Effect of Kangaroo Mother Care on Postpartum Depression

Postpartum depression (PPD) is a serious public health issue.Kangaroo mother care (KMC) is widely considered to be the mostfeasible, readily available and preferred intervention for decreasingneonatal morbidity and mortality in developing countries. Weconducted a prospective study to assess the effect of KMC onPPD. The study population included 177 low-income mothers withtheir preterm infants. We used the validated Portuguese versionof the Postpartum Depression Screening Scale for the assessmentof maternal depression. The mothers were evaluated twice, atNeonatal Intensive Care Unit admission and at KMC discharge.We found 66 mothers (37.3%) with depression and it decreasedto 30 (16.9%) after KMC intervention; p < 0.0001. None developedPPD during the Kangaroo stay. We concluded that KMC may lessenmaternal depression. Further studies, may be required to clarifythese preliminary findings.     

Kangaroo Mother Care: 25 years after

The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infant's cognitive development. CONCLUSION: Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.     

Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care

The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin‐to‐skin vertically between the mother’s breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high‐tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother‐infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow‐up. Current evidence allows the following general statements about KMC in affluent and low‐income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low‐birth‐weight infants should be regarded as extero‐gestational foetuses needing skin‐to‐skin contact to promote maturation. Conclusion: Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin‐to‐skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.     

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.     

Safety of Kangaroo Mother Care in intubated neonates under 1500 g

Kangaroo Mother Care (KMC) has been used as a technique to promote mother-child bonding. It has been discussed of its use for preterm under mechanical ventilation. The objective of this study is to assess the vital signs of preterm infants with a birth weight lower than 1500?g who are under intubation and hemodynamically stable in KMC. Forty-three preterm infants with a mean gestational age at birth of 29.1?±?1.6 weeks and a mean birth weight of 1.1334?±?2318?g. The preterm infants were longitudinally assessed for 90?min (15?min before, 60?min in KMC and 15?min after). These periods were compared, and the dependent variables heart rate, oxygen saturation (SpO(2)), axilary temperature and mean arterial blood pressure were statistically significant (p?相似文献   

Predictional need for supplementing breastfeeding in preterm infants under Kangaroo Mother Care

It has been estimated that 95% of low-birthweight infants are born in developing countries. Nevertheless, most of the globally available resources are invested in developed countries, both for sophisticated, expensive technological care and for research focused on solving problems in scenarios in which access to expensive resources is available. Very little research on scientifically sound, economically accessible interventions reaches internationally recognized scientific journals. For instance, one accepted scientific dogma is that all premature infants must receive breast-milk fortifiers. Thus, healthcare workers consider that not offering fortification or supplementation to all preterm infants under 2000 g is unethical, as it denies them the proven benefits of this intervention. This approach oversimplifies the problem by assuming that infants under 2000 g are a homogeneous population, with similar needs and risks. The largest proportion of preterm survivors in developing countries comprises infants weighing > 1200 g, and their nutritional needs differ from those weighing < 1200 g, who represent a significantly smaller proportion. In developing countries, fortification of breast milk is seldom a feasible option. Even supplementing breast milk with formula implies an expense that cannot always be covered. In addition, many preterm infants (particularly those weighing > 1200 g) can grow properly on exclusive breastfeeding. In our experience, about 45% of infants under ambulatory Kangaroo Mother Care (KMC) thrive properly. The choice between giving and withholding supplementation for all preterm infants is not an ethical issue, because there is no choice. This was the justification for conducting the study reported here, which attempts to answer the question of how to identify, as early as possible, those premature infants who survive the early neonatal period and have no obvious risk factors for inadequate growth other than prematurity, but who are less likely to thrive with exclusive breastfeeding. Conclusion: The answer to this question will allow us to use our meagre resources in the most reasonable way, as supplementing breast milk involves not only the direct cost of the formula but also that of training the mothers in techniques for feeding their infants without compromising breastfeeding or increasing the risk of infectious diseases.     

