, Santos HG dos, Alencar GP. Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais. Cad Saúde Pública. 2019 Jan 21;35:e00211917. Rosa NP da, Mistura C, Leivas DVP, Veiga TM da, Neves ET, Pereira LD. Fatores de riscos e causas relacionados à prematuridade de recém-nascidos em uma instituição hospitalar. Research, Society and Development. 2021 Aug 2;10(9):e55610918431–e55610918431. Pinto B de P, Abalem GC, Mol LR, Almeida MEG de O, Braga MEC, Oliveira MMA de, Machado MR, Daldegan IR, Zimmermmann JB. Gestação gemelar: frequência de pré-eclâmpsia, diabetes gestacional e prematuridade. Revista Eletrônica Acervo Saúde. 2022 Jun 1;15(6):e10454. Brandão T, Moraes CF de, Ferreira DM, Santos KD, Padilha P de C, Saunders C. Pregestational excess weight and adverse maternal outcomes: a systematic review of previous studies in Brazil. Nutr Hosp. 2020 Apr 16;37(2):384–95. Caetano C, Pereira BB, Konstantyner T. Effect on the practice of the kangaroo method on the formation and strengthening of the mother-baby bond: a systematic review. Rev Bras Saude Mater Infant. 2022 May 9;22:11–22. Silveira RC, Procianoy RS. Preterm newborn’s postnatal growth patterns: how to evaluate them. J Pediatr (Rio J). 2019;95 Suppl 1:42–8. Miltersteiner A, Dalle Molle L, Rotta NT. Posição mãe-canguru e posição prona : estudo das respostas fisiológicas de bebês pré-termos e de baixo peso. 2004 [cited 2024 Sep 26]; Available from: https://lume.ufrgs.br/handle/10183/871. Lamy Filho F, Silva AAM da, Lamy ZC, Gomes MASM, Moreira MEL. Avaliação dos resultados neonatais do método canguru no Brasil. J Pediatr (Rio J). 2008 Oct;84:428–35. Marques RFSV, Lopez FA, Braga JAP. O crescimento de crianças alimentadas com leite materno exclusivo nos primeiros 6 meses de vida. J Pediatr (Rio J). 2004 Apr;80:99–105. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016 Jan;137(1):e20152238. Charpak N, Montealegre-Pomar A, Bohorquez A. Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr. 2021 Jan;110(1):45–59. Charpak N, Ruiz-Peláez JG, Figueroa de C Z, Charpak Y. Kangaroo mother versus traditional care for newborn infants </=2000 grams: a randomized, controlled trial. Pediatrics. 1997 Oct;100(4):682–8. Roberts KL, Paynter C, McEwan B. A comparison of kangaroo mother care and conventional cuddling care. Neonatal Netw. 2000 Jun;19(4):31–5. Cattaneo A, Uxa RD F, Tamburlini G. Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants. International Network on Kangaroo Mother Care - PubMed [Internet]. 1998 [cited 2024 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/9628303/. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G. Kangaroo Mother Care in very low birth weight infants. Indian J Pediatr. 2001 Nov;68(11):1019–23. Lorenzini E, Costa TC da, Silva EF da. Prevenção e controle de infecção em unidade de terapia intensiva neonatal. Rev Gaúcha Enferm. 2013 Dec;34:107–13. Nunes AML. A IMPORTÂNCIA DO MÉTODO CANGURU PARA RECÉM-NASCIDOS PREMATUROS E/OU DE BAIXO PESO AO NASCER. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2022 Feb 28;8(2):400–7. Guilherme JP, Camelo Júnior JS. Associação da posição canguru e de fatores perinatais com o aleitamento materno exclusivo à alta ambulatorial do Método Canguru em recém-nascidos de muito baixo peso. 2019 [cited 2024 Sep 25]; Available from: https://repositorio.usp.br/item/003003512. Narciso LM, Beleza LO, Imoto AM. The effectiveness of Kangaroo Mother Care in hospitalization period of preterm and low birth weight infants: systematic review and meta-analysis. J Pediatr (Rio J). 2022;98(2):117–25. Silva DG da, Rodrigues LDS, Soares A, Pinto AGA, Ferreira PC. DESAFIOS DAS MÃES NA TERCEIRA ETAPA DO MÉTODO CANGURU. 2019. Santos AP dos, Sapucaia CO. A influência do Método Canguru no tempo de internação do recém-nascido prematuro em unidades hospitalares: uma revisão integrativa. Revista Pesquisa em Fisioterapia. 2021 Feb 18;11(1):252–72. Cañedo MC, Nunes CB, Gaiva MAM, Vieira ACG, Schultz IL. “Vou para casa. E agora?” A difícil arte do Método Canguru no domicílio. Revista de Enfermagem da UFSM. 2021 Jul 6;11:e52–e52. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Oct, 2025 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 16 Apr, 2025 Reviews received at journal 12 Apr, 2025 Reviewers agreed at journal 02 Apr, 2025 Reviewers invited by journal 02 Apr, 2025 Editor assigned by journal 02 Apr, 2025 Submission checks completed at journal 02 Apr, 2025 First submitted to journal 20 Mar, 2025 You are reading this latest preprint version 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-5611270","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437363045,"identity":"261da2b7-78e3-44c3-a3aa-40b54d243594","order_by":0,"name":"Viviane Saile do Nascimento Pereira","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDACZgaGAxAWY+MBhgoGBgNStDQcYDhDjBZkcICxjQgtBsd5DA/83GHDIN9+uOHAx3mH5c3Zmw8w/KjYhlvLYR6Dg71n0hgMziQ2HJy57bDhzp5jCYw9Z27j1CLZzJZwgLftMNA9iQ2HebcdZtxwI8eAmbENv5aDf9v+M8j3P2w4/HfOYXuCWviZmQ8c5m07wMBwA2gLY8PhROK0yLYlMxjceNhwsOdYevKGM8cSDuLzCxv/weaPb9vsgA5Lf/jgR4217YbjzQcf/KjArQUG6hsgdDOYPEBQPRKoI0XxKBgFo2AUjBAAAMJhYZ9NXCzCAAAAAElFTkSuQmCC","orcid":"","institution":"Maternity School (Federal University of Rio de Janeiro)","correspondingAuthor":true,"prefix":"","firstName":"Viviane","middleName":"Saile do Nascimento","lastName":"Pereira","suffix":""},{"id":437363046,"identity":"4da5304b-6984-41b8-b3b9-ff21fc153ae6","order_by":1,"name":"Luana Teixeira Ghiggino","email":"","orcid":"","institution":"Institute of Nutrition Josué de Castro (Federal University of Rio de Janeiro)","correspondingAuthor":false,"prefix":"","firstName":"Luana","middleName":"Teixeira","lastName":"Ghiggino","suffix":""},{"id":437363047,"identity":"21b7b374-d54e-4296-b025-3eef15d7c1f3","order_by":2,"name":"Maria Luiza Barreto Medeiros da Silva","email":"","orcid":"","institution":"Institute of Nutrition Josué de Castro (Federal University of Rio de Janeiro)","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Luiza Barreto Medeiros da","lastName":"Silva","suffix":""},{"id":437363048,"identity":"8ceb3dfd-86c6-4a15-b72a-1ba63627a95e","order_by":3,"name":"Larissa Brillo Nunes Rúbio","email":"","orcid":"","institution":"Institute of Nutrition Josué de Castro (Federal University of Rio de Janeiro)","correspondingAuthor":false,"prefix":"","firstName":"Larissa","middleName":"Brillo Nunes","lastName":"Rúbio","suffix":""},{"id":437363049,"identity":"d79a0a3d-3bd3-4137-813d-b0c1025fd0ec","order_by":4,"name":"Ursula Viana Bagni","email":"","orcid":"","institution":"Emília de Jesus Ferreiro School of Nutrition (Fluminense Federal University)","correspondingAuthor":false,"prefix":"","firstName":"Ursula","middleName":"Viana","lastName":"Bagni","suffix":""},{"id":437363050,"identity":"223a95f3-a1f0-497c-90ff-eee47eae1ae0","order_by":5,"name":"Claudia Saunders","email":"","orcid":"","institution":"Institute of Nutrition Josué de Castro (Federal University of Rio de Janeiro)","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Saunders","suffix":""},{"id":437363053,"identity":"66870462-d5ba-4d9f-9423-307f1004e885","order_by":6,"name":"Aline Alves Ferreira","email":"","orcid":"","institution":"Institute of Nutrition Josué de Castro (Federal University of Rio de Janeiro)","correspondingAuthor":false,"prefix":"","firstName":"Aline","middleName":"Alves","lastName":"Ferreira","suffix":""}],"badges":[],"createdAt":"2024-12-09 18:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5611270/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5611270/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-025-00963-2","type":"published","date":"2025-10-06T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79907458,"identity":"ba8646c7-a096-43c1-b02c-72749ec0720c","added_by":"auto","created_at":"2025-04-04 11:11:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85791,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of admission to discharge of newborns admitted to the neonatal complex of a reference public maternity hospital in the city of Rio de Janeiro, 2018-2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/2a6369b679d7286ba798c6dc.jpg"},{"id":79909921,"identity":"3ca9f866-aba4-4a43-a357-1caf12e76ae1","added_by":"auto","created_at":"2025-04-04 11:27:18","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69893,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of study’s eligibility criteria and exclusions of newborns admitted to a neonatal intensive care unit of a reference maternity hospital in the city of Rio de Janeiro, 2018-2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/ba8c4482c0158be079530cda.jpg"},{"id":79908393,"identity":"a0b3abf1-dcfc-4594-b454-eecc0d0543a3","added_by":"auto","created_at":"2025-04-04 11:19:18","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":23735,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLongitudinal analysis of the evolution of weight gain in premature newborns, according to the Kangaroo method and the conventional method of hospitalization in a reference maternity hospital in the city of Rio de Janeiro. 