{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T05:27:05Z","timestamp":1793856425361,"version":"4.6.1"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>Kangaroo Care (KC) is an evidence-based intervention, with greatest benefit when initiated early and provided for continuous periods, as recommended by the World Health Organization. However, uncertainty remains around KC operationalisation in research settings and how this may influence subsequent implementation in routine practice. We conducted a narrative synthesis of KC intervention characteristics reported in randomised controlled trials (RCTs), based on a prior systematic review and meta-analysis. We focused on elements relevant to implementation, including instructions for delivery, recommended equipment or environment, initiation timing, duration of skin-to-skin contact, and contraindications. Our synthesis shows that, even within RCTs, KC is frequently not delivered in line with WHO recommendations with respect to initiation timing, duration, and eligibility. This contributes to uncertainty in clinical target setting and reflects an implementation gap that mirrors challenges observed in routine care. Commonly reported barriers included infrastructural constraints, staffing and training requirements, and cultural factors influencing caregiver participation. These findings highlight that evidence of KC effectiveness alone is insufficient to ensure optimal delivery in practice. Implementation studies conducted in real-life settings are needed to determine whether observed benefits translate into routine care and to identify strategies that support timely initiation, sufficient duration, and sustained KC provision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Key intervention characteristics of Kangaroo Care (KC), such as instructions, environment, initiation timing, duration, and contraindications that are often insufficiently reported in randomised controlled trials, but critical for implementation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Even in RCTs, KC is frequently not delivered in accordance with WHO recommendations, highlighting uncertainty in clinical target setting and revealing an implementation gap that extends beyond routine clinical practice into research settings.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>By identifying recurring infrastructural, personnel, and cultural barriers across trials, this work informs the design of real-world effectiveness and implementation studies, including the ongoing NeoDeco effectiveness\u2013implementation trial.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41390-026-05020-5","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T11:29:30Z","timestamp":1776943770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Kangaroo Care as an intervention in randomised controlled trials in neonatal intensive care"],"prefix":"10.1038","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3941-9952","authenticated-orcid":false,"given":"Chiara","family":"Minotti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1787-9025","authenticated-orcid":false,"given":"Lauren","family":"Wallis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Hoesli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2195-2873","authenticated-orcid":false,"given":"Chlo\u00e9","family":"Schlaeppi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7740-7680","authenticated-orcid":false,"given":"Emanuela","family":"Nyantakyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1593-3247","authenticated-orcid":false,"given":"Marie-Therese","family":"Schultes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5634-0774","authenticated-orcid":false,"given":"Kerstin","family":"Jost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3902-5489","authenticated-orcid":false,"given":"Julia Anna","family":"Bielicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"5020_CR1","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1111\/j.1651-2227.2005.tb01930.x","volume":"94","author":"N Charpak","year":"2005","unstructured":"Charpak, N. et al. 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K.J. received funding from EU Horizon 2020 through the NeoIPC Project (European Union\u2019s Horizon 2020 research and innovation programme under grant agreement No 965328) and the Machaon Foundation. J.A.B. received funding from EU Horizon 2020 through the NeoIPC Project (European Union\u2019s Horizon 2020 research and innovation programme under grant agreement No 965328); other grants from European and Developing Countries Clinical Trials Partnership, Swiss National Science Foundation, Swiss Personalised Health Network, State Secretariat for Education, Research and Innovation, Innosuisse, Joint Programming Initiative on Antimicrobial Resistance, Novartis Foundation, and Bill and Melinda Gates Foundation; consulting fees from Shionogi, Global Antibiotic Research and Development Partnership, and bioM\u00e9rieux; payment or honoraria for lectures or presentations from bioM\u00e9rieux; and had unpaid leadership roles in other board, society, committee for SwissPedNet and Penta Foundation.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Given the nature of this study as a narrative literature synthesis, ethical approval was not required.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Ethics"}}]}}