KANGAROO MOTHER CARE
prepared by :
Lactation team
Objectives
• To know why kangaroo mother care
• Origins of KMC & How did it start.
• The positive effects of KMC
&advantages .
• Criteria of the baby ready for KMC.
• Requirements.
• Records and indicators.
• When to discharge the baby.
• Barriers to Kangaroo Care &how to
overcome it.
Introduction
Million of low-birth-weight (LBW) babies are born each
year, → either preterm birth or impaired prenatal growth
→ a high rate of neonatal mortality.
Especially In less developed countries where is effective
interventions are limited.
Under such circumstances good care of preterm and
LBW babies is difficult.
Cont. Introduction:
• Hypothermia ,and nosocomial infections are
frequent due to prematurity& low birth weight
and this is a part from the common reasons ( why
incubators separate babies from their mothers)
depriving them of the necessary contact.
• However, kangaroo mother care (KMC) is an
effective way to meet baby’s needs for warmth,
breastfeeding, protection from infection,
stimulation, safety and love.
History of KMC
It was first presented in Colombia, as an
alternative to inadequate and insufficient incubator
care for those preterm newborn infants and
required only to feed and grow.
Almost two decades of implementation and
research have made it clear that KMC is more than
an alternative to incubator care.
KANGAROO MOTHER CARE
– What is it? It is a form of parental care giving
where the newborn low birth weight or premature infant as
well as full-term is intermittently nursed skin-to-skin in a
vertical position between the mother’s breasts or against
the father’s chest for a non-specific period of time.
Research and experience show that:
KMC is at least equivalent to conventional care (incubators),
in terms of safety and thermal control, protection, if measured
by mortality KMC, by facilitating breastfeeding, offers
noticeable advantages in cases of severe morbidity.
KMC contributes to the humanization of neonatal care and to
better bonding between mother and baby in both low and high
income countries.
The positive effects of KMC :
The preterm infant has special needs in order to facilitate normal growth and development
(maintaining blood sugar, temp. Nutritional requirements, overcoming the mechanical obstacles
to feeding, skin to skin contact).
the earlier KMC is begun ;the greater the effect on
breastfeeding.→ exclusive BF(ideally)
Increasing immunity.
Maintaining physiological stability (Thermal control and metabolism
Heart and respiratory rates ,oxygen consumption, blood glucose.
sleep patterns and behavior observed in preterm/LBW infants held
skin-to-skin tend to be better
For instance, salivary cortisol,an indicator of possible stress, appears
to be lower in newborn infants held skin-to-skin.
(Bystrova et al. Nov. 20, 2002;)
So, it is a gentle effective method that avoids the agitation
experienced in a busy ward.
Cont. positive effects of KMC
Increased mother self confidence, self-esteem, and feeling of
fulfillment, also in high-income countries.
It is initiated in hospital & can be continued at home , so small
babies can be discharged early.
Facilitating parent-infant bonding
Lower recurrent costs is yet another advantage of KMC and could
bring some savings to hospitals
.
the earlier KMC is begun ;the greater the effect on
breastfeeding.
(KMC in labor ward)
Criteria of the baby ready for KMC:
Babies of 1.7kg& above
General condition is well & not NPO ready for B/F
NOT under phototherapy.
Stable not RDS
The baby no longer needs intensive medical care.
But simply warmth, protection from infections and
adequate feeding to ensure growth. KMC can be the
method of choice
KMC is, in this respect, a
modern method of care
in any setting, even
where expensive
technology and adequate
care are available.
Requirements:
The most important resources for KMC are:
1. The Mother
2.Supportive trained personal.
3.supportive environment.
4.Formulation of a policy.
I-Policy
Implementation of KMC and its protocol will
need to be facilitated by supportive health
authorities at all levels(hosp. director, the people
in charge for health care system, doctors & nurses
& midwives
Each health facility that implements KMC should,
in its turn, have a written policy and guidelines
adapted to the local situation and culture.
Developing Policy
The protocol should cover KMC with detailed
instructions on general problems (e.g. hygiene of
staff and mothers, prevention and treatment of
infection)
Monthly meetings and continuous research
updates for staff will be useful to
analyze data and problems, and to improve the
protocol if necessary.
local protocols based on international guidelines.
II-Staffing
KMC does not require any more staff than conventional
care, only they should have:
Adequate training in all aspects of KMC as:
1.When and how to initiate the KMC method;
2. How to position the baby between and during feeds;
3.Feeding LBW and preterm infants;
4. Breastfeeding;
5.Alternative feeding methods until breastfeeding becomes possible;
6. Involving the mother in most of aspects of her baby’s care, and
recognizing danger signs;
7.Ability to encourage and support the mother and the family.
