Article

Thirty Years of Kangaroo Care Science and Practice

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Abstract

IS IT 30 YEARS ALREADY SINCE I RECEIVED my first issue of Neonatal Network: The Journal of Neonatal Nursing (NN)? How time does fly when you are having fun! NN was a newborn 30 years ago and now it is a fully mature, highly respected peer-reviewed professional journal indexed by every relevant database and available to every health professional. Every issue, then and now, has been happily anticipated and definitively rewarding, containing so many articles of interest about innovative and established practices in caring for newborns and their families. I salute the accomplishment of 30 years of this neonatal nursing publication. To celebrate NN's achievement, I was asked to reflect on how Kangaroo Care (KC) has evolved over the last 30 years and to enumerate evidence-based effects and practice changes. I have done so, and conclude with goals for the next 30 years of KC. Please understand that KC refers to maternal–infant, paternal–infant, and surrogate–infant (meaning a surrogate for the biologic parents and includes sibling, grandparent, adoptive parent, and so forth) skin-to-skin (chest-to-chest) care, not just maternal–infant contact. In addition, KC is defined as chest-to-chest, skin-to-skin contact because this ventral contact provides pleasing tactile stimulation of the C-afferent nerves,1,2 which produces release of oxytocin to modulate brain and systemic changes in both the infant and the KC provider.3,4 Most of the calming, physiologic improvements, growth, and recovery-enhancing effects of KC are caused by oxytocin influences in the brain.

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... There is also great variability in an individual's NICU experience. Health, family conditions, medical equipment usage, parental confidence, and restrictive hospital practices may prevent realization of the benefits of KC in the in-patient setting (Feeley, Genest, Niela-Vilen, Charbonnea, & Axelin, 2016;Ludington-Hoe, 2011). The presence of high-level healthcare technology in developed countries is a barrier for kangaroo implementation in addition to poor staffing ratios and difficulties with quantity of caregiver presence (Chan, Labar, Wall, & Atun, 2016). ...
... Though limited time is a reason why many nurses do not encourage KC, evidence shows that skin-to-skin contact stabilizes neonatal physiologic status and decreases crying (Ludington-Hoe, 2011). Insufficient traincontinued on next page ing about the benefits of KC is an important factor in why American hospitals have not fully adopted this standard of care (Ludington-Hoe, 2011). ...
... The benefits of skin-to-skin care and KC are well researched and documented (Nyqvist et al., 2010), but the inconsistent application of the research supporting skinto-skin and KC continues to be problematic (Kymre, 2014;Ludington-Hoe, 2011). Further research is anticipated to show babywearing to be an empowering and beneficial parenting practice for children and caregivers. ...
Article
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Benefits of kangaroo care have been well researched and documented. Despite the large volume of evidence to support various and long-term benefits to both caregivers and children, this intervention continues to be difficult to implement. Babywearing may have similar benefits as skin-to-skin care. This article will outline a plan to bring understanding to healthcare professionals and caregivers of the effects that babywearing can have on caregiver-child dyads after a Neonatal Intensive Care Unit hospitalization and how to best support babywearing as a therapeutic parenting practice.
... Kangaroo mother care (KMC) is a nursing method that promotes skin-to-skin contact to establish mother-child bonding and to meet the biological and psycho-emotional needs of newborns (1). Maternity-ward nurses are required to implement KMC given that it reduces neonatal mortality (2) and infection (3). ...
... Although numerous studies have focused on KMC practice in healthcare settings (1,6), research has neglected to focus on the perceptions and practice of KMC by maternity-ward nurse (4). Therefore, this study assessed the perceptions and practice of KMC by maternity-ward nurses. ...
... A high mean score indicated that the individual has a positive attitude towards KMC. Seven close-ended statements that required yes (1) or no (0) answers were used to ascertain the quality of KMC practices. The quality of KMC practices was scored by summing all scores. ...
Article
Background Successful implementation of KMC depends on the attitudes and practices of maternity‐ward nurses. This study assessed the attitudes and practices of kangaroo mother care (KMC) by maternity‐ward nurses in the Eastern Philippines. Methods A cross‐sectional survey design was used in the study. A convenience sample of 138 maternity‐ward nurses working in six rural health units (RHUs), two public hospitals and one private hospital. A questionnaire was used to assess the attitudes and practices of KMC by the recruited maternity‐ward nurses. Data were collected from June to July 2017 in maternity‐ward nurses’ workplace. Results Maternity‐ward nurses have a positive attitude towards KMC. Age is associated with attitudes towards KMC. Married maternity‐ward nurses have exhibit better attitudes and practice than single nurses. The attitudes of maternity‐ward nurses with master's degrees towards KMC are more positive than those with BSN degrees. Maternity‐ward nurses from Rural Health Units have better attitudes but fewer support to practice the KMC skills than those from public hospitals. Conclusions Maternity‐ward nurses who are married, hold master's degrees and are working in RHUs have better KMC attitudes than their counterparts. Maternity‐ward nurses have good KMC attitude but poor KMC practices. The KMC information and skills of maternity‐ward nurses should be continuously updated to implement KMC effectively and efficiently.
... Though kangaroo care (KC) has long been established as best practice for children and caregivers experiencing NICU stays (Nyqvist et al., 2010) there is great variability in the practice of KC in NICUs (Ludington-Hoe, 2011). Though the first study of kangaroo care appeared in English in 1990(Ludington-Hoe, 2011, nurses practicing in the NICU are verbally supportive but ambivalent in the practice of KC (Kymre, 2014). ...
... Though kangaroo care (KC) has long been established as best practice for children and caregivers experiencing NICU stays (Nyqvist et al., 2010) there is great variability in the practice of KC in NICUs (Ludington-Hoe, 2011). Though the first study of kangaroo care appeared in English in 1990(Ludington-Hoe, 2011, nurses practicing in the NICU are verbally supportive but ambivalent in the practice of KC (Kymre, 2014). There is also great variability in an individual's NICU experience. ...
... There is also great variability in an individual's NICU experience. Despite compelling evidence, health, family conditions, staffing, use of medical equipment, parental confidence, and hospital practices may prevent realization of the benefits of KC in the in-patient setting (Feeley, Genest, Niela-Vilen, Charbonnea, & Axelin, 2016;Ludington-Hoe, 2011). This study seeks a way to mitigate negative effects of NICU stays by promoting babywearing as an extension of kangaroo care after hospital discharge. ...
... Lack of agreement with the statement that certification increases salary has been reported before (Gaberson et al., 2003;Niebuhr & Biel, 2006;, but CKC nurses are even less recognized by a salary level increase than their colleagues, possibly because of the novelty, slowly emerging awareness of certification as a kangaroo caregiver, and the continuing process to achieve accreditation as CKC by the ANCC (2014a). The knowledge and use of KC by nurses is still developing (Athanasopoulou & Fox, 2014;Baylis et al., 2014;Bergh et al., 2014;Higman, Wallace, Law, Bartle, & Blake, 2015;Johnston et al., 2014;Ludington-Hoe, 2011), and demand for certification in the field is slowly increasing (USIKC, 2015a), so the perceived value of certification is not yet optimal among nursing leadership. One other value statement was of note: most CKC respondents agreed that certification "increases consumer ...
... The high number of certified KC nurses who perceived the value of increased consumer awareness is probably due to the fact that parents of neonates often review the experiences of KC with their nurses. Enhanced value of being a CKC will come from using the initials, as has begun in publications (Ludington-Hoe, 2011;Stikes & Barbier, 2013), and answering questions about what the initials mean and how the CKC certification was obtained. ...
Article
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Kangaroo care (KC), also known as skin-to-skin contact, saves lives, but fewer than 50% of newborns and mothers in U.S. hospitals receive KC because of lack of knowledge and skill competency. Because nurses can increase knowledge and skill competency through a certification course, the value of certification as a kangaroo caregiver and administrative incentives for certification as a kangaroo caregiver were evaluated in 71 neonatal intensive care and maternal–newborn unit nurses who completed an electronic questionnaire and the Perceived Value of Certification Tool. Nurses highly valued their KC certification, agreeing with 17 of 18 positive value statements. KC certification increased salary for a few, but institution-based incentives for KC certification are still limited and recognition of KC certification is needed.
... The practice impacts infant physiological stability, stress and sleep as well as maternal stress and parenting behaviour. SSC studies over the last 25 years [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] have collectively translated into a global acknowledgement that SSC is medically safe and significantly affects longer term neurodevelopmental cognitive, social and emotional outcomes. [16][17][18][19][20][21][22] Strengths and limitations of this study ▪ Identifies natural, emergent patterns of skin-to-skin care with extremely preterm infants to reflect authentic human engagement experiences. ...
... However, SSC patterns are evident in this population and potentially have an impact on early cognitive and communication performance. These findings are not new in that numerous studies [11][12][13][14][15][16][17][18][19][20][21][22] have been devoted to the short-term and long-term developmental benefits of SSC. What is initially novel about our findings is that we have found a High SSC participation was defined as having above the median participation for total SSC hours, mother SSC hours, father SSC hours and SSC intensity (see text for details). ...
Article
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Objectives The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. Design This was a retrospective cohort study. Setting This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. Participants Data were collected from the electronic medical records of all extremely preterm infants (gestational age <27 weeks) admitted to the unit during 2010–2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n=97). Outcome measures Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). Analysis Extracted data were analysed through a multistep process of logistic regressions, t-tests, χ² tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. Results Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score ≥80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p>0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30 weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. Conclusions This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance.
... This is a method that consists of holding the baby against the chest of the mother, by analogy with kangaroos, who hold their babies in their pouch. It involves skin-to-skin contact on the parent's bare chest, with the baby in an upright position, wearing only a diaper [148]. As such, it is a non-invasive, supportive, and natural early intervention for preterm babies that compensates for the negative effects of the physical separation of the mother from the baby when placed in an incubator. ...
Article
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Music listening or playing can create a feeling of connection with other listeners or performers, with distinctive levels of immersion and absorption. A major question, in this regard, is whether the music does have an ontological status, as an end in itself, or whether it is only a tool for the mediation of something else. In this paper we endorse a mediating perspective, with a focus on the music’s potential to increase affiliative bonding between listeners, performers and even the music. Music, then, is hypostasized as “something that touches us” and can be considered a partner of affiliative exchange. It has the potential to move us and to modulate the way we experience the space around us. We therefore elaborate on the tactile dimension of being moved, as well as on the distinction between personal, peripersonal, and extrapersonal space, with a corresponding distinction between first-person, second-person, and third-person perspectives on musical engagement.
... Parents participating in skin-toskin care report positive social-emotional responses, decreased perceived stress, increased parent-infant attachment, decreased post-partum depression, and increase breast milk production. 146,147 Evidence-based standards and procedures for holding and skin-to-skin care are carefully reported and described. 148,149 Research demonstrates that skin-to-skin care in infants with CHD in the pre-and post-operative periods is safe and beneficial. ...
Article
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Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
... Parents participating in skin-toskin care report positive social-emotional responses, decreased perceived stress, increased parent-infant attachment, decreased post-partum depression, and increase breast milk production. 146,147 Evidence-based standards and procedures for holding and skin-to-skin care are carefully reported and described. 148,149 Research demonstrates that skin-to-skin care in infants with CHD in the pre-and post-operative periods is safe and beneficial. ...
