Kangaroo care

Kangaroo care is a way of holding a preterm infant so that there is skin-to-skin

contact between the infant and the person holding it. The baby, wearing only a diaper, is
held against the parent's bare chest. Kangaroo care is typically practiced for two to three
hours per day, skin-to-skin, over an extended time period in early infancy. With babies
who are medically stable, there is no maximum duration for kangaroo care, some parents
may keep their babies in-arms for many hours per day.

In less developed countries high rates of low birth weight (LBW) are due to
preterm birth and impaired intrauterine growth, and their prevalence is decreasing slowly.
Since causes and determinants remain largely unknown, effective interventions are
limited. Moreover, modern technology is either not available or cannot be used properly,
often due to the shortage of skilled staff. Incubators, for instance, where available, are
often insufficient to meet local needs or are not adequately cleaned. Purchase of the
equipment and spare parts, maintenance and repairs are difficult and costly; the power
supply is intermittent, so the equipment does not work properly. Under such
circumstances good care of preterm and LBW babies is difficult: hypothermia and
nosocomial infections are frequent, aggravating the poor outcomes due to prematurity.
Frequently and often unnecessarily, incubators separate babies from their mothers,
depriving them of the necessary contact.

Unfortunately, there is no simple solution to this problem since the health of an

infant is closely linked to the mother’s health and the care she receives in pregnancy and
childbirth. For many small preterm infants, receiving prolonged medical care is
important. However, kangaroo care is an effective way to meet baby’s needs for warmth,
breastfeeding, protection from infection, stimulation, safety and love.

The label kangaroo care was chosen to describe this strategy because the method
is similar to how a kangaroo is carried by its mother. It is estimated that more than 200
neonatal intensive care units practice kangaroo care today compared to less than 70 in the
early 1990s. One recent survey found that 82 percent of neonatal intensive care units use
kangaroo care in the United States today.

Researchers have found that the close physical contact with the parent can help to
stabilize the preterm infant's heartbeat, temperature, and breathing. Preterm infants often
have difficulty coordinating their breathing and heart rate. Researchers also have found
that mothers who use kangaroo care often have more success with breastfeeding and
improve their milk supply. Further, researchers have found that preterm infants who
experience kangaroo care have longer periods of sleep, gain more weight, decrease their
crying, have longer periods of alertness, and earlier hospital discharge.

Kangaroo Care (also Kangaroo Maternal [Mother] Care or Skin-to-Skin Contact

and Breastfeeding) is a method used to restore the unique mother-infant bond following
the sudden separation during the birth experience particularly in premature births. It
consists of skin-to-skin contact, exclusive breastfeeding, and support for the mother-
infant pair (Kirsten, Bergman, & Hann, 2001).

Traditional hospital care of premature and small

newborns
In many western cultures, the birth process has become a medical procedure.
Once a baby is delivered, he or she is tended to by health professionals who provide
medical care for the baby apart from the mother and for the mother apart from her baby.
Often, infants are removed from the mother to be washed, weighed, measured, and
sometimes given artificial nourishment (London, Ladewig, Ball & Bindler, 2006). This is
physiologically and emotionally disruptive to a baby who has been securely positioned
for months in the womb, in constant contact with the mother and her familiar rhythms.

When the newborn is premature or a small size, there are additional concerns and
stressors. Neonatal intensive care nurseries (NICU) have developed to provide
specialized, direct care in an environment that is noisy and bright and totally unfamiliar.
Incubators with thermostats are used to keep the baby warm and visible. The people
around the new infant have foreign voices. The tempo is remarkably different from that
in utero and physiologically the newborn exhibits increased responses to the dramatic
change that has taken place. The neonatal attachment has been essentially interrupted.
Artificial temperature regulation, feeding, and lack of physical contact can have
significant deleterious effects on even normal, term newborns. For the premature infant,
the effects are compounded.

In an effort to reclaim the birthing process as a natural occurrence, the Mother-

Friendly Childbirth Initiative was developed to promote the mother-child relationship.
(see www.motherfriendly.org)

Description of kangaroo care

Kangaroo care seeks to provide restored closeness of the newborn with mother
and/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 mother's body responds to the needs of the
infant directly, helping regulate temperature more smoothly than an incubator, her milk
adjusts to the nutritional and immunological needs of her fragile infant, and the baby
sleeps more soundly.

Historical notes on kangaroo care

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 a NICU in Bogotá, Colombia, Dr. Edgar Rey 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 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, 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. (Charpak et al., 2005)

Indications for kangaroo care

Originally babies who were eligible for kangaroo care were pre-term infants, less
than 1500 grams, and breathing on their own. 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. (London, Ladewig, Ball & Bindler, 2006; Robles, 1995).

