is for “K”ardiorespiratory
The most extensively tested area for Kangaroo Care
outcomes is breastfeeding. Second to that is the area of
cardiorespiratory responses to Kangaroo Care, especially
in the premature population. Findings related to heart
rate, respiratory rate, oxygen saturation, desaturation
episodes, fractional inspired oxygen, apnea, bradycardia,
periodic breathing, pulmonary function tests, and heart
rate variability are presented in this module.
Module # 9: K
Cardio-respiratory Outcomes of Kangaroo Care.
______________________________________________________
Objectives:
After completion of this module the participant will be able to:
1. Understand the guidelines for safe practice in relation to cardiorespiratory
outcomes.
2. Understand the anticipated outcomes of Kangaroo Care in regards to cardiorespiratory
variables in premature infants.
3. Understand the anticipated outcomes of Kangaroo Care in regards to cardiorespiratory
variables in full term infants.
4. Relate effects of Kangaroo Care on each of the following cardiorespiratory parameters:
Heart Rate, Respiratory Rate, Oxygen Saturation or Transcutaneous Partial Pressure of
Oxygen, Number of Desaturations, Fractional Inspired Oxygen Concentration, Cerebral
Oxygenation, Pulmonary Function Tests, Apnea, Bradycardia, Periodic Breathing, Heart
Rate Variability, and Life Threatening Events.
5. Identify at least three potential negative cardiorespiratory effects of
Kangaroo Care.
6. Understand the effects of KC on ventilated infants.
Objective 1. Guidelines For Safe Practice of Kangaroo Care in
Relation to Cardiorespiratory Outcomes.
1.Assess each infant for appropriateness for KC, as KC is not appropriate for infants
with the following:
a. Active sepsis
b. Chest tubes
c. Pulmonary hypertension
d. Active weaning from a respirator
e. First 24 hours on respirator. There are few benefits,if any, to the ventilated infant
as a result of KC, and because infants are so swiftly weaned, waiting a day or two
or three for extubation is advised. If mechanical ventilation is continuing more
than 5 days, maternal benefits of ventilated KC may encourage one to do
ventilated KC. If an infant is ventilated for 10 or more days, KC is encouraged
for both infant and maternal closeness and hormonal/bonding effects of skin-toskin contact.
f. Exceptionally high inspiratory oxygen needs when in an incubator (they may have
rapidly increasing inspiratory oxygen needs during KC [Wieland, et al., 1995]}
g. Numerous prolonged apneas that require stimulation when in the incubator.
Infants on theophylline generally do well in KC, but need to be monitored.
h. Infants < 750 grams need to wear a head cap and be closely monitored for
apnea/bradycardia spells during KC.
i. Infants with persistent periodic breathing or disorganized breathing in the
incubator need to be closely monitored during KC.
2. Remember, KC commonly improves cardiorespiratory status, but infants still need to be
monitored during KC as apneas, increased FiO2 needs, dropping oxygen saturation levels,
hypothermia and infant restlessness have been documented. Their occurrence is rare indeed, but
the possibility of their occurrence mandates vigilance.
3.KC may not be appropriate for all infants, but 90-95% of preterm infants will do well in KC.
Very low birth weight infants requiring long term ventilation might need extra oxygen support in
the second hour of KC (Smith, 2001) and very immature infants (< 27-weeks gestational age
might suffer from decreased cerebral oxygenation when first placed in an upright KC position
(Schrod & Walter, 2002). For very small, very immature premature infants, lying on the
reclining mother’s chest is indicated. Children’s Hospital of Philadelphia has been practicing
KC with infants as small as 600 grams and 24 weeks gestational age (Clifford & Barnsteiner,
2001), and Paula Meier reports daily KC sessions with infants as small as 600 grams weight at
Rush Presbyterian Hospital in Chicago (Meier, 2001; Meier et al., 2004)
Objective 2: Anticipated Outcomes of Kangaroo Care in Premature
Infants.