2018-2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/047688cdc2a4c1f21fd87016.jpg"},{"id":79907491,"identity":"99646a85-e2a2-4a45-a931-ff7f06c387ce","added_by":"auto","created_at":"2025-04-04 11:11:20","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":23027,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLongitudinal analysis of the evolution of length gain in premature newborns, according to the Kangaroo method and the conventional method of hospitalization in a reference maternity hospital in the city of Rio de Janeiro. 2018-2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/d91875998544ed78397039fa.jpg"},{"id":79908394,"identity":"4e835a25-324c-4bfd-8287-ae17bdd42f2e","added_by":"auto","created_at":"2025-04-04 11:19:18","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23543,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLongitudinal analysis of the evolution of cephalic perimeter gain in premature newborns, according to the Kangaroo method and the conventional method of hospitalization in a reference maternity hospital in the city of Rio de Janeiro. 2018-2019.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/831801fdee018c060122113f.jpg"},{"id":93597479,"identity":"09396ebc-6329-4214-9fc5-5e758c02fbc9","added_by":"auto","created_at":"2025-10-15 14:08:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1376072,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5611270/v1/624e9e23-cf6c-4cf9-a773-1476467f46c7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the World Health Organization, 152\u0026nbsp;million babies were born preterm in the last decade [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A preterm (or premature) baby is defined as any child born before 37 weeks of gestation (\u0026lt;\u0026thinsp;259 days), counted from the first day of the mother\u0026rsquo;s last menstrual period [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Brazil, the prematurity rate is estimated at 12.2% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], with the most common being late preterm infants, born between 34 and 36 weeks of gestational age. This rate is highly associated with cesarean sections performed in women of advanced age and higher educational levels [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrematurity brings consequences for neonates, such as an increased likelihood of illnesses and complications in the first days of life, longer hospital stays, and higher neonatal mortality rates, with significant impacts on public health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. To assess and monitor the nutritional status of neonates, anthropometric parameters are used, typically weight, length, and head circumference. However, these parameters can be influenced by factors such as early nutrition, the newborn's stay in the hospital environment, and limitations on maternal presence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNutritional care provided to preterm infants aims to minimize potential health risks to the neonate [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In 2000, Brazil's Ministry of Health adopted the Kangaroo Mother Care (KMC) as a public policy through the Standard for Humanization of Assistance for Low Birth Weight Newborns. KMC is a model of care for preterm newborns and their families, hospitalized in the Neonatal Intensive Care Unit (NICU), focused on providing humanized and safe care, which is highly important in public health initiatives [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The KMC is designed for newborns classified as medium-risk and requiring continuous care but with less complexity than that provided in intensive care units [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This policy constitutes a perinatal care model, developed in three stages, aiming to improve the quality of support provided to pregnant women, newborns, and their families through a comprehensive and safe approach [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLiterature has highlighted the advantages of KMC over the conventional hospitalization method (CHM), such as strengthening the bond between the mother and the infant, encouraging breastfeeding, improving weight gain, enhancing growth and development, reducing hospital infections, and enabling earlier discharge [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Although studies describe the benefits of KMC, few investigations assess the physical development of neonates during hospitalization and compare growth between KMC and CHM. Thus, this study aimed to evaluate the physical growth of hospitalized neonates under both methods in a maternity hospital of great reference in the city of Rio de Janeiro, Brazil.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and target audience\u003c/h2\u003e \u003cp\u003e This is a retrospective longitudinal study, using secondary data obtained from medical records of the neonatal intensive care complex at a public health reference unit linked to the Unified Health System (SUS) in the city of Rio de Janeiro, Brazil. The Maternity is a specialized unit providing both outpatient and inpatient care, offering specific care units for high-risk pregnant women and newborns. Additionally, the unit is equipped with technological resources for care and a multidisciplinary team, including an active nutritionist on staff [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study included all preterm neonates born between January 1, 2018, and December 31, 2019, with a gestational age of less than 37 weeks who, after discharge from the Neonatal Intensive Care Unit (NICU), were transferred to KMC or CHM according to the criteria described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No sampling criteria were applied, aiming to evaluate all neonates monitored during the study period.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor inclusion in the KMC, neonates had to meet the following criteria: minimum weight of 1250 grams, clinical stability (no life-threatening conditions), full enteral nutrition, and a mother willing to stay in the unit environment 24 hours a day until hospital discharge. Additionally, the mother needed to express an interest in actively participating in her child\u0026rsquo;s care in the Kangaroo Mother Care Unit, with guidance and support from the team, and be able to maintain the kangaroo position for as long as possible.\u003c/p\u003e \u003cp\u003eNeonates assigned to CHM were those who, after discharge from the NICU, still required complementary care and met the following criteria: clinical stability (no life-threatening conditions), the ability to breathe in ambient air, a weight between 1000g and 1500g, full enteral nutrition, and in treatment for nonspecific infections. Neonates with malformations that prevented shared accommodations, those undergoing phototherapy, or those who had undergone medium-complexity surgeries, provided they were clinically stable, were also considered eligible under the guidelines for comprehensive and humanized care for critically ill or potentially critically ill newborns [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exclusion criteria were neonates with clinical instability, characterized by fluctuations in respiratory or cardiac parameters, as well as those requiring continuous cardiorespiratory or hemodynamic monitoring, such as neonates with neurological or chronic pulmonary conditions, congenital heart disease, craniofacial malformations, and those with seropositivity for the human immunodeficiency virus (HIV).