Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India

Postnatal Kangaroo mother care practice at home and comparison of improvement in vital parameters in low-birth-weight babies in-home setup and non-teaching hospital setup in rural coal mines area Jharkhand, India: A community-based observational study

Introduction

Low birth weight (LBW) newborns especially those <2000 g are more prone to hypothermia due to which other physiological parameters gets deteriorated in the 1st week of life. The objective of this observational study was to continue Kangaroo mother care practice at home and to ascertain whether KMC was effective in improving the vital parameters of LBW babies when it is given at home in a rural coal mines area, in Jharkhand, India.

Materials and Methods

This study was a community-based prospective observational study, done over three years from November 2019 to November 2022. In this study, we included 156 pairs of both mothers and LBW babies (weight 1500 g to <2000 g). After discharge from the hospital on day 3, KMC was continued at home on day 4, day 5, and day 6. Data of four physiological parameters, namely, temperature, oxygen saturation, respiratory rate, and heart rate were collected before and after KMC and analyzed.

Results

Among 400 newborns, 156 LBW babies (39.0%) who were given KMC at home showed similar but statistically significant improvement of vital parameters, especially in temperature and oxygen saturation (P < 0.0001) compared to the same babies 156 (39.0%) given KMC in the hospital (P < 0.001).

Conclusion

Kangaroo mother care, which was continued at home, has a significant role in the Improvement of vital parameters, especially concerning temperature and oxygen saturation. If the babies in the weight range of 1500 g to <2000 g are healthy, well-breast-fed, and have no other risk factors, they can be discharged early and managed at home by delivering supportive care and nursing care along with Kangaroo mother care with continuous follow-up.

Kangaroo Mother Care for Low-Birth-Weight Babies in Low and Middle-Income Countries: A Narrative Review

In low and middle-income countries (LMICs), the infant mortality rate is much higher than the high-income countries (HICs). The higher infant mortality is due to low birth weight (LBW) a combination of intra-uterine growth retardation (IUGR) and prematurity, which are risk factors for acquiring infectious diseases amongst newborns. Kangaroo mother care (KMC) is a neonatal procedure that is carried out in newborn infants, especially in preterm babies and LBW babies. It is skin-to-skin contact between a mother's bare chest and a stable infant. KMC is an important intervention in reducing infant mortality rates in LMICs. A comprehensive literature and data search was done using key databases like PubMed and Google Scholar. A total of 42 articles out of 1,168 articles were selected for review after screening and elimination of the repeated articles. Through this review we have tried to analyse the benefits of KMC in newborns, the need for the participation of fathers and family members, and the need for implementation of this practice at a broader level by policy formulation in LMICs. We have also discussed the need for KMC for the prevention of infant mortality in LBW newborns in LMICs.

Effect evaluation of kangaroo mother care in Liping area, Guizhou province,China

BACKGROUD

Kangaroo mother care (KMC) refers to the mother and baby after the birth of the early start of continuous skin contact way of a newborn care, which is a simple operation, easy controlled and with low cost, no large or high consumption of equipment.So it is very suitable for developing in areas where medical resources are relatively scarce, such as GuiZhou province where is a relatively poor province in China with many ethnic minorities.

METHODS

This study selected the pregnant women who gave birth in Liping County, Guizhou Province, China, as the research object, to explore the impact of kangaroo mother care on the physiologic status of newborns in liping county, Guizhou Province.

RESULTS

A total of 347 hospitalized parturient women were divided into the KMC group and the control group. The results showed that the KMC group showed obvious advantages in stabilizing newborn vital signs, health indicators, promoting the success rate of breastfeeding and reducing newborn pain.

CONCLUSIONS

Research shows that kangaroo mother care is beneficial to postpartum maternal and infant health, and has advantages suitable for local characteristics, which is worth further promotion in minority areas of Guizhou Province.

