Supplementary Material for: Impact of Kangaroo Care on Premature Infants’ Oxygenation: Systematic Review

Introduction: Kangaroo care (KC) is defined by the World Health Organization as a method of care consisting in putting premature infants or newborns in skin-to-skin contact with their parents. KC is an effective method of promoting health and well-being of infants and their families. Physiological stability during KC has been widely analyzed, however with controversial results. Methods: A systematic review was conducted. Electronic databases searched included MEDLINE, Embase, CINAHL, and Scopus. Two authors independently reviewed and extracted information using a data extraction form. The methodological quality of the observational studies was assessed using “STROBE” and the “Cochrane Collaboration tool” for randomized controlled trials. The physiological monitoring parameters included were heart rate (HR), arterial oxygen saturation (SpO2), regional cerebral oxygen saturation (rScO2), and fractional oxygen extraction (FtOE). Results: A total of 345 articles were identified. First, 302 articles were excluded by title and then 34 articles after full-text analysis. Finally, a total of 25 studies were included. Physiological parameters monitored (HR, SpO2, rScO2, and FtOE) showed no significant changes at different study periods: pre-KC, during KC, and post-KC. Conclusions: We conclude that stable preterm infants receiving or not respiratory support show no significant differences in HR, SpO2, FtOE during KC compared to routine incubator care. rScO2 remains stable during KC with slight upward trend. Further studies with a higher level of methodological quality are needed to confirm these findings.引言：袋鼠式护理（Kangaroo Care, KC）由世界卫生组织（World Health Organization, WHO）定义为一种将早产儿或新生儿与父母进行肌肤接触的护理方式。袋鼠式护理是促进婴儿及其家庭健康与福祉的有效手段。目前针对袋鼠式护理期间的生理稳定性已开展广泛分析，但相关研究结论尚存争议。 方法：本研究采用系统综述方法。检索的电子数据库涵盖MEDLINE、Embase、CINAHL及Scopus。由两名研究者独立完成文献筛选与信息提取工作，并采用统一的数据提取表进行信息采集。观察性研究的方法学质量采用STROBE声明进行评价，随机对照试验的方法学质量则采用Cochrane协作网偏倚风险评估工具进行评价。纳入的生理监测指标包括心率（heart rate, HR）、动脉血氧饱和度（arterial oxygen saturation, SpO2）、区域脑血氧饱和度（regional cerebral oxygen saturation, rScO2）及氧摄取分数（fractional oxygen extraction, FtOE）。 结果：本研究共检索到345篇文献。首先通过标题筛选排除302篇，随后经全文阅读排除34篇，最终纳入25项研究。监测的生理指标（HR、SpO2、rScO2及FtOE）在袋鼠式护理前、护理中及护理后三个不同研究阶段均未出现显著变化。 结论：本研究结果显示，无论是否接受呼吸支持，病情稳定的早产儿在接受袋鼠式护理期间，其HR、SpO2及FtOE水平与常规暖箱护理相比均无显著差异。rScO2在袋鼠式护理期间保持稳定，仅呈现轻微上升趋势。未来需开展方法学质量更高的研究以验证本研究结论。