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAll data were collected from physical records organized and stored at the Health Unit and later digitized into an Excel\u0026reg; spreadsheet, ensuring the confidentiality of participants' information. The data collected on the neonates covered the period from admission to the neonatal complex until hospital discharge.\u003c/p\u003e \u003cp\u003eThe collected data included information on sex, gestational age, corrected age, and anthropometric measurements such as weight in grams, length in centimeters, and head circumference in centimeters. These were based on specific Unit protocols adapted from the guidelines of Lohman et al. (1988) and the Ministry of Health [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For the classification of anthropometric measurements, the Intergrowth-21st growth curves were used, providing international prescriptive standards for preterm neonates [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Measurements were taken at birth, upon transfer to intermediate units, weekly during hospitalization, and at hospital discharge. The collection of this information was part of the routine practice of the Nutrition and Nursing teams throughout the hospitalization period.\u003c/p\u003e \u003cp\u003eBesides the anthropometric measurements, the study also collected data related to the mother's age (in years), race/skin color, type of employment, marital status, and gestational age at birth.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe population was divided into two groups: the KMC group and the CHM group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Initially, the normality of the data was verified using the Kolmogorov-Smirnov test and graphical analysis. Due to the parametric nature of the data, descriptive analyses of central tendency and dispersion were presented using means, standard deviation, and minimum and maximum values. Categorical variables were presented in absolute numbers and frequencies, and the differences between the proportions of the KMC and CHM groups were evaluated using the chi-square test. It was adopted a significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Data analysis was performed using the SPSS statistical software for Windows, version 21.0 (IBM SPSS Inc., CHICAGO, IL, USA).\u003c/p\u003e \u003cp\u003eAfterward, longitudinal analyses were performed, taking into account the specificities of the outcome variables (weight, length, and head circumference), which are subject to continuous changes (not necessarily gradual and constant) and tend to increase over time, with inter- and intra-individual variability. Thus, it is assumed that anthropometric measurements between individuals are independent, while measurements taken on the same individual are dependent, having a correlation structure [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the construction of growth curves during the hospitalization period, mixed generalized additive models (GAMMs) were used, developed by [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. GAMMs account for the relationship between measurements from the same individual over time and do not require measurements between individuals to be equally spaced in time or balanced (the same number of measurements). Furthermore, these can be used when there is no linear relationship between the variables [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Mixed models are necessary for longitudinal analyses because a statistical technique is needed to account for the existing inter- and intra-variable correlations, with a spline adjustment function used in the construction of the curves. For this purpose, the statistical software R 3.6.3 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org/\u003c/span\u003e\u003cspan address=\"https://www.r-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used, along with the ggplot [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and gamm4 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] libraries.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical aspects\u003c/h3\u003e\n\u003cp\u003e The project was planned and conducted according to the ethical principles outlined in Resolution n\u0026ordm;. 466/2012 of the National Health Council (Conselho Nacional de Sa\u0026uacute;de). It was approved by the Research Ethics Committee (CEP) of the Maternidade Escola \u0026ndash; ME/UFRJ (n\u0026ordm; CAAE 49243121.50000.5275 / opinion n\u0026ordm;. 4.859.371). Informed consent was obtained from all subjects and/or their legal guardians included in the manuscript.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the studied period (2018\u0026ndash;2019), a total of 250 preterm neonates were admitted to the NICU. Of these, 218 were transferred to the Intermediate Units (KMC and CHM), making them eligible for data collection. However, only 180 (82.5%) participated in the study. The losses occurred due to missing data in the medical records, inconsistencies in the records from measurement or data collection errors, and the loss of medical records (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe anthropometric data of the newborns and maternal age are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, according to the method of hospitalization. In the KMC group, the length of stay in the NICU and the intermediate unit was shorter than in the CHM group. The age and weight in the KMC group at the time of transfer to the KMC unit were lower (16.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4 and 1808.0\u0026thinsp;\u0026plusmn;\u0026thinsp;255.4), with less variation in the neonate's age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and standard deviations of the participants' characteristics, according to the method of admission to a neonatal intensive care unit of a reference maternity hospital in the city of Rio de Janeiro, 2018\u0026ndash;2019.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMean (SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eMin-max\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMCM\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003eCoM\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMin-max\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eMin-max\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,1(7,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15,0\u0026ndash;50,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28,2(7,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,0\u0026ndash;43,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30,6(8,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15,0\u0026ndash;50,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age at birth (weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32,3(2,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26,0\u0026ndash;36,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32,6(2,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27,0\u0026ndash;38,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32,3(3,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26,0\u0026ndash;36,8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight at birth (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1691,0(536,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e550,0-3760,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1605,3(351,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e755,0-2385,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1731,8(661,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e550,0-3330,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLenght at birth (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40,3(3,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30,8\u0026ndash;40,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39,5(2,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34,0\u0026ndash;47,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40,5(4,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30,8\u0026ndash;49,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead circumference at birth (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,3(2,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23,0\u0026ndash;36,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29,1(2,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23,0\u0026ndash;33,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29,4(3,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23,0\u0026ndash;36,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge during transference (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23,9(34,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,0-333,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,2(13,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,0\u0026ndash;66,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27,7(33,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,0-165,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLenght of stay in NICU(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23,9(34,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,0-333,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16,1(13,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,0\u0026ndash;66,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33,6(43,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1,0-165,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight during transference* (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2087,2(568,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1280,0-4655,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1808,0(255,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1315,0-2545,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2373,4(606,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1280,0-4210,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLenght during transference*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43,1 (3,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29,0\u0026ndash;54,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43,8(2,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35,0\u0026ndash;47,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43,8(4,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29,0-(54,0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead circumference during transference*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30,9(2,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30,3(1,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,0\u0026ndash;33,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31,9(2,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24,0\u0026ndash;39,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge during first week in Intermediate Unit (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,1(3,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,0-338,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18,7(8,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,0\u0026ndash;44,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27,1(17,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8,0\u0026ndash;76,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight during first week in Intermediate Unit (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2072,8(491,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1360,0-4950,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1884,3(240,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1540,0-2355,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2152,8(601,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1475,0-3850,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLenght during first week in Intermediate Unit (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43,2(2,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30,0\u0026ndash;52,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42,6(1,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39,0\u0026ndash;45,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44,9(2,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42,0\u0026ndash;51,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead circumference during first week in Intermediate Unit (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31,2(1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u0026ndash;38,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30,6(1,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29,0\u0026ndash;32,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30,8(2,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28,0\u0026ndash;36,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge during neonatal discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34,2(35,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,0-344,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,8(24,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,0\u0026ndash;75,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,8(35,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,0-168,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays of hospitalization in the Intermediate Unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10,2(7,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,0\u0026ndash;48,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,6(5,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,0\u0026ndash;24,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9,1(8,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,0\u0026ndash;46,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight in neonatal discharge (g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2354,7(584,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1550,0-5190,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2062,7(246,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1550,0-2780,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2513,7(610,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1640,0-4270,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLenght in neonatal discharge \u0026nbsp;(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44,2(4,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30,0\u0026ndash;55,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42,3(3,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32,0\u0026ndash;47,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45,5(4,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30,0\u0026ndash;55,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead circumference \u0026nbsp;in neonatal discharge (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32,4(2,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28,0\u0026ndash;47,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32,0(3,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,0\u0026ndash;47,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32,7(2,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28,0-(44,0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of stay for newborns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34,2(34,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,0-344,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,7(14,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,0\u0026ndash;75,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,8(35,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,0-168,0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNotes: Caption: SD\u0026thinsp;=\u0026thinsp;standard deviation; MCM Kangaroo Method; CoM\u0026thinsp;=\u0026thinsp;Conventional Method. NICU\u0026thinsp;=\u0026thinsp;Neonatal Intensive Care Unit *Age during transference (days) in NICU to MCM or CoM/ Weight during transference*(g) in NICU to MCM or CoM/ Lenght during transference* (cm) in NICU to MCM or CoM Head circumference during transference* (cm) in NICU to MCM or CoM.