The earliest research on Kangaroo Care evaluated cardiorespiratory effects of the
holding technique to be sure that infants did not have compromised cardiorespiratory status,
especially once it was learned that all infants warm up during Kangaroo Care. The findings in
premature infants > 28 weeks postconceptional age are rather uniform: heart rate increases up to
10 beats per minute due to warming, respiratory rate increases about 5 breaths per minute due to
warming, oxygen saturation may or may not increase or decrease by 2-4% in each hour of
Kangaroo Care, desaturations may occur with transfer into and out of Kangaroo Care, but are
only instantaneous and self-correcting otherwise, short apneas decrease by 75%, long apneas
>15 seconds may or may not change during Kangaroo Care, bradycardia is very rare, periodic
breathing tends to stop as breathing pattern becomes more regular and the work of breathing
decreases, and heart rate variability shows dampening of sympathetic effects due to higher
parasympathetic control (as measured by Heart Rate Variability) during Kangaroo Care. These
changes do not cause increased oxygen utilization nor increased energy consumption, even when
Kangaroo Care is given 24 hours per day. Sicker, smaller preterm infants tend to have more
beneficial changes in cardiorespiratory status than medically stable, older (>32 weeks post
conceptional age) preterm infants.
Pulmonary function tests do not seem to improve at all during one hour of Kangaroo Care
with ventilated preterm infants even though FiO2 had to be reduced to prevent hyperoxygenation
(Ludington-Hoe, Ferreira, & Goldstein, 1998; Ludington-Hoe, Ferreira, et al., 1996) and in
ventilated bronchopulmonary dysplasia babies, oxygen saturation drops unless the FiO2 is
increased (Smith, 2001).
Cardiorespiratory changes can be seen within minutes of the onset of Kangaroo Care,
continue throughout Kangaroo Care, and diminish within minutes of discontinuing Kangaroo
Care. A current controversy is cardiorespiratory pattern during the second and third hours of
continuous Kangaroo Care as overwarming has been suggested as the cause of cardiorespiratory
compromise in two studies, one with infants an average of 28 days old who were not receiving
oxygen support (Bohnhorst et al., 2001), and the other with infants an average of 34 days old
who were still mechanically ventilated and who had bronchopulmonary dysplasia (Smith,
20001). More research is needed as two studies alone are insufficient evidence, even though
they both were randomized controlled trials.
All Kangaroo Care studies of cardiorespiratory effects were subjected to a meta-analysis
(Ludington-Hoe & Dorsey, 1998) in which statistically significant increases in heart rate,
respiratory rate, oxygen saturation and skin temperature were revealed. Though heart rate may
climb by 10 beats per minute, heart rate commonly remains within the infant’s clinically
acceptable range. These outcomes were confirmed by Mori et al’s most recent meta-analysis of
preKC-KC-postKC studies.
Objective 3: Anticipated Outcomes of Kangaroo Care with Full Term
Infants.
Heart rate and respiratory rate of full term infants in response to Kangaroo Care have been
examined by several randomized controlled trials. No differences in heart and respiratory rates
existed between infants in Kangaroo Care as compared to infants who were swaddled and remained
in their cribs (Chwo & Huang, 2002; Newport, 1984, Villlalon et al., 1992), showing that Kangaroo
Care does not adversely affect full term heart and respiratory rates. In fact, some studies have found
that Kangaroo Care had positive effects of full term heart and respiratory rates, with heart and
respiratory rates being significantly more favorable (more stable, less rise, no decreases) during
Kangaroo Care (Christensson et al., 1992; Mazurek et al., 1999). Across all the studies, heart and
respiratory rates have remained within clinically acceptable range. Oxygen saturation levels did not
differ between Kangaroo Care and crib infants in a randomized controlled trial (Chwo & Huang,
2002). When Kangaroo Care was given during an injection, Kangaroo Care prevented the rise in
heart rate that normally accompanies heel lance, a rise that was seen in the infants who were
swaddled in the crib (Gray Watt, Blass, 2000). This same benefit to heart rate was seen when the
infant was breastfeeding in the Kangaroo Care position during an injection (Gray et al., 2002),
and physiologic recovery from the injection was better with Kangaroo Care than without.
