State of the art and recommendations. Kangaroo Mother Care: application in a high-tech environment

Uppsala University, Uppsala, Sweden.
Acta Paediatrica (Impact Factor: 1.67). 03/2010; 99(6):812-9. DOI: 10.1111/j.1651-2227.2010.01794.x
Source: PubMed


Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent–infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents’ role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability.
Conclusion: Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.

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    • "Efforts should therefore be made to ensure that parents can remain in the NICU for as long as possible (including overnight stays) in accord with the UN Convention on the Rights of the Child [40]. By adhering to this convention, Kangaroo Mother Care could be facilitated in all types of settings [9] [11]. In our study, parents had access to their infants 24 h a day, but to minimize the feeling of liminality and to enhance parental involvement, parents need to feel that there is a space and place for them where they can bond with their infant without feeling supervised [5] [39] [41]. "
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    ABSTRACT: Objective To explore mothers' perceptions of Family Centred Care (FCC) in Neonatal Intensive Care Units (NICUs) in England. Design The qualitative experiences of 12 mothers from three NICUs in the UK were elicited using individual interviews. A Thematic Network Analysis was conducted on the transcribed interviews Main Outcome Measures A central global theme supported by a number of organizing themes were developed reflecting the views of the mothers and their experiences of FCC. Results A global theme of ‘Finding my Place’ was identified, supported by six organizing themes: Mothering in Limbo; Deference to the Experts; Anxious Surveillance; Muted Relations, Power Struggles and Consistently Inconsistent. Mothers experienced a state of liminality and were acutely sensitive to power struggles, awkward relationships and inconsistencies in care. To try to maintain their equilibrium and protect their baby they formed deferential relationships with health professionals and remained in a state of anxious surveillance. Conclusions This study illustrates that despite the rhetoric around the practice of FCC in NICU's, there was little in the mother's narratives to support this. It is of the utmost importance to minimise the consequences of the liminal experience, to improve staff-mother interactions and to facilitate mothers' opportunities to be primary caregivers.
    Full-text · Article · Oct 2014 · Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives
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    • "The current recommendations emphasize the implementation of SSC in high-tech neonatal intensive care as an integral part of modern family centered neonatal care [14]. However, two recent European surveys revealed substantial variation in the intensity and style of parental involvement and the provision of SSC between different countries [33] [34]. "
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    ABSTRACT: Skin-to-skin care (SSC) is widely used in neonatal intensive care units due to its positive effects on infant physiology and parent-infant interaction. We investigated the safety and the effect of SSC on the diaphragm electrical activity (EAdi) in premature infants recovering from respiratory distress syndrome treated on noninvasive neurally adjusted respiratory assist. An observational cross-over study design was used. The infants were evaluated during SSC and in both prone and supine positions before and after SSC during a 9-hour study period. The EAdi was measured via miniaturized sensors incorporated into a feeding tube. Seventeen premature infants with a mean age of 20d (range, 2-43d) were studied. Their mean birth weight was 900g (490-1845g) and mean gestational age at birth 28wk (25-32wk). Under each condition, EAdi peak (representing tidal, neural inspiratory effort) and EAdi minimum (representing neural expiratory activity) were numerically quantified. Oxygen saturation, heart rate, and apnea were recorded. The mean EAdi minimum values were lower during SSC and prone position. In addition, a tendency towards lower EAdi peak values was found during SSC. There were no differences in the occurrence of apnea between the study phases. SSC is safe and it is not associated with increased neural activity of the diaphragm. On the contrary, low EAdi minimum values were registered reflecting more complete diaphragmatic de-activation between respiratory cycles.
    Full-text · Article · May 2014 · Early human development
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    • "e l s e v i e r . c o m / l o c a t e / e a r l h u m d e v safe alternative to conventional bed or incubator neonatal intensive care and has been documented to decrease pain, has positive effects on infant sleep patterns and also improves parent–infant interactions [20] "
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    ABSTRACT: Background Skin-to-skin contact reduces pain response in preterm infants subjected to minor painful procedures, such as heel lance. Diaper change is a procedure performed several times daily in hospitalized preterm infants. Routine care giving tasks such as diaper change may be stressful for the infant. Aims The purpose of this study was to investigate whether diaper change induces stress and if skin-to-skin contact could reduce such stress, measured by changes in skin conductance. Study design This was a randomized crossover pilot study in 19 preterm infants with gestational age between 28 and 34 weeks. The diaper change procedure was done twice in each infant, once during skin-to-skin contact, and once in incubator or bed with the mother present. Outcome measures During diaper change heart rate (HR), peripheral oxygen saturation (SpO2), and changes in skin conductance (SC) peaks per sec, using the Skin Conductance Algesimeter (SCA), were registered. Results The mean SC peaks/sec increased/decreased significantly under/after change of diapers which thereby underpins that this is a stressful procedure for the preterm infant. Skin-to-skin contact (SSC) entails significantly lower stress levels (p < 0.05) compared to diaper changed in an incubator/bed measured by the SCA. Conclusions Diaper change is a stressful procedure for preterm infants and may be ameliorated by skin-to-skin contact.
    Full-text · Article · Apr 2014 · Early human development
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