Kangaroo

Mother Care
Abdu-Raheem Fadlulai
Olaoluwa
 Outline
Introduction
Definition
Terminology
History
Eligibility criteria
Components
Discharge criteria
Benefits
Controversy
References
 Introduction
Some 20 million low-birth-weight (both
preterms and SGA) babies are born each year
mostly in less developed countries
They contribute substantially to a high rate
of neonatal mortality
Of the estimated 4 million neonatal deaths,
LBW babies represent more than a fifth
Therefore, the care of such infants becomes a
burden for health and social systems
everywhere.
 Since causes and determinants of
prematurity remain largely
unknown, effective interventions
are limited.
The few risk factors that are known
cannot be easily prevented
 Purchase of the equipment and
spare parts, maintenance and
repairs are difficult and costly
Power supply is intermittent, so
the equipment does not work
properly
 Moreover, modern technology is
either not available or cannot be
used properly, often due to the
shortage of skilled staf.

Incubators, where available,

are often insufficient to meet local
needs or
are not adequately cleaned
 Under such circumstances good care
of preterm and LBW babies is difficult:
hypothermia and nosocomial
infections are frequent, aggravating
the poor outcomes due to prematurity
Frequently and often unnecessarily,
incubators separate babies from
their mothers, depriving them of the
necessary contact
 For many small preterm infants,
receiving prolonged medical care is
important
Equally important is meeting the
babys needs for warmth,
breastfeeding, protection from
infection, stimulation, safety and
love
Could Kangaroo Mother Care
(KMC) be the answer?
 Definition
Technique practiced on newborn,
usuallypreterm infants wherein
the infant is held, skin-to-skin, with
an adult
 Terminology
Kangaroo Care
skin-to-skin care
Kangaroo Father Care?
 History
Peter de Chateau, Sweden, 1976: first described
studies of "early contact" with mother and baby at
birth, did not specify that this was skin-to-skin
contact
Rey and Martinez, Bogot, Colombia, 1978:
developed as an alternative to inadequate and
insufficient incubator care for those preterm
newborn infants who had overcome initial problems
and required only to feed and grow
"Kangaroo Mother Care" as a term was first
defined at a meeting of some 30 interested
researchers in Trieste, Italy in November 1996
 Requirements
Baby
Stable preterm/LBW infants (i.e.
those who can breath air and have
no major health problems)
Very small newborn infants
(ELBW) and those with
complications are best cared for in
incubators
 Cardiopulmonary monitoring,
oximetry, supplemental oxygen
or nasal (continuous positive
airway pressure) ventilation,
intravenous infusions, and
monitor leads do not prevent
kangaroo care
All mothers irrespective of age,
parity, education, culture and
religion, though they must be willing
 Components
1. Kangaroo position
2. Kangaroo nutrition
3. Kangaroo discharge

Some add :
4. Kangaroo follow-up
Kangaroo position
 Kangaroo position
Place the baby naked between the mothers
breasts in an upright position, chest to chest
Secure him with the binder
The head is turned to one side in a slightly
extended position.
The top of the binder is just under babys
ear
Avoid both forward flexion and
hyperextension of the head
 The hips should be flexed and extended in a
frog position; the arms should also be
flexed
Tie the cloth firmly enough so that when the
mother stands up the baby does not slide
out
Make sure that the tight part of the cloth is
over the babys chest
Babys abdomen should not be constricted
and should be somewhere at the level of the
mothers epigastrium
 This way baby has enough room for
abdominal breathing. Mothers
breathing stimulates the baby
The mother can wear whatever she
finds comfortable and warm in the
ambient temperature
 Kangaroo nutrition
For the first few days a small baby may
not be able to take any oral feeds and
may need to be fed intravenously
Oral feeds should begin as soon as
babys condition permits and the baby
tolerates them
Less than 32 wks EGA: tube (preferrably
orogastric tube) feeding. Gradually
commenced on cup and spoon feeding
 Tube-feeding can be done when the
baby is in kangaroo position
For cup-feeding the baby is taken out
of the kangaroo position, wrapped in
a warm blanket and returned to the
kangaroo position after the feed
 Another way to feed a baby at this
stage is by expressing milk directly
into the babys mouth. This way the
baby does not need to be taken out
from the kangaroo position
More than 32 weeks of EGA: are able
to start suckling on the breast.
Augmentation with cup and spoon
could be necessary
 Preterm babies, irrespective of
weight, should receive iron and
folic acid supplementation from
the second month of life until one
year of chronological age.
The recommended daily dose of iron
is 2mg/kg body weight/day
 Kangaroo discharge
Criteria:
the babys general health is good
and there is no concurrent disease
such as apnoea or infection;
he is feeding well, and is exclusively
or predominantly breastfed;
he is gaining weight (at least
15g/kg/day for at least three
consecutive days);
 Babys temperature is stable in
the KMC position (within the normal
range for at least three consecutive
days);
Mother is capable and confident in
caring for the baby
Mother is able to come regularly
for follow-up visits.
 Kangaroo follow-up
Frequency:
two follow-up visits per week
until 37 weeks of post-menstrual
age;
one follow-up visit per week after
37 weeks.
 What to ask
KMC
Breastfeeding
Growth
Illness
Drugs
Immunization
Mothers concerns
Next follow-up visit
Special follow-up visits
 Stop KMC
2500g or 40 weeks of post-menstrual
age.
 Benefits
Baby
promote frequent breastfeeding
enhance mother-infant bonding
prevents hypothermia
good weight gain
fewer nosocomial infections
prevents apnoea
Improves cognitive development
decreases stress levels
improves motor development
improve sleep patterns of infants
earlier discharge from hospital
reduces mortality
 For parents
it promotes bonding
improves parental confidence
helps to promote lactation and
breastfeeding success
 For the healthcare
facility
Reduces duration of hospital stay
Reduces burden on the already
overwhelmed facility and health
workers
Financially prudent
Increases parental involvement
and teaching opportunities
 Challenges
Culturally alien
Lack of facility (rooms, chairs) and
properly trained personnel for KMC
Frequent changing of staff
 Research needs
-the efectiveness and safety of
KMC before stabilization, in
settings with very limited
resources (i.e. without incubators
and other expensive technologies);
-breastfeeding and feeding
supplements in LBW infants less
than 32 weeks of gestational age;
 simpler and reliable methods for
monitoring the well-being of KMC
infants, especially breathing and
feeding;
-KMC in LBW infants weighing less
than 1000g, and in newborn infants
who are critically ill;
-KMC in very special
circumstances, e.g. in very cold
climates or in refugee camps;
 cultural and managerial barriers that
may hinder the implementation of KMC,
and interventions that may foster it,
particularly in settings with very limited
resources;
-the implementation of KMC for LBW and
preterm infants delivered at home
without the help of trained personnel and
without the possibility of referral to the
appropriate level of care.
 Conclusion
KMC is at least equivalent to
conventional care (incubators), in
terms of safety and thermal
protection, if measured by mortality.
KMC, by facilitating
breastfeeding, offers noticeable
advantages in cases of severe
morbidity.
 KMC contributes to the humanization
of neonatal care and to better
bonding between mother and
baby in both low and high-income
countries
KMC is, in this respect, a modern
method of care in any setting,
even where expensive technology
and adequate care are available
 Reference
Kangaroo Mother Care: a
practical guide, 2003, Department
of Reproductive Health and Research,
World Health Organization
Thank
you