Review of Kangaroo Mother Care in the Middle East

Mothers and newborns have a natural physiological requirement to be together immediately after birth. A newborn has a keen sense of smell and will instinctively seek out the mother’s nipple and begin breastfeeding if placed skin-to-skin with her. This practice is known as Kangaroo Mother Care (KMC). It was first suggested in 1978 and has been recommended by the World Health Organization (WHO) as a means to ensure successful breastfeeding. It is well documented that KMC is associated with positive breastfeeding outcomes, particularly in cases where breastfeeding is exclusive and, on average, continued for 3 months or longer. Studies of infant nutrition and breastfeeding have shown the importance of immediate, uninterrupted skin-to-skin contact between newborn and mother following vaginal birth. This practice is also recommended for mothers who give birth via cesarean section, once the newborn is stable. The rate of breastfeeding is still suboptimal in Middle Eastern countries, in light of the WHO’s recommendation that mothers should exclusively breastfeed for the first six months and continue breastfeeding for up to two years. To increase the rate of breastfeeding, practices should be promoted that have been shown to improve outcomes, such as KMC. However, little is known about this important practice in the region. The aim of this study was to shed light on KMC-related studies conducted in the Middle East between January 2010 and January 2022. Specifically, this review examines breastfeeding practice rates for the first 6 months of birth, and evidence of KMC practices, by country and type of study design. The research terms used for this review were “skin to skin”, “Skin to skin contact”, and “Kangaroo Mother Care”, focusing on “Middle East”, “Eastern Mediterranean”, “Arabian Gulf”, “Arab”, and “GCC”.

Effect on the practice of the kangaroo method on the formation and strengthening of the mother-baby bond: a systematic review

Abstract Objectives: a systematic review study with the objective of estimating the effect on the practice of the kangaroo method (KM) on the formation and strengthening of the mother-baby bond (MBB). Methods: independent searches were performed in three international databases in the United States National Library of Medicine - PubMed, Scientific Electronic Library Online - Scielo and Web of Science databases. Searches were made without limit on languages and year of publication. Results: the final selection consisted of 27 studies, 14 of a quantitative nature (nine clinical trials and five observational) and 13 qualitative. All qualitative articles and most quantitative ones (n=10) indicated the practice of the KM as favorable to the formation and strengthening of the MBB. Other quantitative studies did not show statistically significant differences in the comparisons made between groups. None of the 27 studies found unfavorable effects resulting from the practice of KM on the MBB. Conclusion: the results suggest that the KM favors the formation and strengthening of the MBB regardless of the weight and gestational age of the newborns or the place of measurement (hospital or residence). Thus, encouraging the execution of this biopsychosocial intervention of qualified and humanized care is recommended for the promotion of children’s health.

Barriers and facilitators to kangaroo mother care implementation in Cote d'Ivoire: a qualitative study

Background

Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country.

Method

This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding.

Results

A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders.

Conclusion

Our study highlighted the challenges to implement KMC in Cote d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07086-9.

Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study

Background

Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and prolonged skin-to-skin contact between an infant and caregiver, exclusive breastfeeding, early discharge from the hospital, and post-discharge follow-up. The purpose of this study was to investigate the fidelity of this intervention’s implementation according to national guidelines across all tiers of government (public) health facilities of Bangladesh.

Methods

We adopted a triangulation mixed-methods approach of both quantitative and qualitative components in this research to support and explain the information obtained from quantitative observation with the help of qualitative interviews on the fidelity of KMC practice. We used an observation checklist to find the fidelity of KMC practice and used semi-structured guidelines to explain and understand the moderators of fidelity through key informant interviews and in-depth interviews. We undertook eight facility visits in four districts, observed twenty-three neonates and their caregivers during KMC practice at those facilities, and conducted twenty-seven key informant interviews with facility managers, health care providers, and five in-depth interviews with caregivers. Extracted information was triangulated and arranged under the themes of the fidelity framework.

Results

Despite being a low-cost intervention, findings exhibit some adherence to the national guideline with several gaps in practice. Leadership played a critical role in ensuring the KMC practice. Specific components of KMC practice, like duration, nutrition maintenance, discharge criteria, and follow-up, were not consistent as recommended. Infrastructure, human resources, developmental partner support, and the demand-side and supply-side responsiveness played a critical role in enacting this human-centric approach’s fidelity. The observed interruption found in the implementation process posed threats to achieve the intended outcome as these caused violations of the basic principles of KMC.

Conclusions

The study findings will help find ways to effectively deliver this intervention so that fidelity of practice is maintained, enhancing KMC services’ quality and advocating towards the successful scale-up of this program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00215-9.

