Samantha
Benefits of Kangaroo Care in Premature Infants
Unit 3
Abstract
Kangaroo Care is the simple act of holding an infant “skin to skin.” In medical
terms, and specifically regarding premature babies, its effects are pronounced and proven
beneficial for both babies and parents. Physically, behaviorally and emotionally,
kangaroo care has significantly improved and advanced the lives of countless premature
infants throughout the world. The natural act of placing a pre-term infant on its mother’s
chest has resulted in study after study of positive outcomes. Though many Neonatal
Intensive Care Units (NICUs) support kangaroo care, some hospitals do not routinely
utilize it and/or are undertrained in its use. Expanding and standardizing the provision of
kangaroo care should be undertaken by neonatologists and medical facilities should
incorporate the necessary equipment and training to make kangaroo care a standard in
every hospital NICU.
Introduction
A premature baby is one that is born before 37 weeks of pregnancy. Often times,
these tiny babies enter the world with moderate to severe health issues. Most spend time
in a unit of the hospital known as the NICU, or neonatal intensive care unit. Health issues
common to “preemies” include apnea, jaundice, anemia, infections and respiratory
distress syndrome. The NICU is a uniquely specialized unit that provides incredible care
and support to families going through a health crisis with their newborn.i Preterm birth is
a very serious situation and is the largest direct cause of neonatal mortality. It accounts
for almost 27% of the neonatal deaths every year.ii Parents and families of preemies will
oftentimes spend days, weeks and even month in the NICU, making it difficult to bond
with the newborn and making it harder to feel a connection with the child while they are
living in the hospital.
Kangaroo care (KC) is the practice of using skin-to-skin contact between newborn
babies and their mothers shortly after birth. The technique began in 1978 with a
Columbian doctor named Edgar Rey.iii Rey worked at a hospital that was overcrowded
and low on incubators. Out of necessity, he suggested using the mother’s own body heat
to properly regulate the baby’s temperature. The results were astonishing to the
caregivers as the infants did very well despite the lack of technology. The technique has
flourished and become popular throughout the world, especially in the United States.iv In
many neonatal intensive care units, the practice is highly recommended to maintain skin
temperature of the newborn, reduce stress, increase the comfort of the baby and to help
the baby successfully breastfeed. Along with this, KC care builds a unique relationship
between the newborn and their mother. Yet in one study, only 8% of staff in the NICU
routinely offered kangaroo care to the families.
Though beginning in Columbia back in the 70’s, KC is now widespread and well
known for its benefits. The World Health Organization has even recognized kangaroo
care as equivalent to conventional neonatal care and has published guidelines for the
practice. The cost of care per premature baby born in the U.S. is estimated to be about
$51,600.ii Providing KC costs virtually nothing, and is proven to positively support both
the infant and parents. So why isn’t kangaroo care a standard practice in all NICU’s and
used in conjunction with the other care the infant is receiving?
When to Start Kangaroo Care
The issue that health care professionals address is “readiness” for both the infants
and parents before the use of kangaroo care. The best way to assess readiness of the
infant for KC is through vital signs when the infant is at rest and incubated. If the infant
is tachycardic because of agitation, bradycardic, or has period breathing, KC can be
trialed with the infant’s stats closely monitored. Kangaroo care is not recommended if
their oxygen saturation is less than 85%.ii Infants with arterial lines or those weaning off
a ventilator should not participate in KC as well.
Parents, too, are assessed for readiness for kangaroo care. Studies have found
fathers are often more ready to start kangaroo care while mothers are dealing with the
“loss of the expected infant” and need time to come to terms with the situation.
