Module: Skin-to-Skin Care Session 1

Module Overview: Purpose

The purpose of this module is to provide facilitators with a sound, competency-based training (CBT) methodology which if implemented as designed, will result in physicians attaining mastery of the knowledge, competencies, and skills required to identify and manage neonates on skin-to-skin care.

Module Overview

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Module: Skin-to-Skin Care Session 1

Skin to Skin Care

Ayman El-Mohandes, MD, MPH, FAAP The George Washington University

Module: Skin-to-Skin Care Session 1

Module Overview: Story

Skin-to-skin care, also referred to as kangaroo care, is a form of parent-neonate interaction in which the mother holds her neonate skin-to-skin in a vertical, head-up position on or between her breasts for twenty minutes or longer. This type of contact provides an appropriate thermal environment while conferring many physiological and emotional benefits to both neonate and mother. Egyptian hospitals have not used skin-toskin care extensively.
Module Overview Visual 3

Module: Skin-to-Skin Care Session 1

Module Overview: Story (cont.)

Existing evidence suggests that mothers and infants in Indonesia, especially preterm/LBW infants, would benefit from increased use of skin-to-skin care, for infants born in and outside facilities. Preliminary evidence also exists that Indonesian mothers have a desire to learn and practice this type of care. It is important that midwives, nurses and physicians are knowledgeable in promoting, selecting, and managing neonatal skin-to-skin care..
Module Overview Visual 4

Module: Skin-to-Skin Care Session 1

Task Analysis: Task

Complete a Newborn Assessment and Implement Admission and Discharge Policies and Procedures According to the Service Standards and Protocol to Enroll and Manage Neonates Suitable for Skin-to-Skin Care.

Task Analysis

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Module: Skin-to-Skin Care Session 1

Task Analysis: Competency 1

1.

Competency: Promote Skin-to-Skin Care of the Neonate Skills

1.1. Select neonates appropriate for skin-to-skin care. 1.2. Educate mothers about the advantages of skin-to-skin care. 1.3. Prepare neonates for skin-to-skin care.

Task Analysis

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Module: Skin-to-Skin Care Session 1

Task Analysis: Competency 1

1.

Competency: Promote Skin-to-Skin Care of the Neonate (cont.) Skills

1.4. Prepare parents for skin-to-skin care. 1.5. Monitor the vital signs and oxygenation of the neonate during skin-to-skin care. 1.6. Identify any persistent signs of stress, and manage accordingly.

Task Analysis

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Module: Skin-to-Skin Care Session 1

Session 1: Purpose
The purpose of this session is to introduce participants to the concepts, benefits, implementation, and management of skin-to-skin care. Criteria for selection of neonates appropriate for this kind of care, as well as preparation of the neonate and parents for skin-to-skin care, will be reviewed.

Session Purpose

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Module: Skin-to-Skin Care Session 1

Session 1: Story
Skin-to-skin care, also referred to as kangaroo care, is a form of parent-neonate interaction in which the mother holds her neonate skin-to-skin in a vertical, head up position on or between her breasts for 20 minutes or longer.

Session Story

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Module: Skin-to-Skin Care Session 1

Session 1: Story (cont.)

This type of contact:

Provides an appropriate thermal environment. Improves oxygenation. Decreases apnea and bradycardia. Facilitates early breastfeeding. Increases duration of lactation. Lowers caloric expenditures. Improves weight gain. Increases time in optimal behavioral states. Promotes parental attachment and bonding. Shortens hospitalization period.
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Session Story

Module: Skin-to-Skin Care Session 1

Learning Objectives
1. Define skin-to-skin care and know the criteria used to select neonates for this type of care. 2. Educate mothers about the advantages of skin-toskin care. 3. Prepare neonates for skin-to-skin care.

Learning Objectives

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Module: Skin-to-Skin Care Session 1

Learning Objectives (cont.)

4. Prepare parents for skin-to-skin care. 5. Monitor the vital signs and oxygenation of the neonate during skin-to-skin care. 6. Identify any persistent signs of stress and manage accordingly.