... The SSC group had a greater rate of sucking efficiency during the initial breastfeeding (p< 0.05) and could breastfeed more efficiently earlier (p <0.05). Therefore, early SSC improves nursing success in the first two hours after birth [27]. ...
Article
Background: Postpartum bleeding (PPB) and its clinical management (i.e., skin-to-skin contact and breastfeeding) are the essential parameters in which healthcare services are mandatory to promote maternal and fetal well-being. Aim: The researcher aims to investigate the broader perspectives regarding immediate skin-to-skin initial contact between baby and mother. Besides, breastfeeding significance would encourage the development of clinical outcomes' well-being. Across various institutions and globally, several integrative practices are established to promote and preserve maternal and fetal mortality and morbidity. Hence, comprehensive literature aimed to probe the cause-and-effect relationship association. Methods: The literature search was adopted using appropriate keywords and followed a standard scientific data search system. The search included PubMed and Google Scholar databases. All publications associated with immediate newborn care and bonding with mothers were the highlights of this paper. Results: The results indicate that newborn close bonding through skin-to-skin contact and breastfeeding are the cost-effective paradigm to prevent bleeding after delivery. It was also explored that the critical stages of the PPH are the transitional and fourth stages of labor.
... Bei sehr kleinen Säuglingen mit besonders kritischem Gesundheitszustand empfehlen die ExpertInnen nahezu einhellig, mit Haut-zu-Haut-Kontakt zu beginnen [27], [172], [320]- [322]. In zahlreichen Studien wurde nachgewiesen, dass dieser erste Entwicklungsschritt des Haut-zu-Haut-Kontaktes vielfältige physiologische Vorteile für Frühgeborene und ihre Mütter mit sich bringt und deshalb auf NICUs weltweit als Standard gelten sollte [323]. Es gibt auch Belege dafür, dass NICU-Keime beim Haut-zu-Haut-Kontakt vom Säugling auf die Haut und Atemwegsschleimhäute der Mutter übertragen werden, die daraufhin über das enteromammäre Sytem Antikörper gegen diese Keime bildet [18], [324]. ...
... Oksitosin annenin bebeği ile bağ kurmasına yardımcı olmakta, korku ve stres düzeylerini azaltmakta ve cildin hassasiyetini arttırmaktadır. Aynı zamanda oksitosin annenin sağlığını aktif olarak uyarmakta ve bebeği ile gelecekteki etkileşimlerini ve bağlarını kolaylaştırmaktadır 4,[12][13][14][15] ...
Article
Amaç: Bu araştırma, hemşire ve ebelerin anne ve yenidoğanın erken ten tene temas uygulamasına yönelik bilgileri ile tutumlarını incelemek amacıyla yapılmıştır.Yöntem: Bu tanımlayıcı araştırma, Ankara’da bir eğitim ve araştırma hastanesinde yürütülmüştür. Araştırmanın örneklemini Ekim 2020-Ocak 2021 tarihleri arasında araştırmayı kabul eden 117 hemşire ve ebe oluşturmuştur. Veriler, araştırmacı tarafından hazırlanan yapılandırılmış veri toplama formu ile “Anne-Yenidoğan Ten Tene Temas Ölçeği” aracılığıyla yüz yüze görüşme tekniği ve google forms üzerinden hazırlanan elektronik veri toplama formu kullanılarak toplanmıştır. Veriler, IBM SPSS Statistics 25.0 paket programı kullanılarak analiz edilmiştir. İstatistiksel olarak anlamlılık düzeyi p<0.05 olarak kabul edilmiştir.Bulgular: Katılımcıların Anne-Yenidoğan Ten Tene Temas Ölçeği’nden aldıkları toplam puan ortalaması 136.33±9.53’dür. Katılımcıların %95.7’sinin doğum sonrası dönemde anne ve yenidoğanın ten tene temas uygulamasını daha önceden duyduğu, %89.7’sinin anne ve yenidoğan ten tene temas becerisini doğru bir şekilde bildiği, %65.4’ünün anne ve yenidoğan ten tene temas uygulamasına yönelik bilgiyi hizmet içi eğitim programından aldığı belirlenmiştir. Katılımcıların %92.3’ünün doğum sonrası dönemde anne ve yenidoğanın ten tene temas becerisini uyguladığı belirlenmiştir. Katılımcıların yaş, meslek ve eğitim durumları açısından anne-yenidoğan ten tene temas ölçeğinden aldıkları puan ortancaları arasında anlamlı bir fark olmamasına rağmen ölçeğin bazı alt boyutları açısından katılımcıların eğitim düzeylerine ve çalıştıkları yerlere göre anneye sağlanan hizmet alt boyutu (p=0.002) ile etkinleştiren faktörler (p=0.03) alınan puanlar arasında istatistiksel olarak anlamlı bir farkın olduğu belirlenmiştir.Sonuç: Çalışmamıza katılan tüm ebe ve hemşirelerin anne ve yenidoğanın ten tene temas uygulaması ile ilgili olumlu tutumlarının olduğu, ebe ve hemşirelerin doğum sonu erken dönemde ten tene temasın anne ve yenidoğan sağlığı için bilgi ve farkındalık oluşturmalarının önemli olduğu değerlendirilmiştir.
... The World Health Organization (WHO) defined KMC as early, continued, and prolonged SSC with exclusive breastfeeding [2]. Routine implementation of SSC is encouraged because its beneficial effects on pre-and full-term infants and their mothers have been extensively studied and documented: physiological stability, improved cardiorespiratory function, reduced hypoglycemia, better thermoregulation, less pain, earlier breastfeeding initiation, and longer duration and exclusivity of breastfeeding [1,[3][4][5][6] as well as better sleep and brain maturation [1,[6][7][8]. Moreover, SSC supports the physiological and psychological status of the mothers. ...
Article
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Skin-to-skin, or chest-to-chest, contact (SSC) between newborns and their mothers is known as kangaroo mother care. The physiological and psychological benefits of SSC for infants and mothers are well established. The World Health Organization (WHO) recommends practicing SSC for term and preterm newborns. However, in Saudi Arabia, SSC is not practiced as widely as recommended. There is insufficient evidence of the nurses’ knowledge and attitudes regarding SSC in Saudi Arabia. The aims of this study were to describe and determine relationships between knowledge, education, beliefs/attitudes, and the implementation of SSC in Jeddah, Saudi Arabia. Thank You for Your Time and Kind Suggestion Methods: Cross-sectional descriptive data were collected from 40 nurses using an English-language version of a knowledge, beliefs/attitudes, education, and implementation questionnaire used by others. Results: The mean age of the nurses was 42.4 years (SD = 3.2), with a mean experience of 12 years (SD = 2.1). The mean total score of SSC knowledge was 13.6 (SD = 2.3), the mean of total score of attitudes/beliefs was 12.3 (SD = 3.1), the SSC education mean score was 17.1 (SD = 3.4), and the SSC implementation mean score was 17.0 (SD = 4.1). In total, 55% of the nurses were not sure of the impact of SSC on brain development in neonates, 45% could not interpret infants’ responses during SSC; 67% disagreed that it was the nurses’ responsibility to facilitate SSC, 37.5% were not aware of SSC guidelines, and 47% of the nurses had not received any continuing education on SSC in their units. Pearson correlations revealed a significant association between SSC implementation and nurses’ knowledge level (r = 0.297, p = 0.031), education (r = 0.85, p = 0.015), and beliefs (r = 0.31, p = 0.024). Conclusions: Once nurses have improved their knowledge, education, and beliefs/attitudes, SSC implementation may concomitantly increase. A continuing education program and clear guidelines are needed to promote SSC adoption in practice.
... [5][6][7][8][9][10][11] Physiologic stability has been documented during interfacility transport in KMC. 12 These studies on the physiologic effects of KMC have included very small (<1000 grams), very preterm (<28 weeks GA, ≤30 weeks postmenstrual age when studied), and very sick infants, as well as more mature, older, and relatively stable preterm infants. [13][14][15][16] These studies showed that the physiological effects of KMC, for most variables, were better or similar to other premature infants under different forms of care. However, body temperature and weight gain significantly increased. ...
Article
Background. Kangaroo Mother Care (KMC) is the standard of care for stable low birth weight infants. Provision of KMC to intubated preterm infants may also be beneficial, but strong evidence is still lacking. Objective. To determine the effectiveness of KMC in decreasing mortality among intubated preterm neonates. Study Design. This is a non-blinded, parallel, non-inferiority randomized controlled trial. Methodology. All intubated, preterm admissions, 28-36 weeks gestation, weighing 600-2000 grams, with respiratory distress were included. They were randomized to the intervention group who received KMC for 2-4 hours daily while intubated and the control group who received care inside an incubator. Participants’ physiologic status – before, during, and after the intervention – was recorded. The primary outcome was mortality. Secondary outcomes included comorbidities, days intubated, and hospital stay. Results. There was a total of 32 patients. The risk of dying in the KMC group (n=16) was significantly reduced by 78% (RR 0.22; 95% CI 0.06 - 0.87 p=0.009). The KMC patients were also less likely to have hypothermia, nosocomial pneumonia, NEC, and late-onset neonatal sepsis (p<0.05). The KMC group had higher blood sugar levels (110 vs. 58, p=0.001) and required fewer days of intubation (3.5 vs.1.5 days, p<0.000) compared to the control group. There was no difference in the duration of the hospital stay. Conclusion. KMC is effective in decreasing mortality among intubated preterm neonates. Other comorbidities and days of intubation were also reduced.
... -Temprano: el recién nacido se estabiliza fácilmente e inicia casi desde el nacimiento 7 . El MMC repercute eficazmente en el control de la temperatura, la lactancia materna y el desarrollo de vínculos afectivos referidos a todos los neonatos, al margen de su entorno, peso, edad gestacional y situación clínica 8 . Los autores del MMC encontraron entre sus beneficios: -Contacto piel a piel temprana, continua y prolongada entre la madre y el neonato. ...
Article
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El bajo peso al nacer es un problema de salud pública en todo el mundo y se relaciona con una serie de consecuencias a corto y largo plazos. La técnica de madre canguro consiste en el manejo del recién nacidos de bajo peso al nacer o prematuros, basado en una triada consistente en calor, amor y leche materna. Objetivo: Determinar la diferencia en el incremento ponderal en recién nacidos de pretérmino y con peso bajo al nacimiento con método de madre canguro o la incubadora en pacientes hospitalizados en el Hospital Materno Perinatal “Mónica Pretelini Sáenz” de julio de 2017 a junio de 2018. Material y métodos: Se incluyó a 85 pacientes, en 45 de los cuales se aplicó la técnica de madre canguro y en 40 la atención con incubadora y se comparó el incremento de peso entre ambos. Resultados: Se confirmó que el 60% en el grupo de madre canguro alcanza el objetivo en tan sólo 10 días, mientras que el grupo de la incubadora lo hace en 20 días. Conclusión: Con la técnica de madre canguro el tiempo (días) para conseguir el peso objetivo de 1800 g es menor, ya que en el grupo de incubadora fue de 13.95 ± 9.09 días, en tanto que el grupo de madre canguro fue de 6.47 ± 3.20 días; se concluyó que, en promedio, el grupo de incubadora requiere el doble de tiempo que el grupo de madre canguro.