Interestingly, a mother’s own nurturing instincts sometimes makes it difficult for them to
“kangaroo” their tiny baby as it is very different than nurturing a full term infant. Many
parents are overwhelmed and frightened that they may not be able to care for their own
child. It is a benefit to mothers, however, if they want to breastfeed as KC is then
promoted at the earliest possible time.ii
Lastly, the hospital itself must be ready for kangaroo care. There must be
adequate nurse training in order for the staff to feel comfortable, and adequate staffing for
both basic infant and parental support but potential emergencies as well. Space must be
made available for safe transfer of the infant to the mother, and lounge chairs with feet
support are standard. Parents need gowns to cover themselves with as well as privacy
screens (depending on the layout of the area) and the babies need blankets and head
caps.ii
Procedure and Parental Training
As stated, kangaroo care is the act of skin-to-skin contact between an infant and
its parents. There is equipment required, eligibility to be met and preparation that goes
into this “simple” act of holding ones newborn baby. The hospital must supply blankets, a
reclining chair, a privacy screen and sufficient room for the kangaroo care to occur. The
baby must be “stable” meaning no deterioration in condition within the previous 24
hours. Their tubes must be secured and the mothers and fathers must be willing to
participate.ii
Parents must be educated by the staff on KC verbally, through written materials,
or through videos in order to prepare for this new experience. Lines and tubes must be
secured on the infant and procedures that may disrupt the infant holding must be done
prior to KC. Depending upon the baby’s weight, they may need to wear a hat and booties
to assist in maintaining body temperature. Lastly, the baby’s vital signs must be checked
one last time before transferring the baby over to their mother or father.ii
The transfer can be done while the parent is sitting in the recliner or standing next
to the incubator. This depends on the parent’s comfort level, and his or her ability to get
into the chair easily. The baby’s arms and legs should be in midline in the flexed position.
The infant should be placed upright on the parent’s chest between or on the breast. Next,
a blanket should be put over the infants back. The cover gown on the mother should be
closed over the blanket and infant to protect against side drafts. The infant’s head and
face positioning must be checked to make sure they are able to breathe comfortably.
Some hospitals give parents a mirror to be able to look at the infants face during KC.ii
Throughout the rest of the session, the infant continues to be monitored for vital
sign and/or temperature changes. About 15 to 20 minutes is the average time for the
infant’s vital signs to stabilize after being transferred to the parent. If the infant falls
asleep, KC should be allowed to continue for as long as possible for the baby to remain
asleep and comfortable. The infant may be fed during KC and breast-feeding can be
attempted.ii
Beneficial Outcomes
Since the practice began in the 70’s, there have been numerous studies done to
prove its positive effects. Behavior effects are one of the most obvious benefits of
kangaroo care. Sleeping patterns among premature infants have been shown to
significantly improve with the use of KC. Infants receiving KC show an increase in the
length in time they sleep and in the amount of quiet (more restful) sleep. Crying is
another area in which KC has an effect. Studies show that infants rarely cry when resting
on their mother or fathers’ chest. In addition, and if they are receiving kangaroo care,
they cry less when in the incubator as well.
Breastfeeding is an area that has been widely studied in relation to kangaroo care.
From initiation to performance, milk production and duration, studies prove that KC,
when done as soon as possible and as much as possible, increases the likelihood of
successful breastfeeding. One report showed a 98% exclusive breastfeeding rate when
discharged from the NICU if the infant had been started on kangaroo care daily within a
day or two after birth.
Infants receiving kangaroo care have proven to be more alert and attentive to their
environment. Infants in another study had higher mental and motor development scores at
6 months and 1 year after receiving kangaroo care as compared to other premature infants
who had not. This neurobehavioral development being promoted by kangaroo care is
based on the fact that brain development is dependent on sleep. Since kangaroo care
greatly improves sleep in preemies, it also helps mature brain functioning.
Psychologically, kangaroo care has been found to improve parent’s feelings
about adapting to their premature infant’s new life. Mothers have been able to feel less
guilty and more competent.ii Mothers in one study were found to have a bonding effect
that became much stronger due to KC. They were more resilient in stressful situations
with the child and were measurably more responsive to the infant.v Fathers have been
able to feel a greater attachment to their infant as a result of kangaroo care. Fathering
interactions, infant cues and confidence also increase for fathers who participate in KC.
Overall, parents feel more connected to their baby and less anxiety about their premature
infant after successfully taking part in the act of kangaroo care.ii
Obstacles and Downfalls
Given the wealth of information supporting the benefits of kangaroo care to both
infants and families, one may wonder why some hospitals do not implement this practice.