Learning Objectives

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Module: Skin-to-Skin Care Session 1

Skin-to-Skin Care

Definition

Skin-to-skin care, also referred to as "kangaroo care", is a form of parent-baby interaction in which the mother holds her infant skin-to-skin in a vertical, head up position on or between her breasts for 20 minutes or longer.

Learning Objective 1

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Module: Skin-to-Skin Care Session 1

Skin-To-Skin Care Selection Criteria

No specific gestational age is required. In general, infants should be physiologically stable with a temperature of 36 C or higher. If apnea or bradycardia is a problem, it must be self-resolving or require only minor stimulation. Infants receiving phototherapy may participate by removing them from phototherapy for short periods. In special situations, infants requiring oxygen, CPAP, or even assisted respiratory support, have received this care successfully
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Learning Objective 1

Module: Skin-to-Skin Care Session 1

Advantages of Skin-to-Skin Care

Mothers, fathers, and health care personnel need to know the advantages of this type of therapy in order to promote its adoption and use.

Learning Objective 2

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Module: Skin-to-Skin Care Session 1

Advantages of Skin-to-Skin Care

Provides an appropriate thermal environment Improves oxygenation. Decreases apnea and bradycardia. Facilitates early breastfeeding. Increases duration of lactation

Lowers caloric expenditures. Improves weight gain. Increases time in optimal behavioral states. Promotes parental attachment and bonding. Shortens hospitalization period.
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Learning Objective 2

Module: Skin-to-Skin Care Session 1

Educating Mothers about Skin-toSkin Care

Units should teach mothers skin-to-skin care for use in hospital and at home. Indonesian hospitals/health providers have not used skin-to-skin care extensively. Studies suggest that Indonesian mothers and infants, especially premature/LBW infants, would benefit from increased use of skin-to-skin care and that Indonesian mothers have a desire to learn this type of care. It is also important that nurses and physicians in the unit are comfortable caring for an infant in this manner.
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Learning Objective 2

Module: Skin-to-Skin Care Session 1

Management Guidelines for Skin-toSkin Care

Physicians and nurses should decide which infants are appropriate for skin-to- skin care and provide parents with sufficient information describing the advantages of the technique. It is extremely important to remember that everyone involved should be comfortable and supportive of the decision to hold the infant skin-to-skin.
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Learning Objective 3

Module: Skin-to-Skin Care Session 1

Preparation of the Neonate for Skinto-Skin Care

Once the decision has been made, the infants temperature should be assessed at 36 C or greater and documented on the flow sheet. A skin temperature probe can be left on and all other monitor wire, intravenous lines, and respiratory support tubes should be secured. The infant can be undressed except for a diaper. Hats are generally not necessary unless the infant weighs less than 1,000 grams.
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Learning Objective 3

Module: Skin-to-Skin Care Session 1

Preparation of the Parents for Skinto-Skin Care

Carefully explain the advantages of this type of care for their infant. Demonstrate the type of holding they will do. Encourage the mother to wear a front-opening shirt or cover gown so she can provide this care in a modest manner. Provide as much privacy and quietness as possible.
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Learning Objective 4

Module: Skin-to-Skin Care Session 1

Monitoring the Neonate on Skin-toSkin Care

Once the infant has been successfully transferred to the parent, the infants vital signs and oxygenation status should be monitored, and adjustments made based on the infant's status.

Learning Objective 5

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Module: Skin-to-Skin Care Session 1

Signs of Stress during Skin-to-Skin Care

The infant should be returned to the incubator if any persisting signs of stress are identified, including tachypnea, tachycardia, temperature instability, or oxygen desaturation. The length of time for holding is individually based and depends on the neonates status and parental comfort.
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Learning Objective 6

Module: Skin-to-Skin Care Session 1

Summary: Learning Objectives

1. Define skin-to-skin care and know the criteria used to select neonates for this type of care. 2. Educate mothers about the advantages of skin-toskin care. 3. Prepare neonates for skin-to-skin care.

Learning Objectives

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Module: Skin-to-Skin Care Session 1

Summary: Learning Objectives (cont.)

4. Prepare parents for skin-to-skin care. 5. Monitor the vital signs and oxygenation of the neonate during skin-to-skin care. 6. Identify any persistent signs of stress and manage accordingly.

Learning Objectives

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