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Womens & Childrens Services SDMS ID: P2010/0385-001 Clinical Guidelines WACSClinProc4.

18 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Skin-To-Skin Care (Kangaroo care) New Guideline Provision of skin-to-skin care to special care infants Midwives, registered nurses and mothercraft nurses, 4N Skin to skin care, kangaroo care

Purpose
The purpose of these guidelines is to support the practice of skin-to-skin care within the special care nursery.

Definition
Skin-to-skin care is the name given to the practice of a parent holding an infant dressed in a nappy, skin-to-skin in an upright position against his/her bare chest.

Background
Kangaroo care was first introduced at the Maternal and Child Institute of Bogota, Columbia, by Edgar Sanabria and Hector Martinez in 1979. Since then this method of care has demonstrated physiologic, cognitive and emotional gains for both preterm and sick infants. In the last few decades, health services throughout the world have adopted this practice into their neonatal care, supported by the practical guidelines developed by WHO in 2003.

Criteria
Stable growing babies, > 30 weeks and > 1000grams. Baby may be receiving oxygen by headbox (if stable with O2 by blow-by or face mask), or nasal cannula.

Specific Points
Monitor for drafts. Stop skin-to-skin care if infants temperature drops >0.5C from baseline. Avoid airway occlusion by checking the infants position once in place by ensuring the babys neck does not flex too far forward. Observe infant more closely with parents new to this practice. Reinforce the need to contain the baby by holding firmly and explain that additional stimulation such as talking or stroking may not be tolerated until the baby is more mature. If parent declines skin-to-skin care, attempt to distinguish fear from lack of interest. If the parent is anxious education, patience and support may be beneficial. It should not be forced on a reluctant parent. Offer these parents similar opportunities to hold their baby dressed.

Preparation
Skin-to-skin care may be initiated by the babys nurse caregiver, Lactation Consultant or by the parent, if the above criteria are met and medical permission has been obtained.
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If not previously done, discuss skin-to-skin care with the parents, provide parent information pamphlet and answer any questions. Advise parent to wear clothing that opens down the front. Encourage mother to remove bra to ensure proper skin-to-skin care.

Procedure
Place armchair at bedside and ensure that lines and cords will reach the chair. Organise a pillow for parent/infant comfort. Prepare the environment screens for privacy, reduce bright lights and noise and provide drink for parent. Take the infants temperature, heart rate and respiratory rate as a baseline. Undress the baby to his/her nappy (or encourage parent to do this). Apply a hat if baby < 1800grams until thermal stability during this type of care is established. Ensure lines and tubing are secure. Use tape if necessary Transfer the baby from cot/crib to the parents bare chest. Because transfers can be potentially stressful for the infant, use care to flex and contain the babys arms and legs during the transfer to help the baby remain calm and organized. After the infant is placed on the parents chest, tuck a folded warm blanket over the baby and wrap the parents clothes around the blanket-covered baby. For infants on supplemental oxygen, it may be helpful to increase the F iO2 by 10% during the transfer and for a few minutes of skin-to-skin care. Some babies remain calm or asleep from the beginning; others may take several minutes to stop squirming and settle in, gentle but firm containment by the parents hands may help this to happen. Take the infants axillary temperature after 30 minutes and hourly thereafter, for the first few sessions until thermal stability during skin-to-skin care is established. Reinforce parent awareness of infants cues and responses during kangaroo care (i.e. facial expressions, suckling efforts, improved sleep and alert states). Monitor baby for stress signs such as apnoea or desaturations. Kangaroo care is organized around feed times and can last for 1-2 hours at a time, and may be repeated 2-3 times/day if the infant is stable. It allows completion of routine care such as vital signs, heel prick blood tests and gavage feedings with minimal stress to the baby. The parent may choose to stop skin-to-skin care at any time. Document length of skin-to-skin care, and babys responses.

Breastfeeding
If baby begins to show interest guide mother in how to place baby in position to assist attachment and encourage her to support or shape her breast. Baby may lick and nuzzle at the breast. Reassure mother that baby will attach when he/she is ready. If kangaroo care is offered frequently and regularly, mother and staff will see baby improve and mature in their overall behavior.

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Attachments Attachment 1

References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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ATTACHMENT 1 REFERENCES Anderson G C (1993) Kangaroo care, Neonatal Network 12(5):56 Cantrill R, Creedy D & Cooke M (2004) Midwives knowledge of newborn feeding ability and reported practice managing the first breastfeed, Breastfeeding Review, 12 (1): 2533 Ferber S & Makhoul I (2004) The effect of skin-to-skin contact shortly after birth on the neurobehavioural responses of the term newborn: a randomized, controlled trial, Pediatrics, 113(4): 858-864 Ludington-Hoe S M (1994) Kangaroo care: Research results and practice implications and guidelines, Neonatal network, 13(1): 19-27 Nyvist, K Hedberg (2004) How can kangaroo mother care and high technology be compatible, J of Human Lactation, 20 (1): 72-74. University of Texas Medical Branch, Nursing Practice Standards (2000) Protocol: Skin-to-skin holding ( Kangaroo Care), 1-19. Morton, J., (2002) Video A preemie needs his mother. World Health Organisation (2003) Kangaroo mother care: a practical guide, Geneva.

REFER ALSO TO: Parent information pamphlet (4N): Providing skin-to-skin (Kangaroo care) for your baby, 2006.

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