... SSC is defined as the process of holding a diaper-clad infant in an upright position on the chest of the mother while at the same time maintaining skin-to-skin contact. The infant must be covered to maintain an optimal temperature and prevent respiratory ailments [75,76]. Saxton, Fahy, and Hastie described the process of SSC as follows: ...
Article
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The aim of this paper was to summarize the existing literature regarding postpartum hemorrhage (PPH) and its physiological management (i.e., skin-to-skin contact and breastfeeding). The background surrounding PPH and the role of skin-to-skin contact (SSC) and breastfeeding (BF) in PPH are identified, and these interventions are supported as a crucial means of preventing or minimizing the incidence of PPH. Despite its importance, to the best of my knowledge, an evaluation of this relationship has not yet been undertaken. The narrative literature review approach was used to summarize topic related researches. The search included three databases: CINAHL, PubMed, and Google Scholar. All articles related to the role of SSC and BF in PPH were chosen from the different databases. The findings demonstrate that SSC and BF are cost-effective methods that could be considered practices for the prevention of PPH. Immediate Skin-to-skin contact (SSC) and breastfeeding (BF) are central mediators of the psychophysiological process during the first hour after delivery (the third and fourth stages of labor).
... KC, if practiced, is most often implemented intermittently, for a limited time period when the infant is considered stable, on average for one to 2 h at a time [24]. Despite the strong evidence for positive infant, maternal, and family outcomes and recommendations for the widespread adoption of KC internationally, the integration of continuous KC into the care of preterm infants remains extremely variable [25,26]. ...
Article
Full-text available
Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.
... 1,[7][8][9] However, within published literature, the terms "KMC," "KC," and "skin-to-skin care" are used interchangeably whether the holding is occurring intermittently or continuously. The literature 2 Fluharty et al will also allow interventions that target optimization of KC to be developed. Literature addressing KC implementation has primarily focused on the barriers and facilitators 16,[20][21][22][23][24][25][26][27][28] to practice. ...
Article
Background: Kangaroo care (KC) is recommended for infants during their stay in the neonatal intensive care unit (NICU) due to the benefits to infant growth, stabilized vital signs, and parental bonding; however, literature primarily explores the physiologic benefits, barriers, and facilitators to KC practice. Little is known about the context and mechanisms of KC implementation. Purpose: This realist review is to explore what NICU policies tell us about practices to implement KC in the NICU. Methods: Policies were obtained via email, database, and search engines. Criteria were established to review each policy. Data were entered into a database then exported for frequency counts of identified characteristics. Results: Fifty-one policies were reviewed, which revealed inconsistencies in the implementation of KC practices. Inconsistencies include variability in infant postmenstrual ages and weight criteria, infant medical equipment in place during participation, duration and frequency of KC, KC documentation, and ongoing monitoring requirements. Implications for practice: KC implementation varies widely across NICUs, even with similar infant populations. Exclusion of some infants from receiving KC may decrease the potential beneficial outcomes known to result from KC. Implications for research: More research to understand KC best practice recommendations and implementation in the NICU is needed. Studies are needed to evaluate the duration and frequency of KC, as well as the benefits to infants and families to optimize KC in the NICU setting.
... However, few researchers have examined the effects of SSC for mothers of infants with cCHD, and few have investigated the effect of SSC using maternal biological markers. Although the mental health benefits are well documented for mothers of premature and healthy full-term infants (Bigelow et al., 2012;Holditch-Davis et al., 2014;Ludington-Hoe, 2011;Moore et al., 2016), research is critically needed to determine whether SSC mitigates stress and supports attachment and mental health of mothers during their infants' hospitalizations for neonatal cardiac surgery. ...
Article
Objective To estimate the effect of skin-to-skin contact (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants’ neonatal cardiac surgery. Design A prospective interventional, baseline response–paired pilot study. Setting Cardiac center of a large, metropolitan, freestanding children’s hospital. Participants Thirty women whose infants were hospitalized for neonatal cardiac surgery. Methods Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal–infant attachment, as indicated by self-reported scores and maternal salivary oxytocin. Conclusion Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.
... Nearly all experts propose a pathway that starts with skin-to-skin care for the smallest, sickest infants [27], [172], [320]- [322]. Multiple studies have demonstrated that the first developmental stageskin-to-skin carehas many physiologic advantages for premature infants and their mothers and should be standard of care in NICUs worldwide [323]. There is evidence to suggest that during skin-to-skin care the infant transfers NICU microbes to the mother's skin and respiratory surfaces, after which antibodies to these organisms are produced by the mother via the entero-mammary pathway [18], [324]. ...
... Skin-toskin care (SSC) is a specific form of holding where the mother holds the unclothed, diapered infant directly to her chest. SSC is well-documented as a low-cost, low-risk, and high-impact intervention for both premature and full-term infants (14)(15)(16). Improved outcomes include decreases in pain, mortality, infection, and hospital length of stay, as well as better temperature regulation, brain development, and long-term developmental outcomes (17)(18)(19)(20)(21). Also observed is an associated reduction in levels of cortisol during-SSC for premature infants (22,23). ...
Article
Objectives: To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. Design: A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). Setting: Cardiac ICU and step-down unit in a large metropolitan freestanding children's hospital. Subjects: Convenience sample of 30 infants admitted preoperatively for critical congenital heart disease. Interventions: Eligible infants were placed into skin-to-skin care for 1 hour with their biological mothers once each at T1 and T2. Measurements and main results: Measurements of stress (salivary cortisol), pain and behavior state (COMFORT scale), and physiologic stability (vital signs) were assessed immediately before skin-to-skin care, 30 minutes into skin-to-skin care, and 30 minutes after skin-to-skin care ended. At both T1 and T2, infant pain scores were significantly decreased (p < 0.0001) and infants moved into a calmer behavior state (p < 0.0001) during skin-to-skin care as compared to baseline. At T1, infants also had significantly reduced heart rate (p = 0.002) and respiratory rate (p < 0.0001) and increased systolic blood pressure (p = 0.033) during skin-to-skin care. At both T1 and T2, infant cortisol remained stable and unchanged from pre-skin-to-skin care to during skin-to-skin care (p = 0.096 and p = 0.356, respectively), and significantly increased from during skin-to-skin care to post-skin-to-skin care (p = 0.001 and p = 0.023, respectively). Exploratory analysis revealed differences in cortisol reactivity for infants with higher baseline cortisol (> 0.3 μg/dL) versus lower (≤ 0.3 μg/dL) prior to skin-to-skin care. Infants with higher baseline cortisol at T2 experienced significantly reduced cortisol during skin-to-skin care (p = 0.025). No significant differences in demographics or baseline variables were found between infants in either group. Conclusions: Skin-to-skin care is a low-cost, low-risk intervention that promotes comfort and supports physiologic stability in infants before and after neonatal cardiac surgery.
... Neonatal units perform StS with different modalities (eg duration), and there is ongoing debate about the impact of its duration on neonatal physiology [14]. However, bonding is recommended for at least 60 min, especially with preterm infant, as this timing also allows a complete sleep cycle [15,16]. ...
Article
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Background: Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. Method: An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. Results: A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p < 0.0001), delayed cord clamping practice > 60″ (48.1% vs 68.1%, respectively, p < 0.0001) and skin-to-skin practice > 60' (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83-0.94), p < 0.0001) and maternal temperature (OR 0.57 (CI 95% 0.48-0.67), p < 0.0001). Conclusion: Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth.
... For effective KMC, it is essential to consider the timing and duration of each SSC session. The length of each SSC session varies from a few minutes to hours; however, for optimal benefits, research recommends a minimum of 60 min of continuous SSC (Ludington-Hoe, 2011). In some Jordanian hospitals, nurses carry out intermittent SSC (defined as the practice of SSC alternated with conventional care) immediately after birth and for a short duration of only half an hour (Sweidan, Mahfoud, & Dejong, 2008). ...
Article
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The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross‐sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants.
... Researchers have confirmed significant benefits without any harmful side effects identified. 3,7,9,25,32 SSC is an excellent intervention that reduces infant medical trauma and aligns with the five core measures for TIAAC in the NICU. 1,2 SSC is an evidence-based care strategy that decreases the toxic stress experience associated with parental separation. ...
Article
Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant’s traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant’s traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.
... Skin-to-skin contact protects infants from nosocomial infection, supports growth, and promotes temperature stability for infants requiring an artificial heat source in the preoperative or postoperative period. [78][79][80] ...
Article
Background: Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD. Purpose: The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU. Conclusions: The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives. Clinical implications: The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.
... Bu nedenle anne ile kanguru bakımın yapılamadığı durumlarda baba ve bebek arasında KB yapılması KB, hastanede verilen bakımı tamamlama, anne-babalık rolüne erken geçme, ebeveynlerin bebeklerine bakım vermede güven duygusunda gelişme, ebeveynlik rolünü daha iyi algılama, bebeklerini daha az anormal algılama, bebek işaretlerine karşı artan ebeveyn duyarlılığı, bebeklerin ihtiyaçlarını karşılamada daha fazla bileşene sahip olma ve bebeklerle pozitif sosyal etkileşim sağlamada etkilidir. KB'nin daha fazla aile bağı, baba için daha olumlu bağlanma davranışı, stresi ve depresyonu azaltmayı içeren yararları bildirilmiştir(12,13,29,30). Yapılan çalışmalarda anneler kadar babalar da KB'nin etkilerini genellikle olumlu olarak bildirmişlerdir. ...
Article
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Would kangaroo care between father and baby be an alternative practice for caesarean deliveries? Kangaroo care is a practice assisting the interaction between parents and infants and; facilitates the adaptation of the newborn to the external environment. The baby and mother interaction begins usually late in caesarean delivery compared to vaginal delivery due to maternal and infantile issues. Therefore, it may be declared that applying kangaroo care between father and baby until routine post-delivery care of mother is completed in caesarean delivery, contributes to reducing problems of the newborn that might face during early period of life shortly after delivery and influencing the father positively for his role of parenthood. In this review, we aimed to give information about the effects of kangaroo care on father and newborn that is implemented between them followed by caesarean delivery. Keywords: Kangaroo care, skin-to-skin contact, father-infant interaction, process after ceasarean
... Our study showed that infants received skin-to-skin contact by their mothers (13 min daily on average) and fathers (1 min daily on average), direct breastfeeding from their mothers (4 min daily on average). The amount of skin-to-skin contact provided from both mother and father seemed insufficient to meet preterm infants' needs [33] and direct breastfeeding contact was also poor for the these infants [34]. These low daily averages could be related to the fact that our data were collected during the first four weeks of life when these very preterm infants are very immature and less stable and may not be ready for these interventions. ...