Resistance to implementing Kangaroo Mother Care in developing countries, and proposed solutions

BACKGROUND: Randomized clinical trials have shown that Kangaroo Mother Care (KMC) can decrease morbidity and mortality due to low birthweight. Between 1994 and 2004, 44 teams in 25 developing countries were trained in KMC in Bogotá, Colombia; however, not all the teams were successful in initiating their own programmes and, of those that started, not all replicated the validated model. AIM: To identify factors involved in unsuccessful KMC implementation and find solutions. METHODS: A study was conducted in which 17 open-ended questionnaires were sent by e-mail to the coordinators of functioning KMC programmes in 15 countries, and 15 site visits were made to institutes that reported problems in starting programmes. The information was classified according to the perceived obstacle and the KMC model component involved. RESULTS: The early-discharge component (including ambulatory follow-up) was that found most difficult to implement. Resistance from health professionals, mothers and families was often related to local cultural practices. CONCLUSION: Active surveillance for and appropriate identification of obstacles usually indicated the appropriate solution. Some of the obstacles were common to many second-generation KMC programmes, making this information valuable for the implementation of programmes.     

Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants

Good quality care of low birthweight infants could reduce neonatal mortality in low-income countries, but the technologies used in rich countries are inappropriate. Kangaroo Mother Care does not need expensive and sophisticated equipment, and for its simplicity it can be applied almost everywhere, including peripheral maternity units of very low-income countries. Kangaroo Mother Care (KMC) can also contribute to the humanization of neonatal care and to better bonding between mother and baby in both poor and rich countries. A group of health professionals with experience in KMC met in a workshop to discuss its effectiveness, safety, applicability and acceptability in different settings: from first and second level maternity units in settings with very limited resources, to second and third level units in settings with limited resources, to second and third level maternity and neonatal care units in settings with ample resources and infant mortality rates <15/1000. The paper summarizes the recommendations of this group of health professionals for the implementation of KMC in these various settings, together with suggested research priorities.     

Postasphyxiai Encephalopathy in Preterm Neonates

Objective : Perinatal asphyxia is an important determinant of infant neurological outcome. There are very few studies looking exclusively at postasphyxial encephalopathy in preterm neonates.Methods : We studied the neurologic and sonographic abnormalities in 40 preterm babies with severe birth asphyxia during their hospital stay and till 3 months corrected age.Result : 87.5 % of the asphyxiated preterm babies had neonatal neurologic abnormality, compared to only 17% of the control babies (p < 0.0001). Generalised hypotonia and reduced activity were the commonest abnormalities (observed in 85% of asphyxiated babies) while depressed sensorium (60%) and seizures (35%) were seen in more severe cases. White matter disease (WMD-including periventricular flare, cerebral edema and periventricular leucomalacia) was significantly more frequent in the study cases (34.5% in study casesvs 7.5% in controls, p < 0.0001) as was grade 3/4 intraventricular hemorrhage(IVH) (25% in study cases vs 2.5% in controls, p < 0.0001). There was 11 fold higher mortality among the asphyxiated babies (23 deaths in study casesvs 2 in controls, p < 0.0001).Conclusion :The survivors had a significantly higher incidence of both mild and severe neurological abnormalities at corrected age of 3 months among the asphyxiated babies. There was a good correlation between the severity of the neonatal encephalopathy as well as the sonographic findings and the outcome.     

Role of Sucrose in Reducing Painful Response to Orogastric Tube Insertion in Preterm Neonates

Objectives

To study whether orogastric tube (OGT) insertion elicits a painful response in preterm neonates, and the role of oral sucrose in reducing this pain.

Methods

This double blinded, randomized control trial was conducted in the neonatal intensive care units of Kalawati Saran Children's Hospital. Clinically stable preterms within the first 7 postnatal days, who had not received painful stimulus 30 min prior to intervention, and who required routine OGT insertion were included. Lingual 24 % sucrose or distilled water (1 ml) was administered 2 min before OGT insertion. The primary outcome was painful response assessed by Premature Infant Pain Profile scale (PIPP), while the secondary outcomes were heart rate and SpO₂ changes. The trial is registered with ClinicalTrials.gov (Registration number: NCT 00949104)

