Thermal Stability of Extremely Preterm Infants During Early Kangaroo Mother Care in the First 5 Days of Life

BACKGROUND: Extremely preterm infants are highly vulnerable to hypothermia because of immature thermoregulation and increased heat loss. Kangaroo mother care (KMC) is an evidence‐based intervention associated with improved thermal stability, but evidence in extremely preterm infants during the first days of life remains limited. PURPOSE: To evaluate axillary temperature 60 minutes after initiating KMC in infants <28 weeks' gestation during the first 5 days of life, analyze temperature trends across sessions, and identify factors associated with thermal stability. METHODS: This prospective observational study was conducted as a secondary analysis of a noninferiority randomized controlled trial. Seventy extremely preterm infants admitted to a Level IIIC Neonatal Intensive Care Unit were included. Axillary temperature was measured at 5 time points during each KMC session, with the primary outcome assessed at 60 minutes. RESULTS: Seventy infants (mean gestational age 26 weeks) participated in 285 KMC sessions during the first 5 days of life. Infants maintained normothermia, with a mean axillary temperature of 36.83°C at 60 minutes. Temperature stability followed a cubic trend over time, with no differences by session order. A slight temperature decrease occurred during the first session, whereas subsequent sessions showed temperature increases. Environmental variables were not associated with thermal stability. IMPLICATIONS FOR PRACTICE AND RESEARCH: Early KMC is safe and effective for maintaining thermal stability in extremely preterm infants, including those with central lines. Attention during return transfer is essential to minimize heat loss. Larger studies are needed to confirm these findings and optimize early KMC protocols.