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen comparing KMC and CHM, there was a significant difference in gestation type, maternal employment, and marital status. Most of the conventional hospitalizations were among neonates from single pregnancies, with mothers who self-identified as non-Black, and who worked outside their home (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the newborns\u0026rsquo; mothers, according to the method of admission, in a neonatal intensive care unit of a reference maternity hospital in the city of Rio de Janeiro, 2018\u0026ndash;2019.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMMC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMCo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-valor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIC95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingleton\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58,1\u0026ndash;71,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44(38,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e71 (61,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25,7\u0026ndash;38,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,0(61,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23 (39,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTriplet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,0\u0026ndash;5,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of prenatal visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,8\u0026thinsp;\u0026minus;\u0026thinsp;1,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31(50,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30(49,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,9\u0026thinsp;\u0026minus;\u0026thinsp;1,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52(43,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67(56,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMode of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18,3\u0026ndash;30,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (37,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (62,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC-section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69,1\u0026ndash;81,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67 (48,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70 (51,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-gestational nutritional status (kg/m-2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18,5 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,2\u0026ndash;10,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(30,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9(69,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy weight (18,5 a 24,5 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35,6\u0026ndash;49,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42(50,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40(49,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight (25,0 a 29,9 kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24,1\u0026ndash;37,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36(44,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45(55,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese (\u0026gt;\u0026thinsp;30 Kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,2\u0026ndash;26,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(38,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24(61,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,0\u0026ndash;3,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(100,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete elementary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,2\u0026ndash;13,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(37,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10(62,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompleted elementary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,8\u0026ndash;15,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9(50,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,9\u0026ndash;20,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(42,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16(57,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41,4\u0026ndash;56,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43(49,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44(50,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete higher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,3\u0026ndash;16,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (40,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13(59,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete higher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,5\u0026thinsp;\u0026minus;\u0026thinsp;4,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(80,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(20,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,0\u0026ndash;2,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(100,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58,1\u0026ndash;71,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58(49,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e60 (50,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22,0\u0026ndash;35,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (48,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26 (52,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMora com o companheiro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3,1\u0026ndash;11,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (8,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (91,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStay-at-home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35,1\u0026ndash;49,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (48,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40 (51,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50,3\u0026ndash;64,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47 (45, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e56 (54,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Skin color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19,4\u0026ndash;31,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (43,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26 (56,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0,03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40,8\u0026ndash;54,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (38,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52 (61,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20,4\u0026ndash;32,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (63,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (36, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNotes: p-value\u0026thinsp;\u0026lt;\u0026thinsp;0,05 (chi-square test). MCM Kangaroo Method; CoM\u0026thinsp;=\u0026thinsp;Conventional Method. BMI\u0026thinsp;=\u0026thinsp;Body Mass Index\u003c/p\u003e \u003cp\u003eThe longitudinal analysis of the 180 neonates included a total of 701 repeated measurements throughout their stay in the neonatal complex. In the weight gain progression over time, the weight curve of the KMC group was more homogeneous, consistently showing an upward trend. In contrast, the CHM group exhibited a more fluctuating pattern, including a decline between approximately 10 and 30 days of hospitalization. After this period, although the trend was still upward, the curve presented more heterogeneous inclines, indicating potential growth failures (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor both groups, there was no regression in length increase over time, but rather stagnation. When separated by outcomes (KMC and CHM), the patterns were quite heterogeneous, with oscillations in the slopes of the curves. However, the KMC group tended to be more homogeneous throughout the days of hospitalization, with more continuous splines (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe growth curve of head circumference gain showed the KMC group with more continuous lines, consistently presenting an upward trend. Neonates admitted to the CHM group exhibited a more heterogeneous pattern of curves, with a retraction of the spline between approximately 15 and 30 days of hospitalization. After this period, the curve continued to increase, but with more heterogeneous slopes compared to the KMC group (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe preterm neonates included in this study were primarily born to single women, of brown and black skin color, with low educational levels, similar to findings in the literature [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This is generally the profile of women with lower family income, who, consequently, are more likely to use public healthcare services in the country [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the most common type of gestation in preterm neonates is multiple births [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], in the present study, the majority of pregnancies were single fetuses. Preterm birth could be related to lower attendance of prenatal consultations and high-risk pregnancies.\u003c/p\u003e \u003cp\u003eAnother factor that may partially explain the preterm profile in this study is maternal overweight (overweight and obesity) during the pregestational period. Excess maternal weight exposes the fetus to the risk of prematurity and complications for the mother, such as the likelihood of developing diseases, of having a life-threatening delivery, among others, emphasizing the importance of prenatal care to ensure the healthy development of the baby and reduce risks for the mother [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the analysis of the evolution of anthropometric indicators, neonates admitted to KMC had less variability in weight throughout their hospitalization and shorter lengths of stay. Thus, this method appears to be the most effective during the neonatal hospitalization phase, which may be associated with skin-to-skin contact, frequent breastfeeding, an environment closer to natural conditions, and the promotion of greater emotional stability and security for the baby [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA relevant finding of the present study was that the average anthropometric data at birth were lower in the group of preterm neonates admitted to KMC. Some studies have found similar results [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], while others did not show significant differences between the groups [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This difference may reflect the initial health condition of the preterm neonates. Therefore, it is important to highlight that weight gain should not be analyzed in isolation as a promoter of health, as it is just one factor to be considered in the overall benefits of KMC.\u003c/p\u003e \u003cp\u003eRegarding the increase in length during hospitalization, the KMC group showed consistent and upward growth. However, some neonates who were born AGA (Appropriate for Gestational Age) length were classified as SGA (Small for Gestational Age) at discharge, likely due to complications during hospitalization. It is important to note that the nutritional status classification was performed at birth and before admission to the KMC and CHM groups. As observed in this study, the literature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] mentions an increase in length during hospitalization, but the studies do not perform anthropometric classification to assess the suitability of this growth. In this study, the difference in classification found at birth and discharge may be related to a slower length gain, which is not observed in HC and weight.\u003c/p\u003e \u003cp\u003eAnother important factor was the nutritional care routine adopted in the unit: the KMC group received breast milk on demand, while the conventional hospitalization group primarily received infant formula. Studies suggest that breast milk may have contributed to the more homogeneous growth in the KMC group [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, to assess the impact of this practice, it would be necessary to follow up on growth after hospital discharge [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding weight, there was greater weight gain in the CHM group, as also indicated in the study by Silva et al. (2019). However, the literature remains controversial, with some studies finding no differences [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], while others observed greater weight gain in the KMC group [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is worth highlighting that, although in the present study weight gain was greater in the neonates hospitalized in the CHM group, the weight gain in the KMC group was more homogeneous. This can be considered a positive indicator of the beneficial impact of the method on the development of these children, through favorable conditions for stable and continuous growth. The Intergrowth-21st curve for preterm neonates [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] recommends a growth pattern that is always ascending [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Stability in growth throughout the entire hospitalization period indicates that KMC may help minimize fluctuations and decelerations in weight gain that can occur in preterm neonates subjected to other hospitalization methods [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother factor that can impact weight gain is the length of hospitalization. The higher weight gain in the conventional method may be related to the longer hospitalization time. In the Kangaroo Care method, although studies point to greater weight gain and better growth [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], in the present study, the babies had a shorter hospitalization period, as found by Ornelas et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Consequently, a shorter hospitalization period leads to a lower total weight gain. A systematic review and meta-analysis showed a reduction in the length of hospitalization in days in the ward with the Kangaroo method, and that this method is a safe, low-cost intervention that has been effective in reducing the hospitalization time of preterm and/or low birth weight newborns [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne possible explanation for this difference in hospitalization time is related to the skin-to-skin contact provided by the KMC. This contact promotes greater physiological stability in preterm neonates, which may accelerate the recovery process and contribute to a faster improvement in their health status [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The reduction in hospitalization time is a clinically relevant outcome, as the shorter the preterm neonate's stay in the hospital environment, the lower the exposure to potential infections and associated complications [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the study analyzed data from one of the largest and primary public maternity hospitals in the city, dedicated to high-risk pregnancies in Rio de Janeiro, the results cannot be extrapolated to other units. However, it is important to note that the studied maternity hospital is linked to the Unified Health System (SUS) and receives pregnant women through the System of Regulation (SISREG) and the Carioca Stork Network, meaning that it is part of the same system used by other health units in the municipality of Rio de Janeiro. In addition to this limitation, it was also not possible to evaluate data prior to 2018 due to issues related to the availability of data provided by management and institutional access, nor from the year 2020 onward due to the COVID-19 pandemic, which altered the routine of care practices promoting KMC and the analysis of the evolution of preterm infants after hospital discharge.