Short-time effect of the kangaroo position on electromyographic activity of premature infants: a randomized clinical trial

OBJECTIVE

To verify the short-term influence of the kangaroo position (KP) on the electromyography activity of preterm newborns.

METHOD

A clinical study was conducted in a kangaroo unit sector (secondary and tertiary care) in the city of Recife, Brazil, with 44 preterm infants randomized to intervention (n=21) and control (n=23) groups. The KP was performed through a band that supports the newborn against the adult's thorax, in a prone and vertical position, and infants were dressed with few pieces of clothes, thus keeping skin-to-skin contact with the mother. Surface electromyography was used to investigate the muscle activity of the biceps brachii and hamstrings. The randomization of the groups was performed by the program R® (v. 3.3.1). The electromyography registrations were made at three different times: before the KP and after one and two hours of KP. In the control group, the registrations were performed at the times corresponding to those of the intervention group. The mean values of the electromyography activity among the times were analyzed by ANOVA for repeated measures and the Kruskal-Wallis test. The clinical trial was recorded in ClinicalTrials.gov (NCT02849665 - 07/28/2016).

RESULTS

In the intervention group (n=21), there was a variation of the electromyography activity values between the three recording moments for both the biceps brachii and hamstrings. In the control group (n=23), there was no statistical difference between the recording moments for both.

CONCLUSIONS

The KP increases the short-term electromyographic activity of the biceps brachii and hamstrings.

Emotions and Experience of Fathers applying Kangaroo Care in the Eastern Anatolia Region of Turkey: A Qualitative Study

The aim of this study was to investigate the emotions and experiences of fathers in Eastern Anatolia Region of Turkey who applied kangaroo care in the neonatal intensive care unit. This study applied the qualitative descriptive design. The study included 12 fathers at the NICU of a university hospital. The fathers practiced kangaroo care with their babies two times a day for 15 days. Content analysis was then conducted to determine the main themes and sub-themes of the interviews. Three main themes and six sub-themes emerged from the analysis: (1) Emotions of being a father (feeling that the baby belongs to own and feeling the warmth and scent of the baby); (2) Confidence in fathering roles (self-confidence and caring for the baby); and (3) Happiness in the new parent role (seeing the baby calm down, hugging the baby and touching the baby's skin).

Skin-to-skin contact at birth for vaginally delivered neonates in a tertiary care hospital: A cross-sectional study

Background

Neonates undergoing skin-to-skin contact (SSC) have shown to have better cardiovascular stability, improved duration of breastfeeding, temperature maintenance and bonding. The primary objective was to estimate the existing prevalence of SSC among mother-infant dyads in the first hour after vaginal delivery, and the secondary objective was to ascertain the factors affecting adherence of SSC after vaginal delivery.

Methods

This cross-sectional study was carried out in a tertiary care teaching hospital between September 2017 and December 2017. All mother-newborn dyads in the labour room were eligible for the study. Mothers with their newborns, who gave multiple births, or with major congenital malformations or those requiring any form of resuscitation or having respiratory distress or requiring observation in neonatal intensive care unit (NICU) were excluded. All included mother-newborn dyads, after exclusion, were observed for SSC, and the duration in each dyad was recorded. All enrolled mothers, the attending doctors and nurses were asked questions based on a prevalidated questionnaire for the possible barriers of implementation.

Results

Of a total of 164 mother-infant dyads studied, only 34 (20.7%) carried out SSC for more than 30 min. Sixty-two (37.8%) mother-infant dyads did not participate in any SSC. The commonest reason for non-adherence to SSC was unawareness about the practice in 82.25%, followed by pain and exhaustion after the labour process in 8%.

Conclusion

The rate of SSC at birth is suboptimal, and the commonest reason is lack of awareness about this important step of essential newborn care.

Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

Background

Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).

Methods

A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.

Results

One hundred thirty-five preterm infants received KMC, 21.2% of all preterm infants discharged. 65.2% of those who received KMC were below 32 weeks GA, 60.7% had a birth weight below 1500 g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA < 28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.

Conclusions

After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

Longer duration of kangaroo care improves neurobehavioral performance and feeding in preterm infants: a randomized controlled trial

AIM

To investigate the effect of kangaroo care (KC) and its duration on neurobehavioral performance, stress response, breastfeeding success, and vital signs in premature infants.