Objective 4: Kangaroo Care Effects on Cardiorespiratory Parameters.
Heart Rate in Full Term Infants: A Sample of the Studies
Chwo & Huang, 2002
RCT, 25 fullterms got 60 minutes of KC right after delivery drying. HR measured
every15 minutes, No difference in heart rate between KC and control (routine care, no
skin-to-skin contact after delivery).
Gazzolo et al., 2000
HR decreased significantly during the KC episodes as compared to lying on bed in postop recovery unit after open heart surgery.
Gray Watt Blass 2000
RCT. HR increased 8-10 bpm in KC shot and 36-38 bpm in swaddled, cot based shot.
Gray et al., 2002
RCT. HR increased less during a KC +Breastfeeding shot than during a
Swaddled, cot-based shot.
Mazurek et al., 1999
RCT, heart rate was best in KC group during 75 mins of KC right after delivery
Newport 1998
39 fullterms got 15 minutes of KC right after delivery and 37 got routine care.
No difference in HR between groups.
Sontheimer et al, 2004
HR during transport was stable. One baby had HR increase from 130 to 165 in second
hour of transport due to warming.
Villalon et al., 1992
RCT, no difference in HR between those who got 4 hrs of KC immediately after
birth and those who got routine care (no KC)
Heart Rate in Preterm Infants: A Sample of the Studies
No change in HR over 10 min of KC/day for 10 days
22 spontaneously breathing preemies had a 2hr recording B4, during, after KC. KC was 2
hrs. HR increased during KC. Changes may be due to heat stress
Chen et al., 2000
HR during KC breast or KC bottle feeding did not rise significantly.
Cleary et al., 1997
Stable HR during 2 hours of Paternal KC
Clifford & Barnsteiner, 2000
Micropreemies on vents. Stable HR baseline, No HR drif
Closa et al., 1998
HR was stable during 30-90 minutes of KC 1-8x/day
Fisher et al., 1998
HR stability did not change from incubator to KC & back to incubator
Ludington-Hoe & Dorsey, 1998
Kangaroo Care causes a statistically significant but clinically insignificant
increase in premature infant heart rate.
Ludington-Hoe et al., 1999
HR remained within acceptable clinical range at all times for all babies
Ludington-Hoe et al., 2004
HR
Neu et al., 2000
HR increased during transfer of ventilated infant into and out of KC. HR
returned to baseline during and after KC.
Schrod & Walter 2002.
After 3 minutes of adaptation, prolonged head-up position did not produce further
changes in HR, no prolonged side effects of prolonged head-up position (tested by
using a wedge under the baby) in stable preterms over first days of life (2-12 days
of life. Prolonged head-up positioning has no undesirable effects in preterm infants
with stable circulation including very immature infants of 25 weeks gestation”(pg.
259).
Sontheimer et al, 2004
HR during transport was stable. One baby had HR increase from 130 to 165 in
second hour of transport due to warming.
Tornhage et al., 1999
HR changed minimally (essentially stable) during 60 mins of KC
Wieland et al., 1995
HR did not change from incubator value during KC
Yin et al., 2000
No diff in HR between groups during 30 minutes of KC vs
Staying in incubator for 30 minutes over 7 days.
Bier et al., 1996
Bohnhorst et al., 2001
Respiratory Rate in Fullterm Infants
Gazzolo et al., 2000 RR was lower during KC than during bed time in open heart surgery
recovery
Unit.
Mazurek et al., 1999 FT, RCT. Respiratory rate was best in KC group during 75 minutes of KC
Right after delivery.