Article
Background: Vulnerable preterm infants experience repeated and prolonged pain/stress stimulation during a critical period in their development while in the neonatal intensive care unit (NICU). The contribution of cumulative pain/stressors to altered neurodevelopment remains unclear. The study purpose was to investigate the impact of early life painful/stressful experiences on neurobehavioral outcomes of preterm infants in the NICU. Methods: A prospective exploratory study was conducted with fifty preterm infants (28 0/7-32 6/7weeks gestational age) recruited at birth and followed for four weeks. Cumulative pain/stressors (NICU Infant Stressor Scale) were measured daily and neurodevelopmental outcomes (NICU Network Neurobehavioral Scale) were examined at 36-37weeks post-menstrual age. Data analyses were conducted on the distribution of pain/stressors experienced over time and the linkages among pain/stressors and neurobehavioral outcomes. Results: Preterm infants experienced a high degree of pain/stressors in the NICU, both in numbers of daily acute events (22.97?2.30 procedures) and cumulative times of chronic/stressful exposure (42.59?15.02h). Both acute and chronic pain/stress experienced during early life significantly contributed to the neurobehavioral outcomes, particularly in stress/abstinence (p<0.05) and habituation responses (p<0.01), meanwhile, direct breastfeeding and skin-to-skin holding were also significantly associated with habituation (p<0.01-0.05). Conclusion: Understanding mechanisms by which early life experience alters neurodevelopment will assist clinicians in developing targeted neuroprotective strategies and individualized interventions to improve infant developmental outcomes.
Article
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The metaphor of being touched by music is widespread and almost universal. The tactile experience, moreover, has received growing interest in recent years. There is, however, a need to go beyond a mere metaphorical use of the term, by positioning the tactile experience within the broader frame of embodied cognition and the experiential turn in cognitive science. This article explores the possible contribution of a science of touch by defining music as a vibrational phenomenon that affects the body and the senses. It takes as a starting point the clinical findings on the psychological and physiological value of tender touch with a special focus on the method of kangaroo mother care, which is a method for holding the baby against the chest of the mother, skin-to-skin. It is seen as one of the most basic affiliative bondings with stimuli that elicit reward. Via an extensive review of the research literature, it is questioned as to what extent this rationale can be translated to the realm of music. There are, in fact, many analogies, but a comprehensive theoretical framework is still lacking. This article aims at providing at least some preparatory groundwork to fuel more theorizing about listening and its relation to the sense of touch.
Preprint
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The metaphor of being touched by music is widespread and almost universal. The tactile experience, moreover, has received growing interest in recent years. There is, however, a need to go beyond a mere metaphorical use of the term, by positioning the tactile experience within the broader frame of embodied cognition and the experiential turn in cognitive science. This article explores the possible contribution of a science of touch by defining music as a vibrational art that impinges upon the body and the senses. It takes as a starting point the clinical findings on the psychological and physiological value of tender touch with a special focus on the method of kangaroo mother care, which is a method for holding the baby against the chest of the mother, skin-to-skin. It is seen as one of the most basic affiliative bonding with stimuli that elicit reward. Via an extensive review of the research literature, it is questioned to what extent this rationale can be translated to the realm of music. There are, in fact, many analogies, but a comprehensive theoretical framework is still lacking. This article aims at providing at least some preparatory groundwork to fuel more theorizing about listening and its relation to the sense of touch.
Article
Neonatal hyperbilirubinemia (NNH) is a common morbidity in the neonatal period, especially in the preterm and low-birth-weight babies. Low-birth-weight babies receiving phototherapy do not receive kangaroo mother care (KMC), which may hamper their weight gain and establishment of breast-feeding. The authors investigated the effect of KMC on duration of phototherapy in neonates admitted to a level III nursery with neonatal hyperbilirubinemia. Fifty neonates with gestational age of 30 to 40 wk, birth weight 1001-1999 g, and requiring phototherapy were randomized. Control group received phototherapy in a conventional manner. The intervention group received KMC for 1 h every 8 hourly. The mean (± SD) of total duration of phototherapy required in control group and in KMC group was 39.12 ± 15.3 and 19.44 ± 6.54 h, respectively and this difference was statistically significant.
Article
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Objective:The study was conducted at Sakarya University Hospital Obstetrics Clinic, in Sakarya Province, in Turkey, from January 2019 to February 2019, as a simple randomized (1: 1), experimental, and prospective study. It was aimed to evaluate effect of skin-to-skin contact (SSC) on physiological parameters, pain-stress level of newborn and anxiety level of mother during this stage.Method:In the study, 34 of 68 healthy term newborns were included control group, 34 of them were intervention group. Control group, no other intervention was done except routine applications to evaluate anxiety level of mothers. Intervention group, SSC with mother was ensured while drawing blood from heel and pain-stress level of newborn and its effect on level of anxiety of mother were studied.Results:When the results of ALPS-NEO Pain Scale were compared between groups, It was found that effect of SSC during heel lance on pain-stress level of newborns in intervention group was significantly lower than control group.Conclusion:As a result, SSC application can be used as a supportive method during heel lance, which is a painful procedure. However, there was no statistically significant result on anxiety of mothers.
Article
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PURPOSE: The purpose of this evidence search was to review past and current kangaroo care practice and explore the Iiterature relating to improving kangaroo care for preterm infants. METHOD: A literature review of evidence was undertaken in order to answer pre specified questions. The literature search was undertaken on CINAHL, Google Scholar and Pubmed. Key search terms were kangaroo care, skin to skin care, kangaroo mother care, preterm infants, benefits, practices, enablers and education. CONCLUSION: A lack of training and formal education greatly inhibits kangaroo care provision in the neonatal environment. The level of confidence a nurse has in their ability to decide whether the infant is clinically stable or not, will determine if kangaroo care is offered. Neonatal nurse education is imperative in order to improve kangaroo care practice in the clinical setting.
Article
Early recommendations to separate mothers from their newborns during the coronavirus disease 2019 (COVID-19) pandemic have created a detrimental separation practice. This article presents a review of the latest information regarding the (1) 3 modes of transmission of the virus to the neonate; (2) incidence, clinical signs, and severity of COVID-19 in the neonate; (3) factors to be considered to balance risk and benefits of separation and skin-to-skin contact (SSC) when conducting shared decision making; and (4) compendium of published SSC guidelines; and concludes with recommendations for safe practice of SSC to prevent and/or restrict COVID-19 infection in neonates.
Technical Report
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Statement of standard The hospital sensory environment is adjusted to the infants’ sensory expectancies and perceptual competences.Rationale The hospital environment may be challenging for the infant and their parents. Developmental neurosciences and psychology have enlightened the complex relationships between the environment and brain development. (1) Sensory systems develop progressively and continuously from fetal to neonatal life, with a timeline specific to each sensory modality (2,3); even extremely preterm infants are sufficiently mature to react to their environment. (4) Early brain development is genetically driven, but as early as the third trimester of pregnancy it becomes also sensory driven. Thus the period of hospitalisation is critical, since the sensory experiences can impact neurodevelopment, through many factors including synaptogenesis, synapses elimination, and epigenetic factors. (1,5–8) The harmful role of stressful/painful (over)stimulations and their long-term potential impact have been described. (9–11) As maternal stimuli are particularly salient for newborn infants, the hospital environment poses also a risk of sensory deprivation of biologically meaningful inputs for the infant. (12) Early and prolonged separation from their family can alter the bonding process and later mutual interactions. (13) Both basic and medical research support the provision of a sensory nurturing environment. It is essential to protect infants from deleterious environmental stimuli and to support their access to positive sensory stimulations from their parents and other caregivers. Sensory interventions in the NICU, adjusted to the infants’ needs and responses, attuned to their current developmental stage, are at best implemented through individualised programmes. Skin-to-skin contact is the best strategy to restore some of the sensory discontinuity associated with preterm birth. Benefits Enhanced, natural and direct exposure of the hospitalised infant to hedonically positive and/or biologically meaningful stimuli is provided during social interactions mainly through intimate contact between the mother (partner) and the infant, and minimising exposure to environmental stressors (see TEG NICU design). Theseenhanced sensory experiences are mainly delivered through skin-to-skin care, early vocal contact (direct talking and singing), exposure to maternal/paternal scents, access to breast milk taste and smell, eye contact, touch, and massage. Benefits may also come from other sensory interventions which are individually attuned to the behavioral state of the newborn infant: hedonically positive tastes, postural support, oral stimulation, and music-based intervention.
Article
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Introduction: The aim of this study was to determine the knowledge level of nursing department students about kangaroo care (KC). Methods: The sample of the descriptive research was composed of 572 students. The data were collected through a questionnaire developed by the researchers. Number, frequency, median, minimum and maximum values, Mann Whitney U test and Kruskal Wallis tests were used to evaluate the data. Results: In this study 83,7% of the students were female and 49,7% were in 22-24 age group. Majority of the students stated that they did not know about KC and 72,2% of those who have knowledge have received the information during their education and 54,6% have stated that the information they received is insufficient. When the average scores of students' knowledge about BP are examined; KC application information median scores 8,0 (min 0, max 13); The median scores of information on newborn benefits of KC are 6,0 (min 0, max 13); The median scores of the information about the parent's benefits are 8,0 (min 0, max 10); The median scores of the information on parental characteristics for KC are calculated as 5,0 (min 2, max 7) and the total information score for the KC is 28,0 (min 3, max 42). Discussion and Conclusion: It was determined that the level of knowledge of the nursing students about KC was moderate. In line with the results, it has been recommended to include these issues within the scope of clinical education as well as theoretical training in order to improve the knowledge and awareness of students about KC practice and to ensure their transfer to practice. Keywords: knowledge; nursing; nursing student; kangaroo care
Article
Background: Kangaroo care (KC), or skin-to-skin care, occurs when an infant is dressed in a diaper and held to a parent's bare chest. This form of holding has been shown to have many benefits for hospitalized infants and has been shown to be a safe and feasible intervention to support infants with congenital heart disease. Despite known benefits, KC was not implemented routinely and consistently in our cardiac center for infants with congenital heart disease. The purpose of this project was to support use of KC as a nursing intervention for hospitalized infants with congenital heart disease and their parents. Methods: A KC quality improvement committee formed to develop strategies to increase frequency of KC, including the creation of a new nursing policy and procedure on KC for infants, adaptation of the electronic health record to facilitate KC documentation, provide education, and promote translation of KC into practice through the cardiac center's first Kangaroo-A-Thon. Results: Twenty-six nurses initiated KC 43 times with 14 patients over the 8-week period for the Kangaroo-A-Thon. No adverse events were reported as a result of infants being held by their parents in KC. Conclusion: Our local initiative provided preliminary evidence that KC can be safely integrated into standard care for hospitalized infants with congenital heart disease. Formal standards and procedures, along with creative initiatives such as a Kangaroo-A-Thon, can be a first step toward fostering the translation of KC into practice.
Article
Background: Kangaroo care (KC) improves bonding and neonatal health outcomes worldwide. However, concerns for patient safety, interrupted workflow, and parent readiness continued to impede KC in a level IV neonatal intensive care unit (NICU). Its current policy did not recommend using more than 1 staff member during patient transfer. In addition, NICU staff and parents lacked skills training and education regarding the feasibility of routine KC. Purpose: A KC pathway was developed and integrated within a multifaceted, champion-based, simulated educational training program for NICU staff and families to promote earlier and more frequent KC by increasing their knowledge and comfort with this practice. Methods: Patient data collected before and after the study determined the frequency, timing, and mode of respiratory support during KC. Pre- and posttest surveys evaluated nurses' knowledge and comfort level with KC. Results: The frequency of KC occurred 2.4 times more after the intervention. The percentage of KC episodes for intubated patients nearly doubled. The posttest survey scores for nursing knowledge and comfort level also markedly improved. Implications for practice: The KC pathway ameliorated feelings of discomfort by depicting criteria and instructions for safe practice. Multidisciplinary champions were invaluable in assisting the nursing staff with patient transfer during KC. Implications for research: More dose-response studies are needed to maximize the clinical benefits of KC in developed countries.