METHODS

One hundred and twenty premature infants were randomized to receive either KC for 60 min daily, KC for 120 min daily or conventional care (controls) for at least 7 days. Salivary cortisol was measured before and after the first KC session and then after 7 days. Temperature, respiration rate, heart rate, and oxygen saturation were recorded, before and after KC. Neonates were evaluated by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS).

RESULTS

Both KC groups demonstrated higher scores for attention, arousal, regulation, nonoptimal reflexes, and quality of movements and lower scores for handling, excitability, and lethargy, compared to controls (p < 0.05). Both KC groups had higher infant breastfeeding assessment tool score and reached full enteral feeds faster than controls (p < 0.05). After the first KC session, improvement in O₂ saturation and temperature was observed in KC 120-min group compared with the KC 60-min group (p < 0.05). Salivary cortisol decreased in both KC groups compared with controls after 7 days (p < 0.05).

CONCLUSION

Preterm neonates who receive KC for long durations reach full enteral feeds faster, have better breastfeeding success, neurobehavioral performance, thermal control, and tissue oxygenation.

WITHDRAWN: Short-time effect of the kangaroo position on electromyographic activity of premature infants: a randomized clinical trial

The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years

Background

In 2012, we performed a needs assessment and gap analysis to qualitatively assess providers’ and patients’ knowledge and perceptions regarding preterm birth (PTB). During the study, we identified knowledge gaps surrounding methods to reduce the risk of occurrence of PTB and management options if preterm labor/birth occur. We targeted health messages toward these gaps. The objective of the present study was to assess the impact of our community health worker-based patient education program 3 years after it was implemented.

Methods

Fifteen focus groups including 70 participants were included in the study. The groups comprised either patients/patient couples or health providers. A minimum of two facilitators led each group using 22 a priori designed and standardized lead-in prompts for participants with four additional prompts for providers only. A single researcher recorded responses, and transcript notes were reviewed by the facilitators and interpreters immediately following each group discussion to ensure accuracy.

Results

The understanding of term vs preterm gestation was generally accurate. Every participant knew of women who had experienced PTB, and the general perception was that two to three women out of every ten had this experience. The majority of respondents thought that women should present to their local health clinic if they experience preterm contractions; few were aware of the use of antenatal steroids for promoting fetal lung maturity, but many acknowledged that the neonate may be able to receive life-sustaining treatment if born at a higher level of care facility. The majority of participants were aware that PTB could recur in subsequent pregnancies. All respondents were able to list ways that women could potentially reduce the risk of PTB.

Conclusion

After employing targeted health messages, the majority of participants expressed improved understanding of the definition of PTB, methods to prevent risk of PTB, and management options for preterm labor or PTB.

Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review

Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities. Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities. Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.

Randomized Controlled Trial on Effect of Intermittent Early Versus Late Kangaroo Mother Care on Human Milk Feeding in Low-Birth-Weight Neonates

BACKGROUND

Breastfeeding at discharge among sick low-birth-weight (LBW) infants is low despite counseling and intervention like kangaroo mother care (KMC). Research aim: The aim was to study the effects of early initiation of KMC on exclusive human milk feeding, growth, mortality, and morbidities in LBW neonates compared with late initiation of KMC during the hospital stay and postdischarge.

METHODS

A randomized controlled trial was conducted in level 2 and 3 areas of a tertiary care neonatal unit over 15 months. Inborn neonates weighing 1 to 1.8 kg and hemodynamically stable were randomized to receive either early KMC, initiated within the first 4 days of life, or late KMC (off respiratory support and intravenous fluids). Follow-up was until 1 month postdischarge. Outcomes were proportion of infants achieving exclusive human milk feeding and direct breastfeeding, growth, mortality and morbidities during hospital stay, and postdischarge feeding and KMC practices until 1 month.

RESULTS

The early KMC group ( n = 80) achieved significantly higher exclusive human milk feeding (86% vs. 45%, p < .001) and direct breastfeeding (49% vs. 30%, p = .021) in hospital and almost exclusive human milk feeding (73% vs. 36%, p < .001) until 1 month postdischarge than the late KMC group ( n = 80). The incidence of apnea (11.9% vs. 20%, p = .027) and recurrent apnea requiring ventilation (8.8% vs. 15%, p = .02) were significantly reduced in the early KMC group. There was no significant difference in mortality, morbidities, and growth during the hospital stay and postdischarge.

