Kangaroo care
[1][2] In the 2003 WHO Kangaroo Mother Care practical guide,[1] KMC is defined as a "powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term", with its key components being: The early KMC technique was first presented by Rey and Martinez in 1983,[1] in Bogotá, Colombia, where it was 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.
[3] Today, the WHO recommends "Kangaroo mother care (KMC) for preterm or low-birth-weight infants should be started as soon as possible after birth"[2] based on "high-certainty evidence".
Originally babies who were eligible for KMC included LBW infants weighing less than 2,000 grams (4 lb 7 oz) and breathing and eating independently.
Large reviews of the thousands of scientific articles that present the body of evidence have been published, that serve as the bases for practical guides for practitioners.
Systematic reviews of hundreds of scientific articles have documented the impact of KMC on mortality, morbidity, and quality of survival LBW infants.
This paper supports the hypothesis that, in cases of absence of technical resources, inpatient kangaroo position and nutrition is an acceptable alternative.
In 2016, a Cochrane review, "Kangaroo mother care to reduce morbidity and mortality in low birthweight infants", was published bringing together data from 21 studies including 3,042 LBW babies (less than 1,500 grams (3 lb 5 oz) at birth).
[15] This review showed that babies receiving kangaroo care had a reduced risk of death, hospital-acquired infection, and low body temperature (hypothermia); was also associated with increased weight gain, growth in length, and rates of breastfeeding.
[27] Earlier discharge from hospital is also a possible outcome[6] Finally, kangaroo care helps to promote frequent breastfeeding and can enhance mother–infant bonding.
Newborn infants who are immediately placed on their mother's skin have a natural instinct to latch on to the breast and start nursing, typically within one hour of being born.
[46] In the 1990s, studies began to note a series of innate behaviors in full term infants when placed in SSC with their mothers.
One 2011 study described a sequence of nine innate behaviors as: the birth cry, relaxation, awakening and opening the eyes, activity (looking at the mother and breast, rooting, hand to mouth movements, soliciting sounds), a second resting phase, crawling towards the nipple, touching and licking the nipple, suckling at the breast and finally falling asleep.
[47] It is believed that this 'sensitive period' predisposes or primes mothers and infants to develop a synchronous reciprocal interaction pattern, provided they are together and in intimate contact.
Infants who are allowed uninterrupted SSC immediately after birth and who self-attach to the mother's nipple may continue to nurse more effectively.
[16] Kangaroo care seeks to provide restored closeness of the newborn with family members by placing the infant in direct SSC with one of them.
[48] In kangaroo care, the baby wears only a small diaper and a hat and is placed in a flexed (fetal position) with maximum SSC on parent's chest.
All other supportive technology can be provided as part of care to extremely LBW babies during SSC[55] and appears to produce a better effect.
[56] Based on the scientific rationale, it has been suggested that SSC should be initiated immediately, to avoid the harmful effects of separation (Bergman Curationis).
Kangaroo position means direct SSC between mother and baby but can include father, other family member, or surrogate.
Kangaroo discharge requires that the infant is sent home early, meaning as soon as the mother is breastfeeding and able to provide all basic care herself.
In Colombia in 1985, this took place at weights around 1,000 grams (2 lb 3 oz), with oxygen cylinders for home use; the reason was that overcrowding in their hospital meant that three babies in an incubator would result in potentially lethal cross-infections.
In 1978, due to increasing morbidity and mortality rates in the Instituto Materno Infantil NICU in Bogotá, Colombia, Edgar Rey Sanabria, professor of neonatology at Department of Paediatry National University of Colombia, and the next year Hector Martinez Gomez as coordinator, introduced a method to alleviate the shortage of caregivers and lack of resources.
They suggested that mothers have continuous SSC with their premature or LBW babies to keep them warm and to give exclusive breastfeeding as needed.
In 1996, 30 interested researchers convened by Adriano Cattaneo and colleagues in November 1996 in Trieste, Italy, together with the WHO represented by Jelka Zupan,[66][67] decided to adopt the original term "Kangaroo Mother Care" created by Rey Sanabria in 1978, in Colombia.
An International Network of Kangaroo Mother Care (INK) was convened at the Trieste meeting and has overseen workshops and conferences every two years.
[68] An informal steering committee coordinates these meetings: (alphabetically, current) Nils Bergman, Adriano Cattaneo, Nathalie Charpak, Juan Gabriel Ruiz, Kerstin Hedberg-Nyqvist, Ochi Ibe, Susan Ludington, Socorro Mendoza, Mantoa Mokrachane, Carmen Pallas, Réjean Tessier, and Rekha Udani.
Susan Ludington maintains a "KC BIB" (bibliography) on behalf of INK, endeavoring to be a complete inventory of any and all publications relevant to KMC.
It is a day to increase awareness to enhance the practice of kangaroo care in NICUS, Post Partum, Labor and Delivery, and any hospital unit that has babies up to three months of age.
The main controversy among proponents of KMC relates to eligibility to initiate kangaroo position: in the original Rey Sanabria–Martinez Gomez model and as described in the WHO guidelines,[57] the infant should be stable to "tolerate skin-to-skin contact".
Although consistent results in various contexts support its widespread use, further research is necessary to determine factors such as the optimal daily duration, parental roles, effective inclusion of fathers and other family members, immunological benefits, and its application in patients under phototherapy, among others.