Article
Background: Skin-to-skin care (SSC) for infants improves physiologic stability, pain perception, brain development, parental bonding, and overall survival. Using quality improvement (QI) methodology, this project aimed to increase SSC for surgical infants in the neonatal intensive care unit (NICU). Methods: A multidisciplinary working group composed of key NICU stakeholders instituted a needs assessment querying perceptions and concerns about SSC. Based on survey results, multiple system level interventions were implemented. Data for surgical infants receiving SSC during hospitalization were tracked over time using the electronic health record. Results: Overall, 315 infants requiring a surgical consult were admitted to the NICU in the first 12 months of the project. After six months, SSC rates in this group increased from 51% to 60.5% (p < 0.01) and were sustained for 12 months. After one year, nursing staff reporting that they were somewhat to very comfortable providing SSC for surgical infants increased from 44% to 75% (p = 0.001) and the percent of nurses providing SSC for a surgical infant increased from 12% to 37% (p = 0.001). Inadvertent extubation did not significantly increase after implementation of the QI project. Conclusions: Using QI methodology and multidisciplinary engagement, SSC was integrated safely into the routine care of surgical infants in the NICU. Level of evidence: Level V.
Article
Background: Focus on skin-to-skin contact (SSC) as a family-centered care intervention in Neonatal Intensive Special Care (NISC) Units continues to increase. Previously, SSC has been shown to improve neonatal physiological stability, support brain development, and promote bonding and attachment. Limited research exists investigating SSC duration and neonatal physiological responses. Purpose: This study examined the relationship between SSC duration and the neonate's oxygen saturation, heart rate (HR), respiratory rate (RR), and temperature. Method: An observational cohort study was conducted at The Royal Women's Hospital NISC Unit in Melbourne, Australia. For each neonate participant, 1 SSC with their parent was studied (parent convenience) and neonatal physiological parameters recorded, with a bivariate correlation used to explore the relationship between the duration of SSC and the percentage of time during SSC that the neonate's physiological variables remained within a target range. Findings: No correlation existed between the duration of SSC and the neonatal physiological variables of oxygen saturation, HR, RR, and temperature. However, neonatal oxygen requirement was more often reduced across the duration of SSC. Implications for practice and future research: Due to previously documented benefits to neonates physiologically from SSC, and our supportive finding that SSC reduces neonatal oxygen requirement, we believe that this study adds to the evidence to support promotion of SSC in NISC Units. The duration of SSC does not appear to negatively impact the physiological effects to the neonate. Thus, SSC should be encouraged in all NISC Units to be conducted for the length of time the parent is able. This study should be repeated with a larger sample size.
Article
There has been increased focus on the use of family-centred care interventions, such as skin-to-skin contact (SSC) in Neonatal Intensive Special Care (NISC) Units over the past two decades. SSC between a parent and their neonate has previously shown to promote positive mental and emotional health in parents and assist in bonding and attachment between parent and neonate. The purpose of this study was to investigate the effect that SSC between parent and their neonate has on the parent's heart rate (HR) and blood pressure (BP). There has been a lack of prior research investigating the physiological responses from SSC on parents, hence the need to conduct this study. The study was conducted as an observational cohort study at The Royal Women's Hospital NISC Unit in Melbourne, Australia. One SSC between parent and neonate was recorded, and three repeated measures analysis of variance (anova) were conducted to investigate the relationship between SSC and the parent's HR, systolic BP and diastolic BP. The study found statistically significant differences between the parent's initial HR and BP, to measurements taken during the SSC (p < 0.05). This may suggest that parents’ find SSC with their neonate to be a stress-reducing intervention, whilst they are in a NISC Unit. This may in turn promote associated benefits, such as a decrease in parental depression and anxiety, whilst they are in the NISC Unit, physical health benefits, as well as increased feelings of bonding between parent and their neonate. Based on the findings, it is suggested that SSC should be promoted in NISC Units as a family-centred care intervention that lowers parent's HR and BP and may provide associated health benefits.
Article
Background: One of the adjuvant and desirable therapies is skin contact between mother and baby or Kangaroo mother care (KMC) that is a cheap, accessible, relaxing, noninvasive and easy method. This study aimed to compare the effect of conventional phototherapy method and phototherapy along with KMC on cutaneous bilirubin in neonates with physiological jaundice. Materials and methods: In this randomized clinical trial, all infants with physiological jaundice who referred for phototherapy to Mofid Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran were selected by convenience sampling based on inclusion criteria and were randomly assigned into two groups of conventional phototherapy (n = 35) and phototherapy along with KMC (n = 35). Results: The results showed that there was a significant difference in the average volume of skin bilirubin before treatment with cutaneous bilirubin every 24 hours after treatment (p < 0.001). This significant difference was present in both intervention and control groups. Although the average volume of skin bilirubin every 24 hours after treatment was lower in the intervention group than the control group, this difference was not statistically significant (p = 0.236). Mean duration of hospitalization of infants in the intervention group was significantly lower than the control group (2.09 versus 3.03 days, p < 0.001) Conclusion: Although KMC along with phototherapy has a favorable effect on the reduction of cutaneous bilirubin in neonates with physiological jaundice, there aren’t significant differences with routine care. This may need to do KMC for a longer time (more than 1 hour) which must be surveyed in the future studies. KMC was effective in reduction of the duration of hospitalization in jaundiced infants.
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Background: Less than 20% of the 996 NICUs in the United States routinely practice kangaroo care, due in part to the inadequate knowledge and skills confidence of nurses. Continuing education improves knowledge and skills acquisition, but the effects of a kangaroo care certification course on nurses' knowledge and skills confidence are unknown. Method: A pretest-posttest quasi-experiment was conducted. The Kangaroo Care Knowledge and Skills Confidence Tool was administered to 68 RNs at a 2.5-day course about kangaroo care evidence and skills. Measures of central tendency, dispersion, and paired t tests were conducted on 57 questionnaires. Results: The nurses' characteristics were varied. The mean posttest Knowledge score (M = 88.54, SD = 6.13) was significantly higher than the pretest score (M = 78.7, SD = 8.30), t [54] = -9.1, p = .000), as was the posttest Skills Confidence score (pretest M = 32.06, SD = 3.49; posttest M = 26.80, SD = 5.22), t [53] = -8.459, p = .000). Conclusion: The nurses' knowledge and skills confidence of kangaroo care improved following continuing education, suggesting a need for continuing education in this area. J Contin Educ Nurs. 2016;47(11):518-524.
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Objective: To assess impact of kangaroo care (KC) on parental anxiety levels, breastfeeding rates and readiness at discharge. Methods: Observational, prospective, pre-post interventional study. State-Trait Anxiety Inventory (STAI) surveys pre-post successful KC sessions and parental readiness survey were administered to eligible parents of preterm infants as well as breastfeeding data was collected. Results: The mean change in pre- and post-KC STAI scores was significantly different for state anxiety (12.0 ± 10.9, p < 0.0001) and trait anxiety (5.8 ± 6.6, p < 0.0001) and correlated with parental age and income, but not sex, marital status, education or employment. 91% of parents performing KC vs 66% of parents NOT performing KC reported being very or extremely confident in caring for their infant at discharge. 81% of mothers initiated breastfeeding in NICU with 76% continuing at discharge. Conclusions: KC is associated with a lower parental anxiety level, greater confidence in parenting skills and higher breastfeeding rates.
Article
Infant mental health is an emerging evidence based field that enhances infant parent relationships and provides opportunities for early infant regulation that optimizes later social and emotional development. Infant mental health in intensive care settings is an approach that emphasizes the importance of helping manage stressful events for infants, parents, and staff, and supports early relationship development using reflective practice. Educational and experiential preparation for multidisciplinary IMH providers specific to work in infant intensive care is described.
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Background In some neonatal intensive care units (NICUs), conventional overhead phototherapy is the only phototherapy available, whereas others use fibreoptic blankets only. Several NICUs use both treatments interchangeably. Aim To explore how nurses experience the use of conventional versus fibreoptic phototherapy. Method Six qualitative in-depth interviews involving nurses at three different NICUs with experience in both treatments were conducted. Results Following experiences were revealed: i) Infants displayed discomfort while under phototherapy, whereas blanket use promoted infant satisfaction. ii) Blankets increased parents' satisfaction by facilitating bonding, breastfeeding and kangaroo care. iii) The nurses disagreed as to whether fibreoptic blankets and conventional treatment have similar effects. iv) Nurses were concerned about the possible harm and discomfort to the eyes and skin of infants caused by phototherapy. Conclusion When the efficacy was considered sufficient, nurses preferred blankets compared with conventional overhead, because of ability to facilitate infant comfort and parent–child interaction.
Article
Purpose: To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding. Design and methods: This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest. Outcome measure: Maternal stress was measured using the Parental Stressor:Neonatal Intensive Care Unit (PSS:NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions. Results: The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score. Implications for practice: Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship. Implications for research: The relationship between increased stress and the number of hours of SSC holding warrants further investigation.
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Due to low-birth-weight, preterm birth, HIV and/or AIDS and poverty-related factors, South Africa presents with an increased prevalence of infants at risk of language delay. A Kangaroo Mother Care (KMC) unit offers unique opportunities for training. The aim of the present study was to determine if formal, neonatal communication-intervention training had an effect on mothers' knowledge and communication interaction with their high-risk infants. Three groups of mothers participated: Group 1 was trained whilst practicing KMC; Group 2 was not trained but practiced KMC; and Group 3 was also not trained but practiced sporadic KMC. Ten mothers per group were matched for age, education level and birth order of their infants. The individual training was based on graded sensory stimulation and responsive mother-infant communication interaction, which emphasised talking and singing by the mother. Significant differences were found in mother-infant communication interaction between all three groups, which indicated a positive effect on Group 1 with training. Group 2, KMC without training, also had a positive effect on interaction. However, Group 1 mothers with training demonstrated better knowledge of their infants and were more responsive during interaction than the other two groups. The present study suggests that neonatal communication-intervention training adds value to a KMC programme.
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That was a convergent-care study, carried out in a maternity ward in the Southern Region of Brazil from April to May 2009, with the purpose to comprehend the meanings of premature mother-child skin-to-skin contact and relevant nursing contributions. Data were collected through participant observation and interviews involving nine mothers. Four categories were identified: a) predelivery orientation surrounding premature mother-child skin-to-skin contact; b) establishing premature mother-child skin-to-skin contact; c) meanings of premature mother-child skin-to-skin contact for the mother; and d) nursing contributions in establishing premature mother-child skin-to-skin contact. It was concluded that the meanings of premature mother-child skin-to-skin contact attributed by these mothers is positive, and that nursing's contribution in establishing such contact is significant.
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Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.