CONCLUSION

Early KMC significantly increased exclusive human milk feeding and direct breastfeeding in LBW infants.

The relationship between women's experiences of mistreatment at facilities during childbirth, types of support received and person providing the support in Lucknow, India

BACKGROUND

a growing body of literature has highlighted the prevalence of mistreatment that women experience around the globe during childbirth, including verbal and physical abuse, neglect, lack of support, and disrespect. Much of this has been qualitative. Research around the world suggests that support during childbirth can improve health outcomes and behaviours, and improve experiences. Support can be instrumental, informational, or emotional, and can be provided by a variety of people including family (husbands, mothers) or health providers of various professional levels. This study explores women's reported experiences of mistreatment during childbirth quantitatively, and how these varied by specific types of support available and provided by specific individuals.

METHODS

participants were women age 16-30 who had delivered infants in a health facility in the previous five years and were living in slums of Lucknow India. Data were collected on their experiences of mistreatment, the types of support they received, and who provided that support.

RESULTS

women who reported lack of support were more likely to report mistreatment. Lack of support in regards to discussions with providers and provider information were most strongly associated with a higher mistreatment score. Women who received any type of support from their husband or a health worker were significantly more likely to report lower mistreatment scores. Receiving informational support from a mother/mother-in-law or emotional support from a health worker was also associated with lower mistreatment scores. However, receiving emotional support from a friend/neighbour/other family member was associated with a higher mistreatment score.

CONCLUSIONS

women rely on different people to provide different types of support during childbirth in this setting. Some of these individuals provide specific types of support that ultimately improve a woman's overall experience of her childbirth. Interventions aiming to reduce mistreatment to women during childbirth should consider the important role of increasing support for women, and who might be the most appropriate person to provide the most essential types of support through this process.

The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia

Background

Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries.

Methods

Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders.

Results

The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies.

Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs.

The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998–2006); the newborn-care phase (2007–2012); and lastly the current phase where small babies are also included in action plans.

Conclusions

This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.

Kangaroo mother care: a systematic review of barriers and enablers

OBJECTIVE

To investigate factors influencing the adoption of kangaroo mother care in different contexts.

METHODS

We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization's regional databases, for studies on "kangaroo mother care" or "kangaroo care" or "skin-to-skin care" from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems.

FINDINGS

We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption.

CONCLUSION

Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake.

Keeping babies warm: a non-inferiority trial of a conductive thermal mattress

BACKGROUND

External thermal support is critical for preterm or ill infants due to altered thermoregulation. Incubators are the gold standard for long-term support and have been adopted successfully in many countries. Alternatives such as radiant warmers, blankets and others are often used as standard of care (SoC) in resource-limited settings when infants are otherwise not in Kangaroo Mother Care (KMC).

METHODS

In this pilot study, we evaluate the feasibility of a conductive thermal mattress (CTM) using phase change materials as a low-cost warmer. We conducted a prospective multicentre open-label randomised controlled trial to determine non-inferiority of this CTM to SoC warming practices in low birthweight infants. The primary outcome was maintenance of axillary temperature.

RESULTS

We equally randomised 160 infants to CTM or SoC. The latter cohort continued to receive warmth by radiant warmers (n=48), blankets (n=18), warmed cradles (n=7) or KMC (n=7) before, during and subsequent to the study. CTM was deemed non-inferior since warmed babies had higher axillary temperature compared with SoC (mean increase 0.11±0.03°C SEM; p<0.001). Post hoc comparison to radiant warmers alone showed that CTM led to a higher axillary temperature (mean increase by 0.14±0.03°C SEM; p<0.001).

CONCLUSIONS

Short-term use of CTM compared with radiant warmers and other modes of warming is non-inferior to SoC and efficacious in maintaining body temperature. No adverse effects were reported. An extended multinational trial, preferably one that demonstrates longer-term thermoregulation, is warranted.

TRIAL REGISTRATION NUMBER

Clinical Trials Registry of India (CTRI/2010/091/002916 and CTRI/2011/04/001696).