Newport 1998
No difference in Respiratory Rate over 15 minutes right after delivery
between
Fullterms who got KC (n = 39) and those who did not (n=37)
Villalon et al., 1992 RCT, no difference in RR between those who got 4 hrs of KC immediately
after birth and those who got routine care (no KC)
Respiratory Rate in Preterm Infants
Bier et al., 1996
Bohnhorst et al., 2001
Chen et al., 2000
Closa et al., 1998
Fisher et al., 1998
No change in RR over 10 minutes of KC/day for 10 days
RR increased during 2 hrs of KC. Increase may be due to heat
stress.
RR during KC breastfeeding or KC bottle feeding did not rise
significantly.
RR was stable during 30-90 minute sessions of KC
RR stability did not change from incubator to KC and back to
incubator
Ludington-Hoe et al.,1999
Ludington-Hoe et al, 2004
Wieland et al., 1995
RR remained within clinically acceptable range at all times for all
babies
RR remained and HR remain clinically stable throughout study
RR did not change from incubator rate during KC
Oyxgen Saturation/TcPO2 in Fullterm Infants
Chwo & Huang, 2002
RCT, No difference in SaO2 during 60 minutes of KC right after
delivery between KC and routine care groups.
Gazzolo et al., 2000
SaO2 increased during KC periods as compared to bed periods in
post-op unit recovery from open heart surgery. No change in TcPO2
Oxygen Saturation/TcPo2 in Preterm Infants
Bier et al., 1996
SaO2 was higher during KC and fewer desats during KC than when held swaddled by
moms.
Chen et al., 2000 SaO2 significantly higher during KC breastfeeding than KC
bottle feeding.
Closa et al., 1998
SaO2 was stable during 30-90 minutes of KC 1-8 times per day.
Fisher et al., 1998
SaO2 stability did not change from incubator to KC and back to incubator.
Ludington-Hoe et al. 1999
SaO2 remained within clinically acceptable range at all times for all
babies.
Ludington-Hoe et al., 2004 SaO2 remained within clinically acceptable range at all times in KC &
Control groups
Neu et al., 2000
SaO2 decreased during transfer of ventilated infant from incubator into/out
of KC,
SaO2 returned to baseline during and after KC.
Smith, 2001
SaO2 was lower during ventilated KC than during ventilated incubator
period, and
SaO2 fluctuated across time.
Tornhage et al., 1999 SaO2 increased in 9/17 infants. TcPO2 changed minimally.
Wieland et al., 1995 TcPO2 and SaO2 did not change during KC from incubator values in 39
preterms.
TcPCO2 in Preterm Infants
Gazzolo et al., 2000 TcPCO2 did not change from bed to KC periods during open heart
surgery
Post-anesthesia recovery period.
Tornhage et al., 1999 TcPCO2 changed minimally from pretest in NICU to >60 mins of KC on
one day. Arterial blood gases changed minimally too from pretest-to test
to posttest.
Wieland et al., 1995 TcPCO2 did not change from incubator values during KC in 39 preterms.
Fractional Inspired Oxygen
Ludington-Hoe et al. 1998 In a case study, FiO2 was decreased by 10% over one hour of KC
to prevent hyperoxgenation and keep SaO2 within 92-97% range.
Smith, 2001
Ventilated bronchopulmonary dysplasia babies needed 14% more FiO2
during KC to maintain adequate SaO2.
Tornhage et al., 1999 Oxygen requirements decreased in 15/17 infants during KC and increased in
2/17 infants during 60 minutes of KC.
Wieland et al., 1995 Of 16 infants with elevated FiO2 in the incubator, 13 needed even more
FiO2 during KC. FiO2 had to be increased from 29% to 35%. One of 167
KC sessions had to be stopped for rapidly increasing FiO2.
Cerebral Oxygenation
PT, one grp, pretest (30 min incubator)-test (60 min KC) –posttest (30 min
incubator) of 16 infants whose mothers were 60 degree incline and NO control over head turn as it was positioned
BETWEEN maternal breasts, showed no differences in mean regional oxygenation, HR, and SaO2, but when total
spectral power of regional oxygenation was conducted, cerebral oxygenation, HR, and Sa02 decreased during KC &
increased after KC. Both left and right LF of cerebral oxygenation was decreased during KC & HF in right cerebral
oxygenation power was decreased during KC. LF of HR sig increased and HF of HR sig decreased during KC.