During the early 1990’s, 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. In developing countries, the advantages of kangaroo
care over other methods needs to be proven.

Method of managing kangaroo care

Typically in kangaroo care, the baby wears only a diaper and is tied in a head-up
position to the mother’s bare chest with a strip of cloth in a manner that extends the
baby’s head and neck to prevent apnea. The mother wears a shirt or hospital gown with
opening to the front. The cloth wraps around baby’s body and under the baby’s bottom to
create flexion.
 The tight bundling is enough for the mother’s breathing and chest movement to
stimulate the baby’s breathing. Because of the close confines of being attached to his
(her) mother’s chest, the baby is enclosed in a high carbon dioxide environment which
also stimulates breathing. Fathers can also use the skin-to-skin contact method.

Beginning kangaroo care 30 minutes to 2 hours after birth seems to be the most
effective time period for successful breastfeeding. Many advocates of natural birth
encourage immediate skin-to-skin contact between mother and baby after birth, with
minimal disruption. Babies must be kept warm and dry. This method can be used
continuously around the clock or for short periods per day gradually increasing as
tolerated for infants who are compromised by severe health problems. It can be started at
birth or within hours, days, or weeks after birth. Proponents of kangaroo care encourage
maintaining skin-to-skin contact method for about six weeks so that both baby and
mother are established in breastfeeding and have achieved physiological recovery from
the birth process. (Mohrbacher & Stock, 2003; London et al., 2006)

The practice of babywearing is used by many parents of both preterm and aterm
newborns to facilitate kangaroo care. A variety of slings and other carriers may be used,
some are designed specifically for neonates and the classic "upright between the breasts"
positioning, and some are intended for a wider variety of positions and ages.

Benefits of kangaroo care

For mothers

•Enhanced attachment and bonding ( Tessier et al., 1998)

•Increased milk volume, doubled rates of successful breastfeeding and

increased duration of breastfeeding(Mohrbacher & Stock, 2003)

•Physiologically her breasts respond to her infant’s thermal needs

(Ludington-Hoe et al., 2006)
 •Resilience and feelings of confidence, competence, and satisfaction
regarding baby care (Tessier et al., 1998; Conde-Agudelo, Diaz-
Rossello, & Belizan, 2003; Kirsten, Bergman, & Hann, 2001)

For preterm and low birth weight infants

•Stabilized temperature, heart rate, and respiratory rate (Ludington-Hoe et

al., 2005)

•Breast milk is readily available and accessible

•The maternal contact causes a calming effect with decreased stress and
rapid quiescence (McCain, Ludington-Hoe, Swinth, & Hadeed, 2005;
Charpak et el., 2005)

•Reduced physiologic and behavioural pain responses (Ludington-Hoe,

Hosseini, & Torowicz, 2005; Johnston et al., 2003)

•Increased weight gain (Charpak, Ruiz-Pelaez, & Figueroa, 2005)

•Enhanced mother-infant bonding (Dodd, 2005)

•Positive effects on infant’s cognitive development (Feldman, Eidelman,

Sirota, & Weller, 2002)

•Less nosocomial infection, severe illness, or lower respiratory tract

disease (Conde-Argudelo, Diaz-Rossello, & Belizan, 2003)

•Restful sleep (Ludington, Hosseini, & Torowicz, 2005);

•Earlier discharge (London et al., 2006)

•Possible reduced risk of sudden infant death (see www.infactcanada.ca)

•Normalized infant growth of premature infants (Charpak, Ruiz-Pelaez, &

 Figueroa, 2005)

•May be a good intervention for colic (Ellett, Bleah, & Parris, 2002)

•Possible positive effects in motor development of infants (Penalva &

Schwartzman, 2006).

For institutions

•Shorter hospital stay

•Advanced healthcare technology only used in addition to kangaroo care

•Different monitoring of infants

•More parental involvement, with greater opportunities for teaching and

assessing

•Better use of healthcare dollars (cost)

For the community

•Less morbidity and mortality especially in developing countries

•Opportunities for teaching during pregnancy and follow-up in preparation

for postnatal implementation

•Less drain on financial resources (more economic)

•Promotion of total family health.

Scientific findings
Research support has provided evidence that kangaroo care contributes to:

• Breastfeeding longer and more frequently

• Health and survival of premature infants

• Quiet alertness and deep sleep

• Less time in incubators

• Earlier discharge

• Less crying and distress

• Fewer illnesses

• Fewer readmissions to hospital.

There is evidence of:

• Better maternal milk supply

• Increased confidence of mothers

• Father’s participation and acceptance

• Empowerment.