Barriers and enablers of kangaroo mother care practice: a systematic review

Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: "Issues with the facility environment / resources," "negative impressions of staff attitudes or interactions with staff," "lack of help with KMC practice or other obligations," and "low awareness of KMC / infant health." Considering only publications from low- and middle-income countries, "pain / fatigue" was ranked higher than when considering all publications. Top enablers to practice were included "mother-infant attachment" and "support from family, friends, and other mentors." Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.

Impact of kangaroo mother care on cerebral blood flow of preterm infants

BACKGROUND

Kangaroo mother care (KMC) has been widely used to improve the care of preterms and low birth weight infants. However, very little is known about cerebral hemodynamics responses in preterm infants during KMC intervention. The aim of this study is to evaluate the changes of cerebral blood flow (CBF) in middle cerebral artery, before and after a 30 minute application of KMC in stable preterm infants.

METHODS

It is a prospective, pre-post test without a control group study. CBF flow paremeters were measured with Doppler ultrasonography in one middle cerebral artery. Sixty preterm stable infants were assessed before and after 30 min KMC. CBF indices were assessed in different positions before KMC, forty neonates in supine position and 20 in vertical suspension (baby is held vertically away from the skin of his mother). Other dependent variables heart rate and mean arterial blood pressure and Spo2 were also studied before and after KMC.

RESULTS

The mean gestational age of the infants was (32 ± 2 weeks), and mean birth weight was (2080 ± 270 gm). Comparing CBF indices (Pulsatility index and Resistive index) before and after KMC has shown a significant decrease in both Pulsatility index (PI) and Resistive index (RI) after 30 min. KMC, the mean values were (2.0 ± 0.43 vs 1.68 ± 0.33 & 0.81 ± 0.05 vs 0.76 ± 0.06 respectively P < 0.05*) with mean difference (0.32 & 95% CI 0.042-0.41 & 0.05 & 95% CI 0.04 to 0.06 respectively P < 0.05*) and increase in end diastolic velocity & mean velocity 30 min of KMC (10.97 ± 4.63 vs. 15.39 ± 5.66 P < 0.05*& 25.66 ± 10.74 vs. 32.86 ± 11.47 P < 0.05* ) with mean difference (- 4.42 & 95% CI -5.67 to -3.18 and -7.21 & 95% CI - 9.41 to 5.00 respectively). These changes indicate improvement in CBF. No correlation has been found between CBF parameters and studied vital signs or SpO2.

CONCLUSION

Kangaroo mother care improves cerebral blood flow, thus it might influence the structure and promote development of the premature infant's brain.

Effect of kangaroo mother care on vital physiological parameters of the low birth weight newborn

Objectives:

Low birth weight (LBW; <2500 g), which is often associated with preterm birth, is a common problem in India. Both are recognized risk factors for neonatal mortality. Kangaroo mother care (KMC) is a non-conventional, low-cost method for newborn care based upon intimate skin-to-skin contact between mother and baby. Our objective was to assess physiological state of LBW babies before and after KMC in a teaching hospital setting.

Materials and Methods:

Study cohort comprised in-born LBW babies and their mothers - 300 mother-baby pairs were selected through purposive sampling. Initially, KMC was started for 1 hour duration (at a stretch) on first day and then increased by 1 hour each day for next 2 days. Axillary temperature, respiration rate (RR/ min), heart rate (HR/ min), and oxygen saturation (SpO₂) were assessed for 3 consecutive days, immediately before and after KMC.

Results:

Data from 265 mother-baby pairs were analyzed. Improvements occurred in all 4 recorded physiological parameters during the KMC sessions. Mean temperature rose by about 0.4°C, RR by 3 per minute, HR by 5 bpm, and SpO₂ by 5% following KMC sessions. Although modest, these changes were statistically significant on all 3 days. Individual abnormalities (e.g. hypothermia, bradycardia, tachycardia, low SpO₂) were often corrected during the KMC sessions.

Conclusions:

Babies receiving KMC showed modest but statistically significant improvement in vital physiological parameters on all 3 days. Thus, without using special equipment, the KMC strategy can offer improved care to LBW babies. These findings support wider implementation of this strategy.

Effect of kangaroo mother care on growth and development of low birthweight babies up to 12 months of age: a controlled clinical trial

AIM

Kangaroo mother care (KMC) is a nonconventional low-cost method of newborn care. Our aim was to assess the effect of sustained KMC on the growth and development of low birthweight Indian babies up to the age of 12 months.

