INTRODUCTION:

Kangaroo Mother Care is one of the most promising ways to save preterm and low birth weight babies in high and low income setting alike. This form of care, initiated in hospitals involves teaching mothers and other care givers how to keep new born warn through continuous twenty-four hours per day, skin to skin contact on the mother’s chest. It is a special way of caring of low birth weight babies. It fosters their health and well being by promoting effective thermal control, breast feeding, infection prevention and bonding.¹

Historical notes on Kangaroo Care:

Not all areas in the world have resources to provide technical interventions and health care workers for premature and low weight babies. In 1978, due to increase in morbidity and mortality rate in the Instituto Materno Infantil NICU in Columbia, Dr. Edgar Rey Sanabria, Professor of Neonatology, introduced a method to alleviate the shortage of care givers 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 breast feeding as needed. This freedom overcrowded incubator space and care givers. 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 units that has babies up to 3 months of age.¹

Incidence:

In Africa, the estimated percentage of LBW infants for 1982 is 14.0%, 1% lowers than that for 1979. LBW contributes to 60% to 80% of all neonatal deaths. The global prevalence of LBW is 15.5%, which amounts to about 20 million LBW infants born each year, 96.5% of them in developing countries.²

Concept of Kangaroo Care:

For nine months of pregnancy, mother and foetus have been one entity. In the womb the baby is warm, fed and protected, and that is all it needs to develop. When it is newborn, it still needs to be warmed, fed and protected, and when placed skin-to-skin on mother’s chest, a newborn baby is in the one place where warmth, food and protection is best available. Human newborns are born very immature and in a way complete their gestation and development outside the womb, on mother’s chest. Kangaroo care consists of placing a diaper clad premature baby in an upright position on a mother’s/parent’s bare chest in between the breast. The baby’s head is turn so that the ear is above the parent’s heart. The parent may wear a shirt or hospital gown with an opening to front and a blanket over the wrap for the baby. The tight bundling is enough to stimulate the baby: vestibular stimulation from the mother’s breathing and chest movement, auditory stimulation from the mother’s voice and natural sounds of breathing and heart beat, touch by the skin of the mother and increase awareness and practice of Kangaroo care in NICUs, post partum, labor and delivery and any hospital units that has babies up to 3 months of age.³

Fig: Kangaroo Mother Care

Eligibility Criteria:

Originally babies who are eligible for Kangaroo care include pre term infants weighing less than 2500 gram, and breathing independently. Cardio pulmonary monitoring, oximetry, intra venous 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

Components of KMC:

a. Kangaroo Nutrition:

With KMC, most infants are either breast fed or fed expressed breast milk by cup or nasogastric tube. Infants in KMC position have easy access to their mothers’ breasts. With KMC, successful breast feeding is common and most infants are discharged home on breast feeds. The duration of the breast feeding is also much longer. With KMC may infants as immature as 30 weeks can begin breast feeding early. KMC increases the volume of milk that mother produces.

b. Kangaroo Support:

This is the physical and emotional support which is given when the KMC is practiced, i.e., support must be given by the nursing and medical staff to the mother to assist and encourage her to provide KMC. The family/partner support is helpful. The community should also be informed and educated about KMC from their antenatal visit.

c. Kangaroo Discharge:

With kangaroo discharge, the mother leaves the hospital with her infant in the kangaroo position continues to provide KMC at home. This practice has may advantages both to the mother and her infant. Most low birth weight infants can be discharged home earliest if KMC is used. By reducing the time that the small infant stay in hospital, hospital costs and staffing can be reduced. However, with early discharge (kangaroo discharge) adequate follow up care and support are essential.

Benefits of KMC:

1. Mimics the soothing environment of the womb:

The baby has just been in a safe, enclosed, and warm Environment. Wrapping a baby skin to skin mimics the familiar environment of the womb as the baby continues to receive touch, rhythm and pressure. Not only does the baby have a feeling of containment, but also the soothing and comforting sounds of his mother’s heart beat and breathing and rhythmic rocking that he was so accustomed to.

