Kangaroo care

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A new mother holds her premature baby at Kapiolani Medical Center NICU in Honolulu, Hawaii

Kangaroo care is a technique practiced on newborn, usually preterm, infants wherein the infant is held, skin-to-skin, with an adult. Kangaroo care for pre-term infants may be restricted to a few hours per day, but if they are medically stable that time may be extended. Some parents may keep their babies in-arms for many hours per day. Kangaroo care, named for the similarity to how certain marsupials carry their young, was initially developed to care for preterm infants in areas where incubators are either unavailable or unreliable.

Description

Kangaroo care seeks to provide restored closeness of the newborn with mother or father by placing the infant in direct skin-to-skin contact with one of them. This ensures physiological and psychological warmth and bonding. The kangaroo position provides ready access to nourishment. The parent's stable body temperature helps to regulate the neonate's temperature more smoothly than an incubator, and allows for readily accessible breastfeeding.[1]

While this model of infant care is substantially different from the typical Western NICU procedures described here, the two are not mutually exclusive, and it is estimated that more than 200 neonatal intensive care units practice kangaroo care today. One recent survey found that 82 percent of neonatal intensive care units use kangaroo care in the United States today.

History

Not all areas in the world have resources to provide technical intervention and health care workers for premature and low weight babies. In 1978, due to increasing morbidity and mortality rates in the Instituto Materno Infantil NICU in Bogotá, Colombia, Dr. Edgar Rey Sanabria, Professor of Neonatology at Department of Paediatry - Universidad Nacional de Colombia, introduced a method to alleviate the shortage of caregivers and lack of resources. He suggested that mothers have continuous skin-to-skin contact with their low birth weight babies to keep them warm and to give exclusive breastfeeding as needed. This freed up overcrowded incubator space and care givers.

Another feature of kangaroo care was early discharge in the kangaroo position despite prematurity. It has proven successful in improving survival rates of premature and low birth weight newborns and in lowering the risks of nosocomial infection, severe illness, and lower respiratory tract disease (Conde-Agudelo, Diaz-Rossello, & Belizan, 2003). It also increased exclusive breast feeding and for a longer duration and improved maternal satisfaction and confidence.[2]

The International Kangaroo Care Awareness Day has been celebrated worldwide in May 15th since 2011. It is a day to increase awareness and practice of Kangaroo Care in NICUS, Post Partum, Labor and Delivery, and any hospital unit that has babies up to 3 months of age.

Eligibility criteria

Originally babies who are eligible for kangaroo care include pre-term infants weighing less than 1,500 grams (3.3 lb), and breathing independently. Cardiopulmonary monitoring, oximetry, supplemental oxygen or nasal (continuous positive airway pressure) ventilation, intravenous infusions, and monitor leads do not prevent kangaroo care. In fact, babies who are in kangaroo care tend to be less prone to apnea and bradycardia and have stabilization of oxygen needs.[3][4]

During the early 1990s, the concept was advocated in North America for premature babies in NICU and later for full term babies. Research has been done in developed countries but there is a lag in implementation of kangaroo care due to ready access of incubators and technology.

Techniques

In kangaroo care, the baby wears only a diaper and a hat and is placed in a flexed (fetal position) with maximal skin-to-skin contact on parent's chest. The baby is secured with a stretchy wrap that goes around the naked torso of the adult, providing the baby with proper support and positioning (maintain flexion), constant containment without pressure points or creases, and protecting from air drafts (thermoregulation). If it is cold, the parent may wear a shirt or hospital gown with an opening to the front and a blanket over the wrap for the baby.[5]

The tight bundling is enough to stimulate the baby: vestibular stimulation from the parent's breathing and chest movement, auditory stimulation from the parent's voice and natural sounds of breathing and the heartbeat, touch by the skin of the parent, the wrap, and the natural tendency to hold the baby. All this stimulation is important for the baby’s development.