\u003c/p\u003e \u003cp\u003eHowever, the results emphasize the importance of considering not only the anthropometric data at birth but also other parameters for evaluating growth and continuous development throughout hospitalization, as well as after discharge. Additionally, it highlights the importance of implementing and enabling the Kangaroo Mother Care (KMC) method in other health units, aiming for better outcomes for neonates born prematurely.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results showed more homogeneous growth for the neonates subjected to the Kangaroo Mother Care (KMC), highlighting the physical benefits for the child resulting from the baby-mother-family bond and the importance of public policies that enable this condition for neonates. They also indicate a shorter hospital stay in the KMC, leading to lower risks of complications associated with prolonged hospitalizations in neonates.\u003c/p\u003e \u003cp\u003eThe results support the strengthening of public policies aimed at the humanization of assistance and maternal-infant health, as well as the importance of healthcare professionals in monitoring the anthropometric growth of neonates. It is also crucial to invest in the implementation and viability of KMC in hospitals across Brazil and Latin America, both in the public and private healthcare sectors, strengthening and training professionals specialized in this method.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVSBPN participated in the concept, writing, data analysis, and final revision of the article. LTG participated in manuscript writing, figure formulation, and final manuscript revision. MLBMS contributed to manuscript writing, figure formulation, and final manuscript revision. LBNR participated in manuscript writing, figure formulation, and final manuscript revision. USB participated in the manuscript revision. CS contributed to the manuscript revision. AAF contributed to the concept, writing, data analysis, and final revision of the article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of the article \u0026ldquo;Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods\u0026rdquo; are not publicly available due to the need to protect the privacy of the study participants. Access to the data is therefore restricted and governed by institutional ethical guidelines.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eUnited Nations. Relatório aponta que 152 milhões de bebês nasceram prematuros na última década | ONU News [Internet]. 2023 [cited 2024 Sep 27]. Available from: https://news.un.org/pt/story/2023/05/1814187.\u003c/li\u003e\n \u003cli\u003eBrasil. Atenção humanizada ao recém-nascido : Método Canguru : manual técnico / Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. 3rd ed. Brasília, DF: Ministério da Saúde; 2016. 340 p.\u003c/li\u003e\n \u003cli\u003eBrasil. TabNet Win32 3.2: Nascidos vivos - Brasil [Internet]. 2021 [cited 2024 Sep 25]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinasc/cnv/nvuf.def.\u003c/li\u003e\n \u003cli\u003eBoerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, Moller AB, Say L, Hosseinpoor AR, Yi M, de Lyra Rabello Neto D, Temmerman M. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018 Oct 13;392(10155):1341–8.\u003c/li\u003e\n \u003cli\u003eBischof AY, Geissler A. Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth - PubMed [Internet]. 2023 [cited 2024 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/37891505/.\u003c/li\u003e\n \u003cli\u003ePan Y, Wang H, Xu Y, Zhang X, Chen X, Liu X, Liu S, Gao Y, Hou W, Pan Z, Wu X, Xue M, Wu M, Ju H, Wu W, Han S. Short-time mortality and severe complications of very premature infants—a multicenter retrospective cohort study from Jiangsu Province during 2019–2021. Transl Pediatr. 2023 Apr 29;12(4):608–17.\u003c/li\u003e\n \u003cli\u003eWang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med. 2021 Apr;16(4):282–91.\u003c/li\u003e\n \u003cli\u003eRaman SB, Muthusamy SK, Mohideen AK. Hemodynamically stable very low birth neonates weight gain is affected by the early initiation of full enteral feedings compared to standard feeding. J Educ Health Promot. 2023;12:86.\u003c/li\u003e\n \u003cli\u003eKlossoswski DG, Godói VC de, Xavier CR, Fujinaga CI. Assistência integral ao recém-nascido prematuro: implicações das práticas e da política pública. Rev CEFAC. 2016 Feb;18:137–50.\u003c/li\u003e\n \u003cli\u003ePinheiro MR, Carr AMG. A eficácia do método mãe canguru em comparação aos cuidados convencionais em uma UTI Neonatal / The effectiveness of the kangaroo mother method in comparison of conventional care in a Neonatal UTI. Brazilian Journal of Health Review. 2019 Feb 14;2(2):1039–48.\u003c/li\u003e\n \u003cli\u003eBrasil. Atenção ao pré-natal de baixo risco / Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Brasília, DF: Ministério da Saúde; 2011. (Caderno de atenção básica, 32).\u003c/li\u003e\n \u003cli\u003eSilva LJ da, Leite JL, Scochi CGS, Silva LR da, Silva TP da. Nurses’ adherence to the Kangaroo Care Method: support for nursing care management. Rev Latino-Am Enfermagem. 2015 Jul 3;23:483–90.\u003c/li\u003e\n \u003cli\u003eOrnelas SL, Guimarães RP, Silva LA, Romanelli RM de C. Third stage of the kangaroo method: exclusive breastfeeding and growth of preterm and/or low birth weight newborns. ResearchGate [Internet]. 2024 May 10 [cited 2024 Sep 26]; Available from: https://www.researchgate.net/publication/380267072_Third_stage_of_the_kangaroo_method_exclusive\u003cbr\u003e_breastfeeding_and_growth_of_preterm_andor_low_birth_weight_newborns.\u003c/li\u003e\n \u003cli\u003eMaternidade Escola. l Maternidade-Escola da Universidade Federal do Rio de Janeiro (UFRJ) [Internet]. 2024 [cited 2024 Nov 12]. Available from: https://www.me.ufrj.br/index.php/instituicao.html.\u003c/li\u003e\n \u003cli\u003eBrasil. PORTARIA N o 930, DE 10 DE MAIO DE 2012 Define as diretrizes e objetivos para a organização da atenção integral e humanizada ao recém-nascido grave ou potencialmente grave e os critérios de classificação e habilitação de leitos de Unidade Neonatal noâmbito do Sistema Único de Saúde (SUS). [Internet]. 2012 [cited 2024 Sep 25]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2012/prt0930_10_05_2012.html.\u003c/li\u003e\n \u003cli\u003eBrasil. Orientações para coleta e análise de dados antropométricos em serviços de saúde: Norma Técnica do Sistema de Vigilância Alimentar e Nutricional - SISVANS. Ms; 2011. (G. Estatística e Informação em Saúde).\u003c/li\u003e\n \u003cli\u003eVillar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Gravett MG, Purwar M, Frederick IO, Noble AJ, Pang R, Barros FC, Chumlea C, Bhutta ZA, Kennedy SH, International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):857–68.\u003c/li\u003e\n \u003cli\u003eSinger JD, Willett JB. Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY, US: Oxford University Press; 2003. xx, 644 p. (Applied longitudinal data analysis: Modeling change and event occurrence). \u003c/li\u003e\n \u003cli\u003eBreslow NE, Clayton DG. Approximate Inference in Generalized Linear Mixed Models. Journal of the American Statistical Association. 1993;88(421):9–25.\u003c/li\u003e\n \u003cli\u003ePinheiro JC, Bates D. Mixed-Effects Models in S and S-PLUS. Springer Science \u0026amp;amp; Business Media; 2009. 538 p.\u003c/li\u003e\n \u003cli\u003eWickham H. ggplot2 [Internet]. Cham: Springer International Publishing; 2016 [cited 2024 Sep 27]. (Use R!). Available from: http://link.springer.com/10.1007/978-3-319-24277-4.\u003c/li\u003e\n \u003cli\u003eWood S, Scheipl F. gamm4: Generalized Additive Mixed Models using “mgcv” and “lme4” [Internet]. 2020 [cited 2024 Nov 12]. Available from: https://cran.r-project.org/web/packages/gamm4/index.html.\u003c/li\u003e\n \u003cli\u003eMenetrier JV, Almeida G de. Perfil epidemiológico de gestantes de alto risco com parto prematuro em um hospital de referência. Saúde e Pesquisa. 2016;9(3):433–41.\u003c/li\u003e\n \u003cli\u003eOliveira AA de, Almeida MF de, Silva ZP da, Assunção PL de, Silva AMR, Santos HG dos, Alencar GP. Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais. Cad Saúde Pública. 2019 Jan 21;35:e00211917.