Mean, total power and LF of RR increased during KC. Quiet sleep increased during KC. KC activates the Central
Nervous system and brain function.
Begum et al. 2008, 2009
Martin et al., 2010
PT, cerebral oxygenation taken every one minute in 10 infants in incubator
and in KC and then in incubator again. Cerebral oxygenation decreased in
KC, though in some infants it rose to 85%. This is same finding as
Begum, and cerebraloxygenation drops when infant is at rest, not stressed,
and calm.
# of Desaturations (SaO2 <80) in Preterm Infants
Bier et al.,1996
Fewer desats during KC than when held swaddled by mom. KC was for 10
Minutes per day for 10 days.
Bohnhorst et al., 2001
# hypoxemia (<80%) episodes increased during 2 hrs of KC.
Chen et al., 2000
20 desats during KC + bottlefeeding among 2r infants, none during KC
breastfeeding. KC breastfeeding is less stressful than KC bottlefeeding.
Tornhage et al., 1999 No desaturations occurred during KC of >60 minutes on one day.
Apnea
Acolet et al., 1989
Chen et al., 2000
No apneas during 10 minutes of KC.
Zero apnea during KC breastfeeding, 2 apnea during KC
bottlefeeding. KC breastfeeding is less stressful than KC bottle.
Eichel 2001
Ventilated infants had fewer apnea episodes in KC than in
incubator
Hadeed et al., 1995
KC reduces apnea of prematurity by 75% (In abstract section of
bib)
Ludington-Hoe et al., 1991
No differences in apnea between periods/groups
Ludington-Hoe et al, 1994 Fewer apnea episodes during KC than incubator care, and no
obstructive apneas occurred. . Decreased frequency of total apnea
episodes (Day1 +Day5); significantly shorter apneas in KC than in
incubator(pg.22).
Ludington-Hoe et al., 1998
Decrease in duration of central apnea (p713) during
vent KC with 1 subject
Ludington-Hoe et al., 2004
No apneas in KC, no apneas in controls.
Tornhage et al., 1999
One episode of apnea occurred during17 KC sessions of 60
minutes each
Wahlberg et al., 1992
No problems with apnea during KC
Wieland et al., 1995
167 KC periods, 4 were stopped for increased apnea/bradycardia
Bradycardia
Bohnhorst et al., 2001 # of bradys increased during 2 hrs of KC.
Chwo & Huang,2002 RCT, No difference in bradycardias during 60 minutes of KC right
after delivery between KC and routine care groups as neither group had
any bradycardias.
Cleary et al., 1997
No bradycardias during 2 hrs of KMC and Paternal KC
Clifford & Barnsteiner 2001 Clinical report with micropreemies getting KC. No bradycardias
During 58-84 minutes of ventilated KC
Eichel, 2001
Ventilated infants had fewer bradycardias in KC than in incubator
Ludington-Hoe et al., 2004 No bradycardias during KC, but control group often approached
bradycardic level (<100 bpm).
Wieland et al., 1995 of 167 KC periods, 4 were stopped for increased apnea/bradycardia
Periodic Breathing
Bohnhorst et al., 2001 Proportion of regular breathing decreased during 2 hrs of KC.
Cleary et al., 1997
No irregular breathing or periodic breathing during 2 hours of KMC/KPC
DeLeeuw et al., 1991 No change in regularity of breathing across pretest-test-posttest periods.
Hadeed et al. under review No difference between incubator and KC in amount of time spent
in periodic breathing
Ludington-Hoe et al., 1991 Percent time spent in periodic breathing was significantly less in
KC.
Ludington-Hoe, Ferreira,1995 Decreased periodic breathing during KC (in abstracts on KC
bib)
Ludington-Hoe et al., 1998 Minimization of periodic breathing occurred during KC
Pulmonary Function Tests
Bauer et al.,1998
No change in minute ventilation from pretest (60 minutes in incubator) to
Test (60 minutes in KC) to posttest (60 minutes back in incubator) during
first Week of KC. During 2nd KC week, minute ventilation was higher
than it had been during week 1.