Results

Sixty preterms were randomized in each group. Final analysis was carried out on 52 subjects in the placebo group and 53 in the sucrose group. The mean intra-procedure PIPP scores were significantly higher than the mean pre-procedure PIPP scores, in the gestational age groups of more than 34 wk, and 32 wk to 33 wk, 6 d, in both the placebo (7.25 vs. 3, and 8.14 vs. 3.14, respectively) and sucrose arm (8.06 vs. 3.21, and 7.18 vs. 4.18, respectively). The mean PIPP scores assessed at 30 s post procedure in the sucrose group were significantly lower than the placebo group (4.32 vs. 5.6, p?=?0.014). No significant adverse events were seen.

Conclusions

OGT insertion causes pain in preterms and single dose lingual 24 % sucrose may alleviate this pain.     

IgG Subclass Concentrations in Preterm Neonates

Serum IgG subclass concentrations were measured in 158 sera from preterm, appropriate for gestational age, infants born between 27 and 37 weeks of gestation, pregnancy, delivery and neonatal period being uncomplicated in all cases. At birth the IgG subclass concentrations were inversely correlated to the degree of prematurity. The IgG subclass concentrations decreased mainly proportionately during the neonatal period. The most immature infants born before the 30th week of gestation had critically low concentrations of all IgG subclasses. All immature infants, already in the first week after birth, showed capacity for IgGl and IgG3 synthesis.     

Improving Duration of Kangaroo Mother Care in a Tertiary-care Neonatal Unit : A Quality Improvement Initiative

Objectives

To increase the duration of Kangaroo mother care (KMC) in preterm infants from an average of 3 hours/day to at least 6 hours/day over 7 weeks through a Quality improvement (QI) approach in a tertiary-care neonatal unit.

Methods

Preterm mother-infant dyads who were admitted in the Neonatal intensive care unit and KMC ward were enrolled in this study. A QI team comprising of nurses, nurse educators, resident physicians and nursing-in-charge of unit was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures (allowing family members including male members during night for doing KMC, making KMC an integral part of treatment order, introducing the concept of weekly KMC champions, etc.) were introduced and subsequently tested by multiple Plan-do-study-act (PDSA) cycles. Data on duration of KMC per day was measured by bedside nurses on daily basis.

Results

20 eligible mother-infant dyads were studied during implementation period (50 d). The mean (SD) weight and gestation of infants were 1199 (356) g and 31.1 ( 2.3) wks, respectively. We achieved our goal by step-wise implementation of changes through construction of 3 PDSA cycles. The duration of KMC increased to 6 hours-a-day over a period of 7 weeks. Evaluation at 6 and 12 months in the post-implementation phase suggested sustenance of improved KMC duration up to 9 h/day in the unit.

Conclusions

Ongoing quality improvement measures increased the duration of KMC from a baseline of 3 h to 6 h in eligible preterm infants, and the results were sustained at 6–12 month.

     

Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants

Aim: To study the effect of Kangaroo mother care in the Kangaroo ward in comparison with conventional care at neonatal unit on growth and breastfeeding in very low birth weight infants at 40 weeks’ corrected gestational age. Methods: One hundred and forty neonates with birth weight <1500 g were randomized. The primary outcome was the average weight gain (g/kg/day) from the time of randomization to term gestational age. Results: Mean birth weight, age in days and weight at randomization were similar in both the groups. At term gestational age, average weight gain (g/kg/day) post randomization (23.3 ± 8.7 g vs. 22.64 ± 9.1 g, p = 0.67) and breastfeeding rate (85.9% vs. 87.0%) were comparable. There was no difference in weight gain (g/kg/day) from randomization to hospital discharge between the Kangaroo care group and conventional care group (18.01 g vs. 15.64 g, p = 0.12). Mortality, morbidities like sepsis, hypothermia, apnoea, hypoglycaemia and duration of hospitalization were equally distributed. On average, 11.5 days of intermediate care were saved in the kangaroo group. Conclusion: Kangaroo mother care in the Kangaroo ward is as effective as conventional care in the neonatal unit without any increase in morbidity or mortality in stable VLBW infants.