**Background:** Kangaroo Mother Care (KMC) is an evidence-based intervention for premature and low-birth-weight (LBW) infants, comprising continuous skin-to-skin contact (kangaroo position), exclusive breastfeeding, and early discharge with close outpatient follow-up until 1 year corrected age (CA). In Colombia, outpatient KMC programs (KMCPs) have pioneered systematic follow-up of these high-risk newborns since 1994. This study provides the first comprehensive overview of KMCP outcomes over 28 years.
**Methods:** This descriptive cohort study included 57,154 premature or LBW infants discharged home in kangaroo position and followed in four KMCPs (Casita Canguro 1994–2001; San Ignacio University Hospital, San Jose Children’s University Hospital 2001–2021; Medellin KMCP 2008–2021). Data were collected from birth through 1 year CA using standardized forms and an electronic health record (KAREN). Outcomes included anthropometric measures, neurodevelopment (Griffiths test, INFANIB test), vision and hearing, hospitalization characteristics, exclusive breastfeeding, bronchopulmonary dysplasia (BPD), and mortality. Analyses were stratified by gestational age (GA) groups (≤32 weeks, 33–36 weeks, ≥37 weeks), time periods (5-year intervals, pre-COVID 2018–2019, COVID 2020–2021), and health insurance type (private, worker, government-subsidized).
**Key Results:** Median GA at birth was 34.5 weeks (range 23–43) and median birth weight 2000 g (470–4987 g). Median postnatal age at KMCP entry was 8 days (1–121), with median GA 36 weeks and weight 2200 g. Follow-up compliance to term was 83% (43,250/52,249); loss to follow-up from 40 weeks to 12 months was 15% (6993/45,483).
*Growth:* Harmonious growth (all anthropometric measures >−2 SD) improved from 56% (1993–1997) to 87% (2020–2021) at 40 weeks, and from 36% to 82% at 12 months. In the 33–36 week and ≥37 week groups, birth weights increased by up to 480 g, height by 2.8 cm, and head circumference by 1.4 cm in later periods. At 40 weeks, 6 months, and 12 months CA, weights were 490–767 g higher, length ~2 cm higher, and head circumference ~1 cm higher in recent years.
*Neurodevelopment:* Non-normal INFANIB evaluations at 3 months decreased from 18% (1993–1997) to 19% (2020–2021); at 12 months from 4.6% to 0.9% (2020–2021 data not shown). Griffiths DQ at 12 months declined from 103.3 (SD 9.8) in 1993–1997 to 94.8 (SD 11.3) in 2018–2019, attributed to inclusion of term LBW infants and scale change.
*Sensory disorders:* Hearing impairment fell from 7–8% to 1%. Retinopathy of prematurity (ROP) remained 3–8%; surgery needed in up to 1%; blindness max 0.3% (2003–2007) and min 0.03% (2018–2019).
*Hospitalization:* For ≤32 weeks GA, median NICU stay was 12 days (1993–1997) rising to 14 days (2020–2021); mechanical ventilation days decreased from 4 to 3. For 33–36 weeks, NICU stay fell from 11 to 4 days; ventilation from 3 to 1 day. Intraventricular hemorrhage decreased across all GA groups.
*Breastfeeding:* Exclusive breastfeeding at discharge for ≤32 weeks remained 34–42%; for 33–36 weeks 63–73%; for ≥37 weeks 70–83%. During COVID-19, exclusive breastfeeding at 6 months more than doubled: ≤32 weeks from 8% to 18%; 33–36 weeks from 14% to 32%; ≥37 weeks from 16% to 38%. Readmissions at 40 weeks fell from 7% to 1%; after 40 weeks to 12 months from 18% to 2%.
*BPD:* In Bogotá (2600 m altitude), oxygen dependency at KMCP entry ranged 15–43%; BPD at 40 weeks decreased from 20% (2008) to 6% (2020–2021). Infants with BPD had 5.3 times more ROP, 9.7 times more ROP surgery, 2 times more abnormal audiometry, and 3 times higher mortality at 12 months.
*Health insurance:* Government-subsidized insurance (GI) had 28% teenage mothers vs. 9% worker (WI) and 4% private (PI). DQ at 12 months was 92 (SD 14) for GI, 97 (SD 12) for WI, 95 (SD 11) for PI (ANOVA p<0.001). Cerebral palsy risk was 2.5% (GI) vs. 1.0% (PI) and 1.3% (WI). Mortality was 1.0% (GI), 1.4% (WI), 0.4% (PI).
*Early discharge <72 hours:* 19% (10,891) of infants were discharged <72 hours in kangaroo position. At 40 weeks, 72% received exclusive breastfeeding; at 12 months, 12% exclusive breastfeeding. Normal neurodevelopment at 12 months was 98%. Mortality RR vs. hospitalized kangaroo babies was 1.21 (95% CI 0.99–1.48, p=0.06).
**Clinical Implications:** KMCPs enable close monitoring of preterm/LBW infants, allowing early detection of growth faltering, neurodevelopmental delays, and sensory deficits. Improvements over time in growth, neurodevelopment, and reductions in BPD, hearing loss, and severe ROP reflect advances in perinatal care and KMC protocols. The COVID-19 pandemic highlighted the protective effect of home isolation and breastfeeding. Disparities by insurance type underscore the need for equitable access. Early discharge <72 hours is safe in selected infants. These findings support KMC as a cost-effective public health strategy for high-risk infants in LMICs and high-income settings.