METHODS

We enrolled 500 mother and baby pairs, in groups of five, in a parallel group controlled clinical trial. The three infants with the lowest birthweight in each group received KMC, while the other two received conventional care. All babies were exclusively breastfed for 6 months. Babies in the intervention group were provided KMC until the infant was 40 weeks of corrected gestation or weighed 2500 g. Weight, length and head, chest and arm circumferences were evaluated at birth and at the corrected ages of 0, 3, 6, 9 and 12 months. Development was assessed using the Developmental Assessment Scales for Indian Infants (DASII) at 12 months.

RESULTS

The KMC babies rapidly achieved physical growth parameters similar to the control babies at 40 weeks of corrected age. But after that, they surpassed them, despite being smaller at birth. DASII motor and mental development quotients were also significantly better for KMC babies.

CONCLUSION

The infants in the KMC group showed better physical growth and development than the conventional control group.

Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain

OBJECTIVE

To evaluate intermittent Kangaroo Mother Care (KMC) with additional opportunities to breastfeed on weight gain of low birth weight (LBW) neonates with delayed weight gain.

METHODS

40 LBW neonates were followed to see whether KMC with additional opportunities to breastfeed improved weight gain.

RESULTS

In the KMC group, the mean age of regaining birth weight was significantly less (15.68 vs. 24.56 days) and the average daily weight gain was significantly higher (22.09 vs. 10.39 g, p < .001) than controls.

CONCLUSION

KMC with additional opportunities to breastfeed was found to be an effective intervention for LBWs with delayed weight gain and should be considered to be an effective strategy.

Knowledge and awareness about benefits of Kangaroo Mother Care

OBJECTIVE

To determine mothers' prior knowledge of Kangaroo Mother Care (KMC) and awareness about benefits of KMC for preterm babies.

METHODS

Mothers of a consecutive sample of 46 preterm babies, eligible for KMC admitted to a teaching hospital, from June through August 2009, were studied to determine the attitude and knowledge about KMC. A structured questionnaire was prepared. Mothers were asked questions to determine their baseline knowledge about KMC. Then each mother was explained about KMC and instructed to do KMC. After one hour of KMC, mothers were asked questions again to know their feelings and difficulties regarding KMC and feasibility of breast feeding during KMC.

RESULTS

Most of the mothers could understand what was explained to them (97.8 %; 95 % CI 88.5-99.9 %) in a single session. Positive feelings like closeness to baby (93.5 %) and sense of goodness (97.8 %) were noted amongst mothers. Though statistically not significant, the proportion of mothers who felt it impracticable to give breast feeding while doing KMC was considerable (39.1 %; 95 % CI 25.1-54.6 %) compared to those who felt no difficulty in breast feeding (60.9 %; 95 % CI 45.4-74.9 %). Practicable duration of KMC is 1, 2 and 12 h as felt by 52 %, 19.6 % and 6.5 % of mothers respectively. All the mothers expressed their willingness to continue KMC at home.

CONCLUSIONS

Mothers can understand and implement KMC with simple and clear oral instructions in local language. Positive feelings arise in mothers even with 1 h of KMC. KMC of 24 h is not practicable to almost all of the mothers. There is a need for special emphasis on breast feeding the child while doing the KMC.

Short spell kangaroo mother care and its differential physiological influence in subgroups of preterm babies

In routine practice, 4-6 h of kangaroo mother care (KMC) is adopted. Many mothers feel the duration impracticable. In 86 preterm babies, pre and post 1 h KMC changes in heart rate (HR), respiratory rate (RR), axillary temperature and SpO(2) are measured, in each baby. Postnatal age at the time of the study is 7.7 ± 5.2 days. Significant changes observed are decrease in mean HR by 3 bpm, RR by 3 min(-1) and increase in mean axillary temperature by 0.4 F and SpO(2) by 1.1%. In SGA babies, post KMC decrease in mean HR by 5 bpm, increase in mean axillary temperature by 0.6 F and SpO(2) by 2.1% are significant. In female babies, post KMC decrease in mean RR by 6 min(-1) and increase mean axillary temperature by 0.3 F and SpO(2) by 1.5% are significant. We conclude that preterm babies are benefited by 1 h KMC. SGA and female preterm babies showed different and greater response.