\u003c/li\u003e\n \u003cli\u003eRosa NP da, Mistura C, Leivas DVP, Veiga TM da, Neves ET, Pereira LD. Fatores de riscos e causas relacionados à prematuridade de recém-nascidos em uma instituição hospitalar. Research, Society and Development. 2021 Aug 2;10(9):e55610918431–e55610918431.\u003c/li\u003e\n \u003cli\u003ePinto B de P, Abalem GC, Mol LR, Almeida MEG de O, Braga MEC, Oliveira MMA de, Machado MR, Daldegan IR, Zimmermmann JB. Gestação gemelar: frequência de pré-eclâmpsia, diabetes gestacional e prematuridade. Revista Eletrônica Acervo Saúde. 2022 Jun 1;15(6):e10454.\u003c/li\u003e\n \u003cli\u003eBrandão T, Moraes CF de, Ferreira DM, Santos KD, Padilha P de C, Saunders C. Pregestational excess weight and adverse maternal outcomes: a systematic review of previous studies in Brazil. Nutr Hosp. 2020 Apr 16;37(2):384–95.\u003c/li\u003e\n \u003cli\u003eCaetano C, Pereira BB, Konstantyner T. Effect on the practice of the kangaroo method on the formation and strengthening of the mother-baby bond: a systematic review. Rev Bras Saude Mater Infant. 2022 May 9;22:11–22. \u003c/li\u003e\n \u003cli\u003eSilveira RC, Procianoy RS. Preterm newborn’s postnatal growth patterns: how to evaluate them. J Pediatr (Rio J). 2019;95 Suppl 1:42–8.\u003c/li\u003e\n \u003cli\u003eMiltersteiner A, Dalle Molle L, Rotta NT. Posição mãe-canguru e posição prona : estudo das respostas fisiológicas de bebês pré-termos e de baixo peso. 2004 [cited 2024 Sep 26]; Available from: https://lume.ufrgs.br/handle/10183/871.\u003c/li\u003e\n \u003cli\u003eLamy Filho F, Silva AAM da, Lamy ZC, Gomes MASM, Moreira MEL. Avaliação dos resultados neonatais do método canguru no Brasil. J Pediatr (Rio J). 2008 Oct;84:428–35.\u003c/li\u003e\n \u003cli\u003eMarques RFSV, Lopez FA, Braga JAP. O crescimento de crianças alimentadas com leite materno exclusivo nos primeiros 6 meses de vida. J Pediatr (Rio J). 2004 Apr;80:99–105.\u003c/li\u003e\n \u003cli\u003eBoundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016 Jan;137(1):e20152238.\u003c/li\u003e\n \u003cli\u003eCharpak N, Montealegre-Pomar A, Bohorquez A. Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr. 2021 Jan;110(1):45–59.\u003c/li\u003e\n \u003cli\u003eCharpak N, Ruiz-Peláez JG, Figueroa de C Z, Charpak Y. Kangaroo mother versus traditional care for newborn infants \u0026amp;lt;/=2000 grams: a randomized, controlled trial. Pediatrics. 1997 Oct;100(4):682–8.\u003c/li\u003e\n \u003cli\u003eRoberts KL, Paynter C, McEwan B. A comparison of kangaroo mother care and conventional cuddling care. Neonatal Netw. 2000 Jun;19(4):31–5.\u003c/li\u003e\n \u003cli\u003eCattaneo A, Uxa RD F, Tamburlini G. Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants. International Network on Kangaroo Mother Care - PubMed [Internet]. 1998 [cited 2024 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/9628303/.\u003c/li\u003e\n \u003cli\u003eRamanathan K, Paul VK, Deorari AK, Taneja U, George G. Kangaroo Mother Care in very low birth weight infants. Indian J Pediatr. 2001 Nov;68(11):1019–23.\u003c/li\u003e\n \u003cli\u003eLorenzini E, Costa TC da, Silva EF da. Prevenção e controle de infecção em unidade de terapia intensiva neonatal. Rev Gaúcha Enferm. 2013 Dec;34:107–13. \u003c/li\u003e\n \u003cli\u003eNunes AML. A IMPORTÂNCIA DO MÉTODO CANGURU PARA RECÉM-NASCIDOS PREMATUROS E/OU DE BAIXO PESO AO NASCER. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2022 Feb 28;8(2):400–7.\u003c/li\u003e\n \u003cli\u003eGuilherme JP, Camelo Júnior JS. Associação da posição canguru e de fatores perinatais com o aleitamento materno exclusivo à alta ambulatorial do Método Canguru em recém-nascidos de muito baixo peso. 2019 [cited 2024 Sep 25]; Available from: https://repositorio.usp.br/item/003003512.\u003c/li\u003e\n \u003cli\u003eNarciso LM, Beleza LO, Imoto AM. The effectiveness of Kangaroo Mother Care in hospitalization period of preterm and low birth weight infants: systematic review and meta-analysis. J Pediatr (Rio J). 2022;98(2):117–25.\u003c/li\u003e\n \u003cli\u003eSilva DG da, Rodrigues LDS, Soares A, Pinto AGA, Ferreira PC. DESAFIOS DAS MÃES NA TERCEIRA ETAPA DO MÉTODO CANGURU. 2019.\u003c/li\u003e\n \u003cli\u003eSantos AP dos, Sapucaia CO. A influência do Método Canguru no tempo de internação do recém-nascido prematuro em unidades hospitalares: uma revisão integrativa. Revista Pesquisa em Fisioterapia. 2021 Feb 18;11(1):252–72.\u003c/li\u003e\n \u003cli\u003eCañedo MC, Nunes CB, Gaiva MAM, Vieira ACG, Schultz IL. “Vou para casa. E agora?” A difícil arte do Método Canguru no domicílio. Revista de Enfermagem da UFSM. 2021 Jul 6;11:e52–e52.\u003c/li\u003e\n\u003c/ol\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":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Premature, Extremely Low Birth Weight, Growth and Development, Kangaroo-Mother Care Method, Weight Gain, Humanization of Assistance","lastPublishedDoi":"10.21203/rs.3.rs-5611270/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5611270/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo compare the evolution of anthropometric indicators in preterm newborns (NB) submitted to the Kangaroo Mother Care (KMC) method and the Conventional Hospitalization Method (CHM), through the construction of growth curves, in a neonatal intensive care complex of a high-risk maternity hospital in Rio de Janeiro, Brazil.\u003c/p\u003e\n\u003cp\u003eMethods: A retrospective longitudinal study using medical record data of preterm newborns born between January 2018 and December 2019. Data collected included weight, length, head circumference, and Intergrowth-21st growth curve classification, according to sex and age. Maternal sociodemographic data were also collected. Means and standard deviations of continuous variables were calculated after normality testing. For categorical variables, significant differences were evaluated using the chi-square test (p-value \u0026lt; 0.05). Growth curves were constructed based on the hospitalization method, differentiated by sex, using generalized additive mixed models.\u003c/p\u003e\n\u003cp\u003eResults: The CHM group had a higher proportion of single pregnancies (61.7%, p = 0.017) and single mothers (50.8%, p = 0.025). The length of hospital stay was significantly shorter in the KMC group (26.7 days, SD = 14.5), while discharge length was higher in the CHM group (45.5 cm, SD = 4.1). Growth curves for weight, length, and head circumference in the KMC group were more homogeneous compared to the CHM group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The results indicate better growth patterns in the KMC group than in the CHM group, suggesting the importance of public policies promoting humanized care in neonatal health.\u003c/p\u003e","manuscriptTitle":"Growth Curves of Brazilian Preterm Neonates Submitted to Kangaroo Mother Care and Conventional Hospitalization Methods ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-04 11:11:13","doi":"10.21203/rs.3.rs-5611270/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-16T17:51:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-12T14:06:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26148640357160639148973254156156055571","date":"2025-04-02T10:19:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-02T08:53:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-02T08:48:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T07:47:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-03-20T18:11:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"571f69dc-d42c-4ad8-a562-edc7ba3399f3","owner":[],"postedDate":"April 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:06:08+00:00","versionOfRecord":{"articleIdentity":"rs-5611270","link":"https://doi.org/10.1186/s12982-025-00963-2","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-10-06 15:57:37","publishedOnDateReadable":"October 6th, 2025"},"versionCreatedAt":"2025-04-04 11:11:13","video":"","vorDoi":"10.1186/s12982-025-00963-2","vorDoiUrl":"https://doi.org/10.1186/s12982-025-00963-2","workflowStages":[]},"version":"v1","identity":"rs-5611270","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5611270","identity":"rs-5611270","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}