Supportive trained staff
Staff awareness of KMC:
Staff must be familiar with current local cultural
practices, such as refusal to give colostrum or negative
attitudes towards LBW and preterm infants (“they are
ugly” or “they will not survive) and They should be
trained to discuss such practices and attitudes with the
mother and her family and find ways to overcome them .
III- Facilities, equipment and supplies
KMC does not require special facilities,
but simple arrangements can make the
mother’s stay more comfortable
Mother’s needs:
Two -bed rooms of reasonable size, where
mothers can stay day and night, The rooms
should be equipped with comfortable
chairs for the mothers with enough pillows
to help resting & sleeping.
Curtains can help to ensure privacy The
rooms should be kept warm for small
babies.
The support binder
This is the only special item needed for
KMC It helps mothers hold their babies
safely close to their chest
Place the baby between
the mother’s breasts in an
upright position, chest to
chest
The head, turned to one
side, in a slightly extended
position.
Secure him or her with
the binder
Tie the cloth firmly enough so
that when the mother stands up
the baby does not slide out.
Kangaroo position
The top of the binder is just
under baby’s ear, allows
eye to eye contact.
Duration
• Skin-to-skin contact continues for as long as
possible, first at the hospital, then at home.
It tends to be used until the baby reaches term or
2500g.
•Around that time the baby also outgrows the
need for KMC.
In this position: Mother free to socialize
Baby’s needs
Feeding babies
Mother’s milk is suited to baby’s needs, even if
birth occurred before term or the baby is small.
Mother’s milk should always be considered a
nutritional priority due to:
The biological uniqueness of the preterm milk,
which adjusts itself to the baby’s gestational age
and requirements so the optimal growth of the
preterm infants can occur typically to the growth
curve that they would have followed had they
remained in utero
Cont .Babies needs
(feeding babies)
Breastfeeding preterm babies is a special
challenge.
For the first few days a small baby may not be
able to take any oral feeds and may need to be
fed intravenously. During this period the baby
receives conventional care.
Babies who are less than 30 to 32 weeks
gestational age usually need to be fed through a
naso-gastric tube which can be used to give
expressed breast milk.
special support to mothers who breastfeed
multiple babies.
Baby’s needs
Baby does not need any more clothing than an
infant in conventional care
If KMC is not continuous, the baby can be placed
in a warm cot .
Other equipment and supplies
They are the same as for conventional care
Thermometer, scales.
Basic resuscitation equipment oxygen
should be available .
Caring for the baby in kangaroo position
Show the mother how to move the baby in and out of the binder
( As the mother gets familiar with this technique, her fear of hurting the baby
will disappear )
They need to be moved away from skin-to-skin contact
only for:
1. Changing diapers,
2. Hygiene and cord care.
3. Clinical assessment, according to hospital schedules or
when needed.
4. Daily bathing is not needed and is not recommended
5. During the day the mother carrying a baby in the KMC
position can do whatever she likes: she can walk,
stand, sit, or engage in different recreational and
educational activities.
Don’ts of KMC
• Don’t keep baby in horizontal position.
• Don’t bath till baby weighs 2500gms. Bathing can be
stressful for a premature baby and may even be
harmful .
(a jump in heart rate will lead to increase in demand
for oxygen by the heart, and a decrease in oxygen
saturation in premature babies ), Subcutaneous fat is
little, This fat is not enough to form a layer of
insulation for stopping heat loss, which aids in the
process of homeostasis.
• Don’t handle baby too frequently.
• Don’t give bottle feed.
• Don’t keep baby with sick people.
Monitoring baby’s condition
1. Temperature
2. Observing breathing and well-being
3. Reassure the mother that there is no danger if
the baby:
•Sneezes or has hiccups
•Passes soft stools after each feed;
• Does not pass stools for 2-3 days.
Monitoring growth
• Adequate daily weight gain from the second
week of life is15g/kg/day.
• Head circumference
• Measure head circumference weekly
(increase by between 0.5 and 1cm per week)
Stimulation
Records and indicators
For the baby hospital record:
• Each mother-baby pair needs a record sheet to note daily
observations , information about :
feeding and weight, and instructions for monitoring the
baby .
– When KMC began (date, weight and age);
– Details on duration and frequency of skin-to-skin
contact.
– Whether the mother is hospitalized or is coming from
home.
– Predominant feeding method observation on lactation.