"Birth Kangaroo Care" places the baby in kangaroo care with the mother within one minute after birth and up to the first feeding. The American Academy of Pediatrics recommends this practice, with minimal disruption for babies that don't require life support. The baby's head must be dried immediately after birth and then the baby is placed with a hat on the mother's chest. Measurements, etc. are performed after the first feeding. According to the US Institute of Kangaroo Care, healthy babies should maintain skin-to-skin contact method for about 3 months so that both baby and mother are established in breastfeeding and have achieved physiological recovery from the birth process.

For premature babies, this method can be used continuously around the clock or for sessions of no less than one hour in duration (the length of one full sleep cycle.) It can be started as soon as the baby is stabilized, so it may be at birth or within hours, days, or weeks after birth.

Kangaroo care is different to the practice of babywearing. In Kangaroo care, the adult and the baby are skin-to-skin and chest-to-chest, securing the position of the baby with a stretchy wrap, and it is practiced to provide developmental care to premature babies for 6 months and full term newborns for 3 months. In Babywearing the adult and the child are fully clothed, the child may be in the front or back of the adult, can be done with many different types of carriers and slings, and is commonly practiced with infants and toddlers.

Benefits

For Parents

Kangaroo care is beneficial for parents because it promotes attachment and bonding, improves parental confidence, and helps to promote increased milk production and breastfeeding success.[6][7][1][8][9]

For fathers

Both preterm and full term infants benefit from skin to skin contact for the first few weeks of life with the baby's father as well. The new baby is familiar with the father's voice and it is believed that contact with the father helps the infant to stabilize and promotes father to infant bonding. If the infant's mother had a caesarean birth, the father can hold their baby in skin-to-skin contact while the mother recovers from the anesthetic.[10]

For preterm and low birth weight infants

Kangaroo care arguably offers the most benefits for preterm and low birth weight infants, who experience more normalized temperature, heart rate, and respiratory rate,[11] increased weight gain,[2] fewer nosocomial infections and reduced incidence of respiratory tract disease.[8] Additionally, studies suggest that preterm infants who experience kangaroo care have improved cognitive development, decreased stress levels, reduced pain responses, normalized growth, and positive effects on motor development.[2][1][12][13][14][15] Kangaroo care also helps to improve sleep patterns of infants, and may be a good intervention for colic.[16] Earlier discharge from hospital is also a possible outcome [3] Finally, kangaroo care helps to promote frequent breastfeeding, and can enhance mother-infant bonding.[17]

Promotes more successful breastfeeding of full-term infants

Infant nursing shortly after birth

According to some authorities there is a growing body of evidence that suggests that early skin-to-skin contact of mother and baby stimulates breast feeding behavior in the baby. Newborn infants who are immediately placed on their mother’s skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of being born. It is thought that immediate skin-to-skin contact provides a form of imprinting that makes subsequent feeding significantly easier. The World Health Organization reports that in addition to more successful breastfeeding, skin-to-skin contact between a mother and her newborn baby immediately after delivery also reduces crying, improves mother to infant interaction, and keeps baby warm. According to studies quoted by UNICEF, babies have been observed to naturally follow a unique process which leads to a first breastfeed. After birth, babies who are placed skin to skin on their mothers chest will:

  • Initially babies cry briefly – a very distinctive birth cry
  • Then they will enter a stage of relaxation, recovering from the birth
  • Then the baby will start to wake up
  • Then begin to move, initially little movements, perhaps of the arms, shoulders and head
  • As these movements increase the baby will actually start to crawl towards the breast
  • Once the baby has found the breast and therefore the food source, there is a period of rest. Often this can be mistaken as the baby is not hungry or wanting to feed
  • After resting, the baby will explore and get familiar with the breast, perhaps by nuzzling, smelling and licking before attaching


Providing that there are no interruptions, all babies are said to follow this process and it is suggested that trying to rush the process or interruptions such as removing the baby to weigh or measure is counter-productive and may lead to problems at subsequent breastfeeds.[18]

For institutions

Kangaroo care often results in reduced hospital stays, reduced need for expensive healthcare technology, increased parental involvement and teaching opportunities, and better use of healthcare dollars.

For the community

Overall, kangaroo care helps to reduce morbidity and mortality, provides opportunities for teaching during postnatal follow-up visits, and decreases hospital-associated costs.