Ludington-Hoe et al, 1999 No change in airway pressure, minute ventilation, tidal volume,
end tidal CO2, Dynamic compliance over 1 hour pretest in incubator, one
hour of KC, and one hour back in the incubator. This reference is an
abstract, so it is in published
Abstract section of the Kangaroo Care bibliography.
Heart Rate Variability
Ludington-Hoe, et al. Recovery from pain of heelstick is facilitated by significantly less
sympathetic activity in the presence of increased parasympathetic
activity during KC.
McCain et al.,( in press) Case study of 90 minutes of incubator followed by 90 minutes of KC.
Decreased sympathetic activity in face of increased parasympathetic
activity during KC as compared to incubator period. Even during quiet
sleep of KC, sympathetic nervous system is active – ready to respond to
cardiorespiratory threats.
Schrod & Walter, 2002 Greater increase in low frequency than high frequency activity after
being returned to horizontal position, suggesting a relative increase in
sympathetic versus vagal activation with head up position (as might be the
case in KC).
Smith, 2002
No change in low frequency, high frequency or ratio of HRV from
incubator to KC position.
Understanding heart rate variability (HRV). Heart rate variability is a measure of the
interval from the peak of one “r” wave to the next. The amount of time between the peaks is
called the interval and measuring the length of the intervals gives us a “time” value. When the
heart is healthy and well oxygenated, this heart rate interval varies a good deal, thus the name
“variability” and “heart rate variability”. A higher time value indicates a healthy responsive
heart; decreasing time and less variability in the intervals indicates a poorly oxygenated heart. In
addition to the “time domain” measure of the r-to-r interval, the heart rate data provides
information about the sympathetic and parasympathetic nervous systems. Measuring the
sympathetic and parasympathetic nervous systems is done by calculating “frequency domain”
measures. There are three frequency domain measures: low frequency, high frequency, and
low:high frequency ratio. The low frequency value reflects the amount of sympathetic nervous
system control being exerted. The sympathetic nervous system is activated under stress – it
provides resources needed for “fight” or “flight” and to respond to sudden infant death threats.
The high frequency value reflects the amount of parasympathetic nervous system control being
exerted. The parasympathetic nervous system exerts a calming, quieting, peacekeeping
influence. The ratio of the sympathetic:parasympathetic tells us how much sympathetic
activation there is for every one unit of parasympathetic activation. When the
sympathetic:parasympathetic ratio is high, the sympathetic nervous system is exerting a good
deal of control over the situation and the sympathetic nervous system is highly responding to the
situation. A lower ratio indicates much less intense sympathetic activation. You will be hearing
more about heart rate variability as it is becoming a new vital sign for intensively ill infants
(Verklan & Padhye, 2004)
One very important study was conducted by Schrod and Walter (2002). This study
examined the effect of the head up position on cerebral hemodynamics. The head up position
they tested was one that they said was similar to the head up position of Kangaroo Care. The
authors started the manuscript by stating that handling, temperature control, and head elevated
body position are stress factors for infants during KC (pg. 258). 36 preterm infants who were a
mean 32.5 weeks post conceptional age, and with birth weights ranging from 880 to 2980 grams
(average birthweight was 1460 grams) were tested to determine if head-up position of KC caused
autonomic (sympathetic and parasympathetic nervous systems) stress. After 3 minutes of
adaptation, prolonged head-up position did not produce further changes in HR, mean arterial
pressure, and SaO2. Respiratory frequency was reduced by 6-12% in the head-up position. Heart
rate variability (HRV) showed greater increase in low frequency (sympathetic) than high frequency
(parasympathetic) activity after being returned to horizontal position, suggesting a relative increase
in sympathetic activation versus vagal or parasympathetic activation. Preterm infants <1500 grams
weight showed a significant decrease in regional cerebral oxygen saturation of about 2%-5% from
day 2-day 8 of testing. A decrease of 2%-5% cerebral oxygen saturation is NOT clinically
significant. There were no prolonged side effects of prolonged head-up position in stable preterm
infants over first days of life (2-12 days of life), though initial decline in total cerebral hemoglobin
in first 3 minutes of head-up position might be critical in very immature infants. Prolonged head-up
positioning has no undesirable effects in preterm infants with stable circulation including very
immature infants of 25 weeks gestation” (pg. 259).