– Daily weight gain. episodes of illness, or complications;
– The drugs baby is receiving;
– Details on discharge.
WHEN TO DISCHARGE THE BABY
• Once the baby is feeding well, maintaining stable body
temperature in KMC position and gaining weight.
• Mother is confident in caring for the baby, they can go
home.
• Regular follow-up by a skilled professional must be
ensured, For Example Appointment @ AAH
Outpatients Clinic .
• Mothers also need free access to health professionals for
any type of counseling and support related to the care of
their small babies.
,
EARLY DISCHARGE
To go home In this
position, Mother is
giving intensive
care and is able to
do so at home
much sooner
Barriers to Kangaroo Care
1.
2.
3.
4.
5.
6.
7.
8.
9.
Safety issues for very low birth weight infants.
Nurses’ feelings that their work load increased.
Nursing reluctance.
Medical staff reluctance.
Difficulty of administering care during KC.
Staff concerns for parental privacy.
Lack of experience with KC.
Insufficient time for family care during KC.
Belief that technology is better than KC.
How to over come these barriers:
1.Acting specifically on the UAE culture by ensuring
privacy of the mothers
2.Recommendations for education
Comprehensive education detailing the
benefits of KMC to the parents by Showing
them
Up to date evidence based information
supported by videos & leaflets showing the
KMC practice in the different areas of the
world.
Success depends on the good start !!!
The newborn may appear helpless, but displays an
impressive and purposeful motor activity which,
without maternal assistance brings the baby
to the nipple.
Early interpersonal events positively and
negatively impact the structural organization of
the brain So, we all can agree.
Success depends on a good start !!!
video
Successful experiences about KMC in Alain
hospital
B/O Ola (Roqa) preterm baby Gest.age= 33weeks
DOB: 19-9-2009
BW : 1700gms
Mother was not coming regularly from home but baby started on
EBM on his first feeds
Baby was on mixed feeding at the time when he was in the NICU.
After that mother started (rooming in) on 20/10/2009 ;baby was on
BF+EBM+F/M+KMC
On 2/11/2009 baby’s weight is 2830gms and mother is already
exclusively breastfeeding her baby.
Successful experiences about KMC in Alain hospital
B/O Samar
DOB:16/1/2010
BW :3.7 KG
On 20/1/2010 ,mother came to the pediatric clinic and the baby
lost 555 gms.baby’s weight was =3.145KG
Actually the pediatrician wanted to admit the baby but she saw the
mother has enough milk then she referred her to the lactation
team then the plan was ( proper BF technique + EBM& to be fed
by cup + KMC as much as parents can do.
On 21/1/2010 baby’s weight =3.405KG KMCdone by parents for
6 HRS approximately.
On 25/1/2010 baby’s weight was =3.630KG- KMC done for one
Hour only every day.
Thank you
References
1 Low birth weight. A tabulation of available information. Geneva, World
Health Organization, (WHO/
MCH/92.2).
3 Essential newborn care. Report of a Technical Working Group (Trieste
25-29 April 1994). Geneva, World
Health Organization, 1996 (WHO/FRH/MSM/96.13).
4 Ashworth A. Effects of intrauterine growth retardation on mortality and
morbidity in infants and
young children. European Journal of Clinical Nutrition, 1998,
52(Suppl.1):S34-S41; discussion:
S41-42..
12 Cattaneo A, et al. Recommendations for the implementation of
kangaroo mother care for low birth weight infants. Acta Paediatrica, 1998,
87:440-445
for preterm infants. Journal of Perinatology, 1991,.
References
10 Thermal control of the newborn: A practical guide. Maternal
Health and Safe Motherhood Programme.
Geneva, World Health Organization, 1993 (WHO/FHE/MSM/93.2).
11 Shiau SH, Anderson GC. Randomized controlled trial of
kangaroo care with fullterm infants: effects on maternal anxiety,
breast milk maturation, breast engorgement, and breast-feeding
status. Paper presented at the International Breastfeeding
Conference, Australia’s Breastfeeding Association,
Sydney, October 2325, 1997
13 Cattaneo A, et al. Kangaroo mother care in low-income countries.
Journal of Tropical Pediatrics, 1998,
44:279-282.
14 Bergman NJ, Jürisoo LA. The “kangaroo-method” for treating low
birth weight babies in a developingcountry. Tropical Doctor, 1994, 24:5760.
16 Anderson GC. Current knowledge about skin-to-skin (kangaroo) care
for preterm infants. Journal of Perinatology, 1991,.