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The effectiveness of skin-to-skin contact to decrease pain from heel-lancing in healthy term neonates and whether breastfeeding in addition to skin-to-skin contact provided a more effective analgesia than skin-to-skin contact alone were investigated. A randomised, controlled trial was conducted in 107 neonates undergoing heel-lance. Infants were randomly assigned to three groups: (i) being breastfed with skin-to-skin contact (group 1, n=35), (ii) being held in their mother's arms with skin-to-skin contact but no breastfeeding (group 2, n=36), or (iii) lying on the table before, during and after painful stimulus (group 3, n=36). Physiological responses to pain were measured by heart rate and oxygen saturation changes and behavioural responses were measured by duration of crying and grimacing. Infants had a mean (SD) birthweight of 3355 (270) g and gestational age of 39.5 (0.6) weeks; at the time of the procedure, mean (SD) postnatal age was 33.1 (5) hours. There was no significant difference between the groups in clinical characteristics and time spent squeezing the heel. Heart rate, oxygen saturation changes and length of crying were significantly reduced in groups 1 and 2 compared with group 3 (p<0.001). No difference was found between group 1 and group 2. Grimacing was less in group 2 than in group 3 (p<0.001). In healthy term neonates, skin-to-skin contact with the mother and breastfeeding with skin-to-skin contact reduce both physiological and behavioural pain response. Breastfeeding in the 1st 2 postnatal days with skin-to-skin contact did not increase the analgesic effect of skin-to-skin contact alone.
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To determine if clinically stable extremely preterm infants can maintain their temperature during skin-to-skin contact and to screen for other negative effects. Continuous measurement of 22 stable infants' physical parameters 2 h before, during, and 2 h after skin-to-skin-contact. Mean gestational age at birth was 25 weeks and 4 days, mean post-natal age was 8 days, postmenstrual age was 26 weeks and 6 days, and mean actual weight 702 g. Mean duration of skin-to-skin-contact was 98 min. 16 infants were skin-to-skin with the mother, five with the father and one with an older sister. There were no significant differences in mean skin temperature, heart rate, respiration rate, or oxygen saturation before, during, and after skin-to-skin contact. While staying within normal range, the mean skin temperature increased 0.1 degrees C during skin-to-skin contact with the mother and decreased 0.3 degrees C during skin-to-skin contact with the father (p = 0.011) (without post-hoc correction). Clinically stable, extremely preterm infants can keep adequate skin temperature and adequate physical stability during skin-to-skin contact with their parents.
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To estimate the influence of skin-to-skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin-to-skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t-test, Fisher test or chi-square test as appropriate. Greater thermal stability in the skin-to-skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin-to-skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin-to-skin care group. This study shows that skin-to-skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.
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Heel stick is the most common painful procedure for preterm infants in neonatal intensive care units. Resultant pain causes adverse physiological effects in major organ systems. Kangaroo Care (KC), involving mother-infant skin-to-skin contact is a promising analgesic for infant pain; however, the effect of KC on the autonomic nervous system's response to pain is unknown. To determine if KC results in improved balance in autonomic responses to heel stick pain than the standard method where infants remain in an incubator care (IC) for the heel stick. A randomized cross-over trial. Fourteen preterm infants, 30-32 weeks gestational age and less than 9 days postnatal age. Infant behavioral state, heart rate, heart rate variability (HRV) indices including low frequency (LF) and high frequency (HF) power, and the LF/HF ratio measured over Baseline, Heel Warming, Heel Stick, and Recovery periods in KC and IC conditions. HRV differences between KC and IC were that LF was higher in KC at Baseline (p<.01) and at Heel Stick (p<.001), and HF was higher in KC at Baseline than in the IC condition (p<.05). The LF/HF ratio had less fluctuation across the periods in KC than in IC condition and was significantly lower during Recovery in KC than in IC (p<.001). Infants experienced better balance in response in KC than IC condition as shown by more autonomic stability during heel stick. KC may be helpful in mediating physiologic response to painful procedures in preterm infants.
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This study aims to assess the efficacy of Kangaroo Care (KC) on behavioral responses of term neonates to the pain of an intramuscular injection. One hundred healthy term neonates were enrolled and randomly assigned to intervention and control groups. In the intervention group, the neonate was held in KC for 10 min before the injection and remained in KC for the duration of the procedure. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score immediately after injection. The cumulative NIPS score immediately after injection in the intervention group was significantly lower (p<.001) than in the control group. KC given before injection seems to effectively decrease pain and should be considered for minor invasive procedures in neonates.
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CT (C tactile) afferents are a distinct type of unmyelinated, low-threshold mechanoreceptive units existing in the hairy but not glabrous skin of humans and other mammals. Evidence from patients lacking myelinated tactile afferents indicates that signaling in these fibers activate the insular cortex. Since this system is poor in encoding discriminative aspects of touch, but well-suited to encoding slow, gentle touch, CT fibers in hairy skin may be part of a system for processing pleasant and socially relevant aspects of touch. CT fiber activation may also have a role in pain inhibition. This review outlines the growing evidence for unique properties and pathways of CT afferents.
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The method of skin-to-skin contact (kangaroo care [KC]) has shown physiologic, cognitive, and emotional gains for preterm infants; however, KC has not been studied adequately in term newborns. To evaluate the effect of KC, used shortly after delivery, on the neurobehavioral responses of the healthy newborn. A randomized, controlled trial using a table of random numbers. After consent, the mothers were assigned to 1 of 2 groups: KC shortly after delivery or a no-treatment standard care (control group). Included were 47 healthy mother-infant pairs. KC began at 15 to 20 minutes after delivery and lasted for 1 hour. Control infants and KC infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth, respectively. During a 1-hour-long observation, starting at 4 hours postnatally, the KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements. KC seems to influence state organization and motor system modulation of the newborn infant shortly after delivery. The significance of our findings for supportive transition from the womb to the extrauterine environment is discussed. Medical and nursing staff may be well advised to provide this kind of care shortly after birth.
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To compare mothers' and fathers' individual views and experiences of the attachment process in a neonatal intensive care unit within the first week after a premature birth. The attachment between parents and children is a precursor to the consolidation of parenting skills, the growth and development of the infant and the establishment of a bond between parent and child. Premature birth and the resultant hospitalization disrupt the normal attachment process between parent and child. Most of the literature on attachment theory focuses on the mother-child connection and is being criticised for regarding the father's role as supportive and peripheral. The design of this study was descriptive with a hermeneutic approach. Twelve parents (six mothers and six fathers) in a 13-bed neonatal intensive care unit in a Norwegian regional hospital participated in a field study addressing the encounter between parents and nurses. This paper is based on the semi-structured interviews with the parents at discharge. The interview analysis revealed two main categories. (a) Taken by surprise: For mothers, the premature birth created a feeling of powerlessness and they experienced the immediate postnatal period as surreal and strange. The fathers experienced the birth as a shock, but were ready to be involved immediately. (b) Building a relationship: Mothers experienced a need to regain the temporarily lost relationship with their child, whereas the fathers experienced the beginning of a new relationship. Comparing parents' experiences of the attachment process within the first days after a premature birth reveals a striking contrast between the mother's experience of surrealism and the father's ability to be involved immediately after birth. Relevance to clinical practice. Parents' of premature children's different starting points should be acknowledged as professionals encourage parents to have early skin-to-skin contact with their premature infant.
Article
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding.
Article
Objective To assess the efficacy of Kangaroo Care (KC) in decreasing stress in newborns of 29-34 weeks’ post-menstrual age (PMA).
Article
Aim: To investigate Irish neonatal nurses' knowledge and beliefs of Kangaroo care. Background: Although kangaroo care existed in other countries for 25 years, it is a new occurrence in Irish neonatal care. A review of the literature suggests that, while it demonstrates benefits for both infants and parents, some neonatal nurses do not exhibit an awareness of current kangaroo care research, or hold positive beliefs towards its use with preterm infants. As they have the most parent-infant contact and influence over whether kangaroo care is carried out, their knowledge and beliefs are of importance. Method: A quantitative, descriptive design with neonatal nurses (n = 62) was used. Findings: Fifty six neonatal nurses (90.3%) believed kangaroo care a safe alternative for stable growing preterm infants, agreeing on the benefits for both infants and parents The overall level of neonatal nurses' knowledge of kangaroo care varied from good to excellent, the lowest score being 35/51. Results indicated nurses' uncertainty regarding kangaroo care with intubated infants, and infants requiring blood pressure support, umbilical lines and phototherapy. This suggests the need to provide education on kangaroo care to foster the development of more positive beliefs and increase staff knowledge of potential adverse effects.
Article
Kangaroo care (KC) was safely conducted with mechanically ventilated infants who weighed less than 600 grams and were less than 26 weeks gestation at birth. These infants, ventilated for at least 24 hours at the time of the first KC session, were considered stable on the ventilator at low settings (intermittent mandatory ventilation < 35 breaths per minute and FiO2 < 50%), had stable vital signs, and were not on vasopressors. A protocol for implementation of KC with ventilated infants that uses a standing transfer, with two staff members assisting to minimize the possibility of extubation, is presented. Also discussed is the positioning of the ventilator tubing during KC. This protocol was implemented without any accidental extubation throughout an experimental research study. The criteria and protocol were compared to those available in published reports and revealed many similar elements, providing additional support for the recommended protocol. No adverse events occurred with the criteria and protocol reported here, suggesting that they can be adopted for broader use.
Chapter
A "low-cost intervention" must, by definition, capitalize on the resources available in the natural ecology. Yet, transforming natural substances, behaviors, or patterns of relatedness into an organized intervention that can be subjected to scientific scrutiny requires more than the use of nature's offerings. As a first step, one must establish that the specific substance or activity advocated as intervention is not just "good for you", but that there are specific, theoretically-based, and empirically proven links between "cause" and "care". Second, the mechanisms by which the proposed intervention improves the level of functioning must be laid out for empirical testing. In this context, it is important to distinguish between natural resources that promote well-being in general from the use of these same resources for the treatment of a pathological state (i.e., use as prevention versus use as intervention). Third, specific outcomes of the intervention should be proposed and tested, not only a global promotion of well-being and development. Such specificity may further define chains of cause-care-cure in the case of lowcost interventions. Finally, at least in the domain of infant development, the role of the natural resource in shaping specific brain systems and its effects on structure-function relationship is an important aspect of the intervention. Thus, applying a "sensitive period" approach, which underscores the need for specific environmental inputs during unique time-windows in structurefunction relationship, is likely to increase the scientific value, testability, and generalizability of the proposed intervention.
Article
To assess the efficacy of Kangaroo Care (KC) in decreasing stress in newborns of 29-34 weeks' post-menstrual age (PMA). Quasi-experimental pre-post without control group analytical study conducted in the Gregorio Marañón University Hospital Neonatal Unit. The inclusion criteria were: infants 29 to 34 weeks' PMA, in an incubator, did not have neurological pathology, were not post-surgical, and with a Spanish-speaking mother and/or father. The sample size was fifty-one premature infants. The study variables selected were: clinical variables (additional oxygen and pathology), socio-demographical variables (PMA, KC duration) and the outcome variable, premature infant stress, which consisted of two variables: the physiological stress signal and the behavioural stress response. The variables were collected at three different times: basal stress, during KC and after KC completion, making a comparison analysis between the basal stress and after KC. The response rate was 100%, without registering any loss. The stress variables that changed after the intervention (statistically significant) were: irregular breathing, trunk arching or hyperextension, very open fingers, contraction of the face muscles, apnea, irritability and exaggerated and sustained extension of arms and legs. O(2) saturation was 94.73%±3.05% before KC and 95.92%±2.97% after the intervention. The heart rate (HR) ranged from 158.14±17.48 bpm (beats per minute) before the KC to 151.47±4.47 bpm after it. KC is related to the decrease in the occurrence of neonatal variables of stress, helping to organize motor and physiological systems to achieve a state of tranquility.