See also

References

  1. ↑ 1.0 1.1 1.2 Ludington-Hoe, S., Lewis, T., Morgan, K., Cong, X., Anderson, L., & Reese, S. (2006). Breast and infant temperatures with twins during shared kangaroo care. Journal of Ostetrics, Gynecologic, and Neonatal Nursing, 35 (2), 223-231.
  2. ↑ 2.0 2.1 2.2 Charpak, N., Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., & Worku, B. (2005). Kangaroo mother care: 25 years after. Acta Paediatric, 94 (5), 514-522.
  3. ↑ 3.0 3.1 London, M., Ladewig, P., Ball, J., & Bindler, R. (2006). Maternal and child nursing care (2nd ed.). Upper Saddle River, NJ: Pearson Prentice Hall. (p. 573, 791 - 793)
  4. ↑ Robles, M. (1995). Kangaroo care: The human incubator for the premature infant. University of Manitoba, Women’s Hospital in the Health Sciences Centre: Winnipeg, MN.
  5. ↑ "Skin-to-skin contact requires SAFE TECHNIQUE". Kangaroo Mother Care. Retrieved 30 April 2013. 
  6. ↑ Mohrbacher, N., & Stock, J. (2003). The breastfeeding answer book. Schaumburg, IL: LaLeche League International. (pp. 285-287)
  7. ↑ Tessier, R., Cristo, M., Velez, S., Giron, M., Figueroa de Calume, Z., Ruiz-Palaez, J., Charpak, Y., & Charpak, N. (1998). Kangaroo mother care and the bonding hypothesis. Pediatrics, 102 (2), e17-33.
  8. ↑ 8.0 8.1 Conde-Agudelo, A., Diaz-Rossello, J., & Belizan, J. (2003). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev, (2), CD002771.
  9. ↑ Kirsten, G., Bergman, N., & Hann, F. (2001). Part 2: The management of breastfeeding. Kangaroo mother care in the nursery. Pediatric Clinics of North America, 48 (2).
  10. ↑ "Fathers and skin-to-skin contact". Kangaroo Mother Care. Retrieved 30 April 2013. 
  11. ↑ Ludington-Hoe, S., Hosseini, R., & Torowicz, D. (2005). Skin-to-skin contact (kangaroo care) analgesia for preterm infant heel stick. AACN Clinical Issues, 16 (3), 373-387.
  12. ↑ Feldman, R., Eidelman, A., Sirota, L., & Weller, A. (2002). Comparison of skin-to-skin (kangaroo) and traditional care: Parenting outcomes and preterm development. Pediatrics, 110 (1), 16-26.
  13. ↑ McCain, G., Ludington-Hoe, S., Swinth, J., & Hadeed, A. (2005). Heart rate variability responses of a preterm infant to kangaroo care. Journal of Ostetrics, Gynecologic, and Neonatal Nursing, 34 (6), 689-694.
  14. ↑ Penalva, O., & Schwartzman, J. (2006). Descriptive study of the clinical and nutritional profile and follow-up of premature babies in a Kangaroo Mother Care Program. Journal of Peditrics, 82 (1), 33-39.
  15. ↑ Johnston, C., Stevens, B., Pinelli, J., Gibbins, S., Filion, F., Jack, A., Steele, S., Boyer, K., & Veilleux, A. (2003). Kangaroo care is effective in diminishing pain response in preterm neonates. Archives of Pediatrics and Adolescent Medicine, 157 (11), 1084-1088.
  16. ↑ Ellett, M., Bleah, D., & Parris, S. (2004). Feasibility of using kangaroo (skin-to-skin) care with colicky infants. Gastroenterol Nursing, 27 (1), 9-15.
  17. ↑ Dodd, V. (2005). Implications of kangaroo care for growth and development in preterm infants. Journal of Ostetrics, Gynecologic, and Neonatal Nursing, 34 (2), 218-232.
  18. ↑ "Skin to skin contact". The Baby Friendly Initiative. UNICEF United Kingdom. 2010. Retrieved 30 April 2013. 

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