Studies have illustrated a greater need for: follow-up research for use of kangaroo
care for infants with colic (Ellett, Bleah, & Parris, 2004); for increasing the perception of
support parents feel when unexpected set-backs occur (Tessier et al., 1998); for further
exploration of the effects of kangaroo care on preterm infants and on making
recommendations for kangaroo care routinely for low birth weight infants (Dodd, 2005);
clearly defining the effectiveness of the various components of the kangaroo care
intervention in different settings and for different therapeutic goals (Penalva &
Schwartzman, 2006).

Promotion of kangaroo care

Given the benefits of the kangaroo care method on mothers, babies, families,
hospitals, health care workers, and society, it is essential that it be promoted and
implemented on a wider scale in developed and developing countries (Kennell, 2006).
Further research and studies must be done to provide quality information for evidenced –
based practice in mother-infant care.

[edit] References
Charpak, N., Ruiz-Pelaz, J., & Figueroa, Z. (2005). Influence of feeding patterns
and other factors on early somatic growth of healthy, preterm infants in home-based
kangaroo mother care: A cohort study. Journal of Pediatric Gastroenterol Nutrition, 41
(4), 430-437.
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.
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.
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.
Ellett, M., Bleah, D., & Parris, S. (2004). Feasibility of using kangaroo (skin-to-
skin) care with colicky infants. Gastroenterol Nursing, 27 (1), 9-15.
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.
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.
 Kennell, J. (2006). Randomized controlled trial of skin-to-skin contact from birth
versus conventional incubator for physiological stabization in 1200 g to 2199 g
newborns. Acta Paediatric, 95 (1), 15-16.
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).
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)
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.
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.
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.
Mohrbacher, N., & Stock, J. (2003). The breastfeeding answer book. Schaumberg,
IL: LaLeche League International. (pp. 285-287)
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.
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.
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.

[edit] External links

•"Kangaroo Care Benefits" from Prematurity.org

•Kangaroo care

•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
Retrieved from http://en.wikipedia.org/wiki/Kangaroo_care

Summary

Kangaroo mother care is a method of care of preterm infants which involves

infants being carried, usually by the mother, with skin-to-skin contact. This guide is
intended for health professional responsible for the care of low-birth-weight and preterm
infants. Designed to be adapted to local conditions, it provides guidance on how to
organize services at the referral level and on what is needed to provide effective kangaroo
mother care.

The guide provides practical advice on when and how the Kangaroo Mother Care
(KMC) method can best be applied. It is intended for health professionals caring for low-
birth-weight and pre-term newborn babies in first referral hospitals with scarce resources.
It also provides decision-makers and planners at the national and local levels with
essential information for deciding on the appropriateness of KMC for their health system
and identifying what is required to implement it successfully.

Introduction (di awal)

Some 20 million low-birth-weight (LBW) babies are born each year, because of
either preterm birth or impaired prenatal growth, mostly in less developed countries.
They contribute substantially to a high rate of neonatal mortality whose frequency and
distribution correspond to those of poverty.1, 2 LBW and preterm birth are thus
associated with high neonatal and infant mortality and morbidity.3, 4 Of the estimated 4
million neonatal deaths, preterm and LBW babies represent more than a fifth.5 Therefore,
the care of such infants becomes a burden for health and social systems everywhere.

In affluent societies the main contributor to LBW is preterm birth. The rate has
been decreasing thanks to better socioeconomic conditions, lifestyles and nutrition,
resulting in healthier pregnancies, and to modern neonatal care technology and highly
specialised and skilled health workers.

In less developed countries high rates of LBW are due to preterm birth and
impaired intrauterine growth, and their prevalence is decreasing slowly. Since causes and
determinants remain largely unknown, effective interventions are limited. Moreover,
modern technology is either not available or cannot be used properly, often due to the
shortage of skilled staff. Incubators, for instance, where available, are often insufficient to
meet local needs or are not adequately cleaned. Purchase of the equipment and spare
parts, maintenance and repairs are difficult and costly; the power supply is intermittent,
so the equipment does not work properly. Under such circumstances good care of preterm
and LBW babies is difficult: hypothermia and nosocomial infections are frequent,
aggravating the poor outcomes due to prematurity. Frequently and often unnecessarily,
incubators separate babies from their mothers, depriving them of the necessary contact.

Unfortunately, there is no simple solution to this problem since the health of an

infant is closely linked to the mother’s health and the care she receives in pregnancy and
childbirth. For many small preterm infants, receiving prolonged medical care is
important. However, kangaroo mother care (KMC) is an effective way to meet baby’s
needs for warmth, breastfeeding, protection from infection, stimulation, safety and love.