Life Threatening Events.
Objective 5: Identify at least three potential negative cardiorespiratory
effects of Kangaroo Care.
90-95% of infants do well in Kangaroo Care and have improved cardiorespiratory status.
But some infants may not respond positively to Kangaroo Care. In all the literature available to
date (about 325 publications and more than 5000 infants studied in Kangaroo Care), the
occurrence of negative events is small indeed, and some of the negative outcomes listed below
are not necessarily negative outcomes, but warnings instead. For example, the first two
references on the list below reveal the finding that 25-27 weekers did not gain body temperature
from the mother (and in the first one actually had a slight drop in body temperature), but infants
of 28 weeks gestation or more do not lose body temperature and gain body temperature. Be sure
that you are aware of the issues that have been encountered to date. The list below is
comprehensive.
Bauer K et al., 1998
Bauer J et al., 1996
Bohnhorst et al., 2001
Bosque et al., 1995
Diaz-Rosello et al., 1990
25-27 weekers who got KC lost body temp. 28 or more weekers do
not.
25-27 weekers did not gain body temp in KC, 28 or more wks do.
Proportion of regular breathing decreased in 2nd hour of KC,
possibly due to heat stress, even though temp in 2nd hour was still
< 37.4.
Mean axillary temp dropped 3/10 of a degree- due to no control
over
insulating clothing across the infants’ backs.
Exclusive breastfeeding for LBW infants in 24/7 KC is insufficient
for adequate weight gain over first year of life. LBWs need
fortification.
Drosten-Brooks,1993
Gale, Franck, Lund, 1993
Neu et al., 2000
Smith, 2001
Sontheimer et al.,1995
Vanden, Bosch,
& Nhaine, 1993
Wieland et al., 1995
Accidental extubation of one infant during ventilated KC
15 minutes of wriggling around when first put in KC with
substance abusing moms.
Desaturations occur during transfer into/out of ventilated KC
Though no sig diff between groups in temperature, KC group
gained more than 0.1degree per hour and desats occurred in 2nd
hour of KC with 34 days old ventilated bronchopulmonary
dysplasia infants.
Signal detection of apnea may be masked by maternal respiration if
electrode is on front of chest beneath mother instead of in infant
axilla
Sufffocation by sleeping mothers of two babies in 24/7 KC at
home and lack of good support when using slings was seen.
Of 167 first KC sessions of 30 minutes duration, KC had to be
stopped for infant restlessness 5 times, for increasing
apnea/bradycardia 4 times, for hypothermia 3 times, and for
rapidly increasing FiO2 needs one time. Also, of 16 infants with
elevated inspiratory oxygen need before KC, 13 infants needed
more FiO2 during 30 minutes of KC (babies were 25-32 wk GA
tested at 28 wks with wgts of 740-2125 gram with mean of 1110
gram on day 10 of life) .
References ( If not listed here, the reference is in the Kangaroo Care bibliography in the
appendix).
Meier PP, Engstrom JL, Mingoletti SS, Miracle DJ, & Kiesling S. 2004. The Rush
Mother’s Milk club: Breastfeeding interventions for mothers with very-low-birth-weight inants.
J.Obstet Gynecol Neonatal Nurs, 33 (5), 164-174.
Verklan MT & Padhye NS. 2004. Spectral analysis of heart rate variability: An emerging
tool for assessing stability during transition to extrauterine life. J Obstet Gynecol Neonatal Nursing,
33 (2), 256-265.