From studies done, it is not that hospitals do not believe in kangaroo care or its healing
powers but that there are other confounding variables that must be dealt with. For
instance, certain wards are not large enough for this practice to go on. Overcrowding of a
NICU is not hygienically safe or physically safe for the baby or the parents. A baby in the
NICU is obviously very susceptible to germs so overcrowding could put the baby at risk
for infections. Overcrowding can also mean difficulty getting around the ward in an
emergency situation, creating an unsafe environment for unstable preemies. Another
reason for concern for some hospitals is the worry of the parent falling asleep with the
baby on their chest. If this occurred, the baby could be accidentally smothered. One
particular study found that parents who want to use kangaroo care often need the support
of the nursing staff, whether from a lack of confidence or a feeling of being
overwhelmed. This has resulted in some hospitals believing that kangaroo care translates
into more work for the staff.vi In another study, the main concern with kangaroo care was
the ability to monitor the baby’s respiratory stats during the practice. Though heart rate
and oxygen saturation did not present as a problem, respiration can be an issue for nurses
monitoring the baby. During kangaroo care, the baby is on its parent’s chest. Because of
this, the electrodes on the baby were recording both the baby and the parent’s respiration.
The parents’ respiration was superimposed on the monitor making it difficult to tell if the
baby was stable or in any type of distress such as apnea.vii
Conclusion
Embracing alternative methods of health care is not a new concept, yet standard
protocols are not in place in hospitals for kangaroo care for infants. When the
conventional medical community dismisses alternative care it is usually because of a lack
of scientific research to support its benefits. That is not the case with kangaroo care,
which has been studied extensively throughout the world. Perhaps because the patients
are so tiny and oftentimes fragile, it appears that many healthcare professionals fear the
slightest change for these delicate babies, despite proof that the benefits far outweigh the
negatives. Mandatory training for NICU nurses in the provision of kangaroo care would
go a long way to remove the fear associated with it, and create a more comfortable
environment for the infant, the parents and the professional staff themselves. Making
small adjustments to the physical space in the NICU would accommodate safe and
effective KC for all who wanted it. There is a minimal dollar cost to provide the
equipment needed, but the human costs are overwhelmingly helpful to the overall and
unanimous goal of assisting premature babies with their growth, healing and
development.
Reflective Note
I would definitely include this paper in my professional portfolio. To date, I feel this
is one of the more in depth papers we have done in this class or any class at
Northeastern and I think because of the audience I cater to throughout the paper, it
would be great for my portfolio. It definitely has a few things that need to be cleaned
up but once it is a final
draft, I would include this piece for sure.
References
March of Dimes. Your Premature Baby. Available at
http://www.marchofdimes.com/baby/premature_indepth.html. September 2012.
i
Ludington–Hoe, S.M., Morgan, K. and Abouelfettoh, A. 2008 A clinical guideline for
Implementation of kangaroo care with premature infants of 30 or more weeks’
postmenstrual age. Advances in Neonatal Care, 8, 3S, 3-23.
ii
McKee M. Mums’ warmth is best way to incubate babies. Nov 20, 2004. New
Scientist. 184.2474
iii
Cooper, L. G. (2012), The Perfect Pouch: A March of Dimes Intervention to Enhance
Onset and Frequency of Kangaroo Care. Journal of Obstetric, Gynecologic, & Neonatal
Nursing, 41: S49–S50. doi: 10.1111/j.1552-6909.2012.01360_32.x
iv
Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, Charpak Y,
Charpak N. Kangaroo mother care and the bonding hypothesis. Pediatrics. 1998
Aug;102(2):e17. PubMed PMID: 9685462.
v
Solomons N., Rosant C. Knowledge and attitude of nursing staff and mothers towards
kangaroo mother care (KMC) in the eastern sub-district of Cape Town. South African
Journal of Clinical Nutrition, 2012;25(1):33-39.
vi
Sontheimer D, Fischer CB, Scheffer F, Kaempf D, Linderkamp O. Pitfalls in
respiratory monitoring of premature infants during kangaroo care. Arch Dis Child Fetal
Neonatal Ed. 1995 Mar;72(2):F115-7. PubMed PMID: 7712268; PubMed Central
PMCID: PMC2528385.
vii