Article
In spring 2011, the American Academy of Pediatrics (AAP) will release sixth edition materials for the Neonatal Resuscitation Program (NRP). This edition brings changes in resuscitation practice and a new education methodology that shifts the instructor from "teacher" to "learning facilitator" and requires the NRP course participant to assume more responsibility for learning. The change from a lecture format to simulation-based learning requires instructors to learn new skills and meet new requirements to maintain instructor status.The sixth edition of the Textbook of Neonatal Resuscitation and the fifth edition of the Instructor's Manual for Neonatal Resuscitation are currently in press. The AAP granted permission to use material from these forthcoming publications in this article.
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There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth. To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants. Non-experimental study. Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO(2)) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis. HR and SpO(2) measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth. Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P=0.001 by log-rank test). As for SpO(2) stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P=0.046). Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.
Article
Cesarean section is associated with delayed mother-infant interaction because neither the mother nor the father routinely maintains skin-to-skin contact with the infant after birth. The aim of the study was to explore and compare parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section. A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin-to-skin contact either with fathers or mothers after an initial 5 minutes of skin-to-skin contact with the mothers after birth. The newborns' and parents' vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns' and parents' soliciting, newborns' crying and whining, and parental speech directed to the other parent and to the newborn. Newborns' soliciting increased over time (p=0.032). Both fathers and mothers in skin-to-skin contact communicated more vocally with the newborn than did fathers (p=0.003) and mothers (p=0.009) without skin-to-skin contact. Fathers in skin-to-skin contact also communicated more with the mother (p=0.046) and performed more soliciting responses than the control fathers (p=0.010). Infants in skin-to-skin contact with their fathers cried significantly less than those in skin-to-skin contact with their mothers (p=0.002) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers (p=0.029). Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin-to-skin contact and exposed to the parents' speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section, to support the early onset of the first vocal communication.
Article
To examine whether a supportive nursing intervention that promoted kangaroo holding of healthy preterm infants by their mothers during the early weeks of the infant's life facilitated coregulation between mother and infant at 6 months of age. Randomized controlled trial. Sixty-five mother/infant dyads with mean gestational age at birth of 33 weeks. Fifty percent of infants were male, and 50% were non-White. An 8-week home intervention encouraged daily 1-hour, uninterrupted holding with either blanket (baby wrapped in blanket and held in mother's arms) or the kangaroo (baby in skin-to-skin contact on mother's chest) method. In both conditions, weekly home visits by an experienced RN included encouragement to hold the infant, emotional support, and information about infant behavior and development. A control group received brief social visits, had no holding constraints, and participated in all assessments. When infants were 6 months of age, the Still-Face Paradigm was used to assess mother/infant interaction. Outcome measures were coregulation of the dyad's responses during the play episodes of the Still-Face Paradigm and vitality in infant efforts to reengage the mother during the neutral face portion of the Still-Face Procedure. Significant differences among groups were found in mother/infant coregulation. Post hoc analysis showed that dyads who were supported in kangaroo holding displayed more coregulation behavior during play than dyads in the blanket-holding group. No differences were found between groups in infant vitality during the neutral face portion of the Still-Face Procedure. Dyads supported in practicing kangaroo holding in the early weeks of life may develop more coregulated interactional strategies than other dyads.
Article
Health care professionals caring for neonates (birth to 28 days of life) and infants up to 1 year of age have a professional and ethical responsibility to provide safe and effective pain management during painful procedures. Despite 14 years of research reports highlighting that sick infants are exposed to large numbers of painful procedures with minimal or no provision of pain management strategies, and generation of abundant evidence to support effectiveness of pain reduction strategies, insufficient practice changes have been made. As untreated pain in infancy has both immediate and longer-term negative consequences, such as increased sensitivity and responses to subsequent pain, it is imperative that widespread sustained practice changes are made to reduce the burden of pain. This review highlights recent advances within the past 2 to 3 years in pain management of acute procedural pain for neonates and infants, proposes recommendations for future research, and addresses practical implications and challenges for implementing best pain management practices.
Article
The nonapeptide oxytocin (OT) has been repeatedly implicated in processes of parent-infant bonding in animal models; yet, its role in the development of human parenting has received less attention and no research has addressed the involvement of OT in the transition to fatherhood. Using a prospective longitudinal design, 160 cohabitating mothers and fathers and their firstborn infant were visited at home during the first postpartum weeks and again at 6 months postpartum. Mothers' and fathers' plasma OT was analyzed at each time point with enzyme-linked immunosorbent assay methodology. Interactions between each parent and the infant were observed in the postpartum and microcoded for parenting behavior. Overall, parental OT increased across the study period and there were no differences between maternal and paternal OT at each time point. Oxytocin showed high intraindividual stability across the first 6 months of parenting and the OT levels of husband and wife were interrelated at both assessments. Maternal OT was related to the amount of affectionate parenting behaviors, including "motherese" vocalizations, the expression of positive affect, and affectionate touch, whereas paternal OT correlated with the degree of stimulatory parenting behaviors, including proprioceptive contact, tactile stimulation, and object presentation. Results are the first to describe plasma OT levels in new fathers and mothers across the transition to parenthood in relation to maternal and paternal typical parenting behaviors. These data may provide a normative basis for the study of parenting under conditions of high risk.
Article
The effectiveness of skin-to-skin contact (SSC) after vaginal delivery has been shown. After cesarean births, SSC is not done for practical and medical safety reasons because it is believed that infants may suffer mild hypothermia. The aim of this study was to compare mothers' and newborns' temperatures after cesarean delivery when SSC was practiced (naked baby except for a small diaper, covered with a blanket, prone on the mother's chest) with those when routine care was practiced (dressed, in the bassinet or in the mother's bed) in the 2 hours beginning when the mother returned from the operating room. An experimental, noninferiority adaptive trial was designed with four levels of analysis: 34 pairs of mothers and newborns, after elective cesarean delivery, were randomized to SSC (n = 17) or routine care (n = 17). Temporal artery temperature was taken with an infrared ray thermometer at half-hour intervals. Compared with newborns who received routine care, SSC cesarean-delivered newborns were not at risk for hypothermia. The mean temperatures of both groups were almost identical: after 30 min, 36.1 degrees C for both groups (+/-0.4 degrees C for SSCs and +/-0.5 degrees C for the controls), and after 120 min, 36.2 degrees C +/- 0.3 degrees C for SSCs versus 36.4 degrees C +/- 0.7 degrees C for the controls (no significant differences). Time from delivery to the mothers' return to their room was 51 +/- 10 min. The SSC newborns attached to the breast earlier (nine SSC newborns and four controls after 30 min) were breast-fed (exclusively or prevalently) at discharge (13 SSCs and 11 controls) and at 3 months (11 SSCs and 8 controls), and the SSC mothers expressed high levels of satisfaction with the intervention. Cesarean-delivered newborns who experienced SSC within 1 hour of delivery are not at risk for hypothermia.
Article
To pilot test a standardized intraoperative and postoperative nursing intervention protocol to minimize maternal-infant separation after Cesarean. Randomized-controlled trial. A 250-bed acute care community hospital labor/delivery/recovery/postpartum unit with approximately 150 repeat Cesarean deliveries per year. Fifty women having a live, term, singleton, repeat Cesarean delivery and their newborns. A standardized nursing intervention protocol was designed and administered to minimize the amount of maternal-infant spatial, tactile, olfactory, auditory, and visual separation post-Cesarean. Maternal outcomes included maternal pain, anxiety, and childbirth perception. Infant outcomes included respiratory rate, temperature, stress (infant salivary cortisol), and breastfeeding rates. Compared with the control group, the intervention group experienced earlier first physical contact and feedings and a longer interval until the infant first bath. Differences were found between treatment groups for infant temperatures and respiratory rates. Three infants in the control group experienced suboptimal temperatures. Infants in the intervention group had significantly higher salivary cortisol levels but were within the normal upper level range. No differences were noted in maternal pain, maternal anxiety, or perception of birth experience among treatment groups. The pilot was valuable in examining intervention feasibility, appropriate outcome measures, and data collection strategies. The standardized intervention protocol shows promise for positively affecting maternal-infant outcomes after Cesarean delivery and merits further testing.
Article
Skin-to-skin care has been adopted all over the world, although physiological changes during or after it have not been evaluated very well. The purpose of the present study was therefore to investigate whether skin-to-skin contact for newborn babies and their mothers affects body temperature, heart rate and oxygen saturation of the babies. Studies investigating body temperature, heart rate and oxygen saturation of babies during and/or after skin-to-skin contact were systematically searched and reviewed. Meta-analyses to examine the effects and meta-regression analyses to investigate correlations between the effects and birthweight, duration of the care, environmental temperature, and resources of the setting, were conducted. A total of 23 studies were included. Meta-analyses showed evidence of an increase in body temperature (weighted mean difference [WMD] 0.22 degrees C, P < 0.001) and a decrease in saturation of babies (WMD -0.60%; P= 0.01) during skin-to-skin care, compared with those before skin-to-skin care. Increase in body temperature was more evident in middle-low-income settings (WMD, 0.61 degrees C, P < 0.001) than high-income settings (WMD 0.20 degrees C, P < 0.001). Both the positive effect on body temperature and the negative effect on saturation were more marked in cold environments than where the environmental temperature was higher (WMD 0.18 degrees C, P < 0.001; WMD -0.82%, P= 0.02). Skin-to-skin care is effective in increasing the body temperature of babies, especially where resources are limited and the environment is cold. Decreased oxygen saturation of the babies, however, warrants further prospective studies to confirm the findings.
Article
A tradition of separation of the mother and baby after birth still persists in many parts of the world, including some parts of Russia, and often is combined with swaddling of the baby. The aim of this study was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation. A total of 176 mother-infant pairs were randomized into four experimental groups: Group I infants were placed skin-to-skin with their mothers after birth, and had rooming-in while in the maternity ward. Group II infants were dressed and placed in their mothers' arms after birth, and roomed-in with their mothers in the maternity ward. Group III infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group IV infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or dressed in baby clothes. Episodes of early suckling in the delivery ward were noted. The mother-infant interaction was videotaped according to the Parent-Child Early Relational Assessment (PCERA) 1 year after birth. The practice of skin-to-skin contact, early suckling, or both during the first 2 hours after birth when compared with separation between the mothers and their infants positively affected the PCERA variables maternal sensitivity, infant's self-regulation, and dyadic mutuality and reciprocity at 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. These findings support the presence of a period after birth (the early "sensitive period") during which close contact between mother and infant may induce long-term positive effect on mother-infant interaction. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad. Skin-to-skin contact, for 25 to 120 minutes after birth, early suckling, or both positively influenced mother-infant interaction 1 year later when compared with routines involving separation of mother and infant.
