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

Breastfeeding

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

.

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 unit

Neonatal intensive care unit

A Neonatal Intensive Care Unit —also called a Special Care Nursery, newborn intensive care unit, intensive care nursery , and special care baby unit —is an intensive care unit specializing in the care of ill or premature newborn infants.The problem of premature and congenitally ill infants is not a...

s 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

Low birth weight

Low birth weight is defined as a birth weight of a liveborn infant of less than 2,500 g. regardless of gestational age-Causes:LBW is either the result of preterm birth or of the infant being small for gestational age , or a combination of...

 babies to keep them warm and to give exclusive breastfeeding as they 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

Nosocomial infection

A nosocomial infection , also known as a hospital-acquired infection or HAI, is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff...

, 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.

Eligibility Criteria

Originally babies who are eligible for kangaroo care include pre-term infants weighing less than 1500 grams, and breathing independently. Cardiopulmonary monitoring, oximetry

Pulse oximetry

Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot....

, 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

Apnea

Apnea, apnoea, or apnœa is a term for suspension of external breathing. During apnea there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged...

 and bradycardia

Bradycardia

Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

 and have stabilization of oxygen needs.

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 vertical/"frog" position skin-to-skin to 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

Flexion

In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...

), 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 opening to the 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 the heartbeat, touch by the skin of the mother, the wrap, and her natural tendency to place the hands over the baby. All this stimulation is important for the baby’s development. Fathers can also use the skin-to-skin contact method.

"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

Babywearing

Babywearing is the practice of wearing or carrying a baby or child in a sling or other form of carrier. Babywearing is far from new and has been practised for centuries around the world...

. 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.

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

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, increased weight gain, fewer nosocomial infections and reduced incidence of respiratory tract disease 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. Kangaroo care also helps to improve sleep patterns of infants, and may be a good intervention for colic. Earlier discharge from hospital is also a possible outcome Finally, kangaroo care helps to promote frequent breastfeeding, and can enhance mother-infant bonding.

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.

External links

• "Kangaroo Care Benefits" from Prematurity.org
• http://www.infactcanada.ca
• http://www.kangaroomothercare.com/whatis01.htm
• http://www.asklenore.info/parenting/kangaroo/kangaroo1.html
• http://www.parentsinpartnership.ca/newsart14.html
• http://www.motherfriendly.org
• http://who.int./reproductive-health/publications/kmc/text.pdf
• http://home.mweb.co.za/to/torngren/eng-berg.html
• http://www.neonatosunal.150m.com/ (Spanish)
• Thepediatriccare.com – Article on Kangaroo Mother care information