Influence of housing conditions from weaning to adulthood on the ventilatory, thermoregulatory, and endocrine responses to hypoxia of adult female rats

Housing conditions affect animal physiology. We previously showed that the hypoxic ventilatory and thermoregulatory responses to hypoxia of adult male rats housed in triads during the juvenile period (postnatal day 21 to adulthood) were significantly reduced compared with animals housed in pairs. Because sex hormones influence development and responsiveness to environmental stressors, this study investigated the impact of housing on the respiratory and thermoregulatory physiology of female rats. Since neonatal stress attenuates the hypoxic ventilatory response (HVR) of female rats at adulthood, experiments were performed both on "control" (undisturbed) animals and rats subjected to neonatal maternal separation (NMS; 3 h/day, postnatal days 3-12). At adulthood, ventilatory activity was measured by whole body plethysmography under normoxic and hypoxic conditions [fraction of inspired oxygen (Fi(O(2))) = 0.12; 20 min]. The ventilatory and body temperature responses to hypoxia of female rats raised in triads were reduced compared with rats housed in pairs. Housing female rats in triads did not affect basal or hypoxic plasma corticosterone levels but did increase levels of estradiol significantly. We conclude that modest changes in housing conditions (pairs vs. triads) from weaning to adulthood does influence basic homeostatic functions such as temperature and respiratory regulation. Triad housing can reverse the manifestations of respiratory instability at adulthood induced by stressful neonatal treatments. This should raise awareness of the benefits of increasing social interactions in clinical settings but also caution researchers of the potential impact of such subtle changes on experimental protocols and interpretation of results.

The Effects of Kangaroo Care on Maternal Self-esteem and Premature Infants' Physiological Stability

PURPOSE

This paper identified the effects of kangaroo care (KC) on maternal self-esteem and the growth and physiological stability of premature infants hospitalized in the neonatal intensive care unit.

METHODS

The experiment was conducted with an experimental group of 17 infants, and a control group of 17 infants selected by convenience sampling. KC was given to the infants one time a day for 30 minutes after feeding for two weeks. Their weight was measured every morning, and their physiological stability was measured in terms of their body temperature, respiratory rate, heart rate, oxygen saturation, and stability of the cardio-respiratory system in premature infants (SCRIP) score, as physiological responses at every 10 minutes during the intervention. Maternal self-esteem was assessed by a maternal self-report inventory.

RESULTS

The experimental group showed significant increase in the self-esteem of mothers. Also, KC was effective on physiological stabilization of preterm infants.

CONCLUSION

This study suggests that KC can be provided in clinical settings more widely in Korea as one of the nursing interventions aimed at promoting maternal self-esteem as well as infants' physiological stabilization.

Influence of juvenile housing conditions on the ventilatory, thermoregulatory, and endocrine responses to hypoxia of adult male rats

“Extreme” housing conditions, such as isolation (single housing) or crowding, are stressful for rats, and their deleterious impact on behavior is well documented. To determine whether more subtle variations in housing can affect animal physiology, the present study tested the hypothesis that the hypoxic ventilatory response (HVR) of adult male rats housed in pairs during the juvenile period (postnatal day 21 to adulthood) does not differ from that of animals housed in triads. Because neonatal stress augments the neuroendocrine responsiveness to stress and HVR, experiments were performed both on “control” (undisturbed) animals and rats subjected to neonatal maternal separation (NMS; 3 h/day, postnatal days 3–12). At adulthood, ventilatory activity was measured by whole body plethysmography under normoxic and hypoxic conditions (inspired fraction of O2 = 0.12; 20 min). The ventilatory and body temperature responses to hypoxia of rats raised in triads were less than those of rats housed in pairs. For the HVR, however, the attenuation induced by triad housing was more important in NMS rats. Triad housing decreased “basal” plasma corticosterone, but increased estradiol and testosterone levels. Much like the HVR, housing-related decrease in corticosterone level was greater in NMS than control rats. We conclude that modest changes in housing conditions (pairs vs. triads) during the juvenile period can influence basic homeostatic functions, such as temperature, endocrine, and respiratory regulation. Housing conditions can influence (even eliminate) the manifestations of respiratory plasticity subsequent to deleterious neonatal treatments. Differences in neuroendocrine function likely contribute to these effects.