Article
The purpose of this study was to examine coregulation between mothers and preterm infants in hypothalamic-pituitary-adrenocortical (HPA) system activity, as indicated by salivary cortisol levels, while mothers held their infants. The research questions were (a) does mother-infant coregulation in HPA activity occur during holding? and (b) if mother- infant coregulation in HPA activity exists during holding, do type of holding, antenatal steroids, sound level, and maternal touch influence this coregulation? The sample consisted of 20 mother- infant dyads with infants at a mean postconceptional age of 34.7 weeks (+0.7) and average postnatal age of 15 days (+9) at the time of cortisol sampling. The design was exploratory using convenience sampling. Maternal and infant cortisol levels were obtained at Time 1 (baseline) and Time 2 (end of holding); at each time, the absolute differences in levels between mother and infant were determined. Coregulation was operationalized as less difference between maternal-infant cortisol levels immediately after holding (Time 2) as compared to before holding (Time 1). The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother-infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.
Article
Novel hypothesis of human fetal growth regulation in amniotic fluid environment integrates lanugo, vernix caseosa and a second tactile system of unmyelinated low-threshold C-afferents - all three forming a unique natural instrument powerfully speeding fetal growth during mid-gestation and lowering its tempo at the end of gestation. Repeated oscillations of lanugo hairs encased by vernix caseosa during fetal movements in amniotic fluid activate highly sensitive mechanoreceptors connected to unmyelinated C-afferents, which prime function is to conduct originated impulses from all fetal skin dermatoms via spinal cord and to activate vagal sensory zone, hypothalamus and insular cortex, for concomitant promotion of the anti-stress effect through oxytocin release, and stimulation of fetal growth by the incretin effect of gastrointestinal hormones.
Article
The effects of skin-to-skin contact on three indexes of energy expenditure: heart rate, activity level, and behavioral state, were examined in a pilot study. It was hypothesized that skin-to-skin contact, because of its soothing effects, would increase sleep, lower activity level, and reduce heart rate. Eight healthy preterm infants in a neonatal intensive care unit, who had reached 34 to 36 weeks gestation, experienced one session of skin-to-skin contact for an interfeeding interval. Observations were made once each minute using continuous videotape throughout three consecutive interfeeding intervals (before, during, and after skin-to-skin contact). Significant treatment effects were found by repeated-measures analysis of variance for behavioral state and activity level; pair-wise comparisons showed that quiet sleep frequency was significantly increased and activity level reduced during skin-to-skin contact. Infants had longer durations of quiet sleep during skin-to-skin contact. The Pearson product-moment correlation between heart rate and behavioral state was robust and generally linear, supporting use of heart rate as a measure of energy expenditure in these subjects. The findings suggest that skin-to-skin contact is a simple, cost-effective intervention that reduces activity and state-related energy expenditure.
Article
Results of two studies of the effects of 2 to 3 hours of kangaroo care (KC), one a randomized trial of 25 premature infants in open-air cribs and the other a pilot of 6 premature infants who were at least 24 hours postextubation, who were cared for in incubators are reviewed. Both studies incorporated a pretest/posttest control group design. Heart rate and abdominal skin temperature rose for KC infants during KC. Heat loss did not occur during KC, and infants slept more during KC. Kangaroo care had a comforting effect on infants and their mothers. Apnea and periodic breathing episodes dropped during KC for incubator infants. Suggestions and guidelines for selection of infants and practice based on these studies are presented.
Article
The indicators of newborns' adaptation during 75 min after birth were compared in three randomised groups of full-term newborns: skin-to-skin contact (group I), swaddled newborns beside the mother (group II), swaddled and separated from the mother (group III). The changes in skin temperature, blood glucose, pH, heart rate, respiration rate and crying time were studied. All the above characteristics but pH were significantly the most favourable for infants in the skin-to-skin group. The analysis of individual trends of changes in skin temperature indicated that for all but two newborns not separated from the mother (skin-to-skin or lying besides) the temperature was growing during the observation period, whereas in the separated group, six newborns (27%) had unstable not growing temperature. The mean level of blood glucose was the highest in skin-to-skin group (60.1 mg/dl), lower in group of swaddled and lying beside mother (52.5 mg/dl) and the lowest (49.6 mg/dl) in the separated group. The mean duration of crying time in the skin-to-skin contact was a little shorter than in the group of newborns lying besides the mother and more than three times shorter than in the separated group. The observed number of episodes of crying were 7, 17 and 38 in the three groups respectively. All results indicated that skin-to-skin contact is optimal for newborns', adaptation after birth especially as a protection against hypothermia and hypoglycaemia.
Article
Conservation of energy assumes an important role in the care of infants requiring assisted ventilation, yet little research has been conducted on this group of infants in terms of thermoregulation, oxygenation, heart rate, or sleep states during skin-to-skin care. To compare the impact of two different transfer techniques used in skin-to-skin care (nurse transfer and parent transfer) on physiologic stability and other descriptive measures of physiologic stability related to energy conservation in ventilated preterm infants during and after skin-to-skin care. Fifteen ventilated preterm infants weighing a mean of 1,094 g were randomly assigned to receive either parent or nurse-to-parent transfer on the first of 2 consecutive days and the alternate method the following day. Temperature was taken before and after skin-to-skin care. Oxygen saturation and heart rate were recorded minute by minute, and the Assessment of Behavioral Systems Observation (ABSO) scale scores was used to measure physiologic organization, motor organization, self-regulation, and need for caregiver facilitation during transfer to and from the parent and during pre, post, and skin-to-skin periods. Temperature remained stable. Oxygen saturation decreased and heart rate increased when the infant was transferred to and from the parent, but returned to baseline levels during and after skin-to-skin care regardless of the transfer method. Infants showed more physiologic and motor disorganization, less self-regulation, and more need for caregiver facilitation during transfers to and from the parent than during the pre, post, and skin-to-skin care periods. Both transfer methods resulted in physiologic disorganization. However, during and after skin-to-skin care, infants exhibited no signs of energy depletion.
Article
To study the influence on breastfeeding of skin-to-skin contact after birth. Using a prospective cohort study design, a group of 1250 Polish children was investigated with 3 y follow-up. The implementation of the practice significantly increased mean duration of exclusive breastfeeding by 0.39 mo and overall breastfeeding duration by 1.43 mo. The infants kept with the mothers for at least 20 min were exclusively breastfed for 1.35 mo longer and weaned 2.10 mo later than those who had no skin-to-skin contact after delivery. The skin-to-skin contact after birth significantly coexisted with the other hospital practices supportive to breastfeeding, especially rooming-in without separation longer than 1 h per 24 h [relative risk (RR) = 3.18, 95% confidence interval (95% CI): 2.34-4.31] and first breastfeeding within 2 h after birth (RR = 2.94, 95% CI: 2.36-3.67. Multivariate analysis performed by a general linear model with duration of exclusive breastfeeding as the dependent variable indicated skin-to-skin contact and mother education as two independent variables influencing the duration of exclusive breastfeeding. The results indicate that extensive mother-infant skin-to-skin contact lasting for longer than 20 min after birth increases the duration of exclusive breastfeeding.
Article
Kangaroo care (KC) was safely conducted with mechanically ventilated infants who weighed less than 600 grams and were less than 26 weeks gestation at birth. These infants, ventilated for at least 24 hours at the time of the first KC session, were considered stable on the ventilator at low settings (intermittent mandatory ventilation < 35 breaths per minute and FiO2 < 50%), had stable vital signs, and were not on vasopressors. A protocol for implementation of KC with ventilated infants that uses a standing transfer, with two staff members assisting to minimize the possibility of extubation, is presented. Also discussed is the positioning of the ventilator tubing during KC. This protocol was implemented without any accidental extubation throughout an experimental research study. The criteria and protocol were compared to those available in published reports and revealed many similar elements, providing additional support for the recommended protocol. No adverse events occurred with the criteria and protocol reported here, suggesting that they can be adopted for broader use.
Article
Human milk is the preferred food for infants, including ill and preterm infants. Ensuring skilled and comprehensive breastfeeding support for these vulnerable infants requires a specialized approach. The author outlines 10 steps for promoting and protecting breastfeeding in vulnerable infants. The steps include providing the parents with information necessary to make an informed decision to breastfeed; assisting the mother with the establishment and maintenance of a milk supply; ensuring correct breast milk management (storage and handling) techniques; developing procedures and approaches to feeding the infant breast milk; providing skin-to-skin care (kangaroo care) and opportunities for non-nutritive sucking at the breast; managing the transition to the breast; measuring milk transfer; preparing the infant and the family for infant hospital discharge; and providing appropriate follow-up care. Material and examples are drawn from the author's research and clinical work at the Children's Hospital of Philadelphia. Current research is utilized, and the role of the nurse is emphasized throughout.
Article
A necessary condition for the individual’;s survival is the capacity for mental, behavioral, and physiological adaptation to external and internal conditions. Consequently, the integrated organism strives to maintain a dynamic, functional balance and integrity under varying conditions. Effective individual adaptation processes are basically dependent on the functioning of the integrated psychophysiological system. In humans, the brain plays a fundamental role in these processes. It serves the adaptation of individuals to current and anticipated conditions by selecting, interpreting, and transforming information into mental, behavioral, and physiological responses. In doing so, the incoming information is linked to existing structures of emotions, values, and goals. Consequently, the interpretation of external information may vary and become subjective depending on an individual’s present and past experiences (see e.g., Magnusson, 2003). Hitherto, empirical research has been mainly concerned with the aspect of the psychophysiological system, which is activated in situations that are perceived by the individual as threatening, harmful, or demanding and in which the fight—flight and stressresponsesdescribedbyCannon(1929)andSelye(1976)playanimportantrole. The aim of this article is to draw attention to a component of the psychophysiological system, the calm and connection system, underlying well-being and socialization. By including this new system, the model of the integrated individual becomes more complete and it enriches the understanding of emotional aspects of brain functioning.
Article
Kangaroo Care has been shown to keep a singleton preterm infant warm by body heat generated in maternal breasts that is conducted to the infant. No studies have examined whether twins simultaneously receiving Kangaroo Care, called Shared Kangaroo Care, are sufficiently warm and how the breasts respond to twin presence. Two case studies were done to determine the temperatures of twins being simultaneously kangarooed and the temperatures of maternal breasts during Shared Kangaroo Care. Two sets of premature twins were held in Shared Kangaroo Care for 1.5 hours. Infant temperatures were recorded from incubators; breast temperatures were recorded from thermistors. Infant temperatures remained warm and increased during Kangaroo Care, and each breast appeared to respond to the thermal needs of the infant on that breast. Physiological explanations for thermal synchrony exist. These data suggest that twins can be simultaneously held in Kangaroo Care without thermal compromise because each breast responds individually to the infant's thermal needs.
Article
A woman's right to health includes her right to a healthy childbirth and newborn, and the baby possesses his or her own right to life as well. While overall child mortality has declined, 4 million newborns still die each year, primarily in the first days of life. Most could be prevented through existing, cost‐effective interventions. Field trials and programs show that low‐cost, home‐ or community‐based neonatal care can quickly lead to dramatic decline in neonatal mortality. Newborn health should be integrated with maternal and child health–and these programs should be strengthened and expanded–in order to achieve both the child and maternal survival Millennium Development Goals. Policies and programs should include participatory household and community‐based care, with links to the formal health system. Despite recent attention to newborn health, much remains to be done to achieve sustained, high coverage of effective interventions, especially in poor communities where most newborns are born and die, mostly in the first week of life.