2. Regulates body temperature:

A mother has actual “thermal synchrony” with her infant. When a baby is placed in the kangaroo position, skin to skin with his mother, the temperature of the mother’s breasts actually change so that her baby can better maintain his own temperature.

3. Enhances lactation, the prevalence and duration of breastfeeding:

With easy access to the breast, mothers experience easier let down, increased milk supply. Mothers are more likely to breastfeed exclusively and have more success with prolonged nursing.

4. Enhances immunological protection:

If the mother is breastfeeding her baby, she will raise antibodies in response to all of the microbes that they come in contact with and transfer them to the baby. Some antibodies can even be transferred skin to skin. Touch is so important to the healthy development of an infant that a lack of touch, or separation of mother and newborn, actually causes high amounts of the toxic stress hormone cortisol to be released. High levels of cortisol in the blood and separation from mother may negatively impact immune function as the body may stop producing leukocytes.

5. Lessens crying:

Babies, both preterm and full-term, cry less when placed in skin to skin contact with their mothers. Decreased crying means less stress and subsequently lower levels of cortisol.

6. Enhances growth/weight gain:

High cortisol levels that result from mother baby separation have a negative impaction growth hormone. With mother present to help assist in regulating the baby’s breathing, heart rate, and temperature, the baby has decreased energy needs and can conserve his energy and calories, and direct it toward growth. In an upright prone position babies also regurgitate less.

7. Leads to shorter hospital stays:

Babies that are practicing Kangaroo Care can have up to a 50% shorter hospital stay than babies who are not “kangarooed”.

8. Provides a buffer against overstimulation:

In an upright prone position babies tolerate noise and activity around them much better.

9. Relieves stress reactions:

Babies deal with pain better and cry less in response to pain while Kangarooed.

10. Improves neurobehavioral:

Preterm babies that were given many hours of KMC in the early weeks after birth, compared to those given little or no care, scored higher on mental and motor development tests in the first year of life.

11. Increases oxygenation of the baby’s body.

12. Assists in bonding process and builds attachment:

increases maternal sensitivity, responsiveness and connectedness.

13. Builds parent confidence and competence:

Holding baby close reduces stress among parents and family. Kangaroo Mother Care empowers parents as they feel that they can do something incredibly Beneficial and positive for their preterm infants.

14. Helps parents play an active rather than passive role in their baby’s recovery.

15. Provides longer periods of restful sleep:

Kangaroo Care when carried out in a low light, quiet environment with any baby, full or preterm, helps babies to remain more calm and transition from one sleep state to another. Preterm babies were found to have spent more time sleeping during Kangaroo Care.

16. Saves lives:

The latest studies show a 51 percent reduction in newborn mortality when babies (stable and less than 2 kg) were kangarooed within the first week after birth and breastfed by their mothers.

17. It is safe:

Not one study has proven that it can hurt your baby.⁴

CONCLUSION:

Despite the emphasis of our society, on high tech medicines leading neonatal centers worldwide are embracing and promoting Kangaroo care. Doctors and nurses taking preemies out of the machine controlled warmth of the incubators and placing them confidently on their mother’s bare chest. Modern medicine is actually encouraging parents to play an active and powerful role in their babies’ recovery.⁵

REFERENCE:

1. Parul data. A textbook of pediatric nursing.2^nd edi. jaypee publisher.2002.

2. Available from http/google.com.

3. Charpak, N. “Kangaroo Mother Care: 25 years after,” 2005 Acta Pediatric, 94 (5), 514-522.

4. Ferber et al. “The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial,” 2004 Pediatrics 113: 858-865.

5. Furman, L. “Correlates of Lactation of Very Low Birth Weight Infants,” 2002 Pediatrics Vol. 109 (4) 57.

Received on 27.09.2015 Modified on 17.10.2015

Int. J. Nur. Edu. and Research 4(1): Jan.-Mar., 2016; Page 61-63

DOI: 10.5958/2454-2660.2016.00011.9