Effects of Immediate Kangaroo Care on Premature infants

Christine E. Lynn College of Nursing

Sara Hulbert, Emily King, Karen Poch, Rachel Rushton Sha’Wren Wray
PICOT QUESTION SUPPORTING DATA
Citation Conceptual Framework Design/Method Sample/Setting Major Variables & Definitions Measures Data Analysis Findings Appraisal

Conde-Agudelo, A., & Díaz-
In severely low weight premature infants, how does immediate Rossello, JL. (2016). Kangaroo
mother care to reduce morbidity
kangaroo care compared to immediate admission to the NICU and mortality in low birthweight
infants.
influence their long-term wellbeing?
Effects of early intervention of
kangaroo mother care (KMC)
Systemic Twenty-one RCTs including a total The dependent variable of each of Primary outcome measures: Outcomes were analyzed on an In comparison with conventional Rating: Level I
Review of 3,042 infants were included by the studies was the reduction of mortality, severe infection/ “intent-to-treat” basis. neonatal care, KMC reduced Strengths: A systemic review is
searching medical databases. morbidity and mortality in low sepsis, severe illness, infant mortality at discharge (or 40-41 the highest level of evidence. The
birthrate
Samples were of infants with low Interventions/
growth, and neurodevelopmental
and neurosensory impairment.
Data for similar outcomes from
two or more separate studies
weeks) as well as morbidity. sample size was adequate. All
components of the study were
birth weight. Sample sizes in the Independent variable in each of
studies reviewed ranged from 28 the studies was the
Secondary outcome measures:
nosocomial infections, mild to
were combined in a meta-analysis KMC also increased weight,
and a pooled RR or MD was length, head circumference, and
easy to identify and comprehend.
The article provides a “plain
to 777 participants. implementation of kangaroo moderate infection or illness, calculated, all with 95% breastfeeding in the same time language summary” which is easy
mother care. lower respiratory tract disease, confidence intervals. frame. to understand and highlights the
diarrhea, hypothermia, The Grading of Recommendations It also increased mother main points and findings of the
The settings were multiple hyperthermia, length of hospital Assessment, Development and satisfaction and some measures of article. The quality of the evidence
NICUs/ newborn nurseries/ stay, re-admission to hospital, Evaluation (GRADE) approach attachment and home was studied to reduce the risk of
homes. breastfeeding, attachment, was used to assess the quality of environment. limitations and bias. The study
interactions, family satisfaction, evidence for clinically relevant discussed the reliability and
home environment and father outcomes. No differences were noted in generalizability of the
involvement & costs of care. neuro-developmental and information, along with the
A planned sensitivity analysis was neurosensory outcomes at 12 comparison with other systematic
used to explore the impact of risk months’ corrected age reviews on KMC.
of bias of findings. Limitations: None stated

NURSING SITUATION Gregson, S., & Blacker, J. (2011).

Kangaroo care in pre-term or low
birth weight babies in a postnatal
ward.
A 28-year-old Caucasian woman that was 21 weeks pregnant
entered the labor and delivery room at 1600 with contractions
Caption of the uterus. Upon inspection, Valery’s cervix was beginning to
thin out and dilate. Unable to halt the birth, Valery gave birth to
a 1,014 g (2.2lb.) baby girl. Valery’s concern for her daughter
was heightened when the nurse began to take her baby away Jayaraman, D., Mukhopadhyay, K.,
Bhalla, A. K., & Dhaliwal, L. K.
from her and transport her to the neonatal intensive care unit (2017). Randomized Controlled
Trial on Effect of Intermittent
(NICU). In order to calm the mother’s nerves, create a bond, Early Versus Late Kangaroo
Mother Care on Human Milk
and ultimately increase the survival rate of her daughter, the Feeding in Low-Birth-Weight
Neonates
mother wondered if the nurse should have allowed skin-to-skin
contact, or kangaroo care, between the mother and daughter
prior to being transported to the NICU. Murmu, J., Venkatnarayan, K.,
Thapar, R. K., Shaw, S. C., & Dalal,
S. S. (2017). When alternative
female Kangaroo care is provided
by other immediate postpartum
mothers, it reduces
postprocedural pain in preterm
babies more than swaddling.
Sharma, D., Murki, S., & Pratap, O.
T. (2016). The effect of kangaroo
ward care in comparison with
“intermediate intensive care” on
Transtheoretical Model
Effects of early intervention of
kangaroo mother care (KMC)
Social Cognitive Theory
Health Promotion Model
Cohort Study N-214 preterm infants with
gestations of 34-36 weeks, small
for dates <2nd percentile for
gestational age, and babies of
diabetic mothers
Setting: Pembury Hospital,
Maidstone and Tunbridge Wells
NHS Trust
RCT N=160 neonates in level 2 and 3
in the tertiary neonatal unit of a
hospital
Crossover Study N=102 neonates born between
30-36 weeks gestation and
required blood sugar monitoring
for 10 days
Setting: Command Hospital,
Kolkata
RCT N=141 neonates <32 weeks
gestation and a birth weight
<1100g
IV1: (control) infants receiving
skin-to-skin contact
IV2: (study) pre-term infants
receiving kangaroo care as much
as possible within 24 hours
DV1: length of stay
DV2: breast feeding rates on
discharge
Early vs. late initiation of KMC and Anthropometric measures-vital
breastfeeding
Definition of exclusive breast
feeding- no other liquid or solid
from any other source enters the stay and up to 1 month after
infant’s mouth.
IV1: babies received KMC, then
alternative female KC and then
swaddling
IV2: babies received alternative
female KC, then swaddling and
then KMC
IV3: babies received swaddling,
then KMC and then alternative
female KC
DV: post-heel lancing pain relief
IV1: Infants in KWC group
IV2: Infants in IIC group
DV1: Infants weight gain
Primary outcome measure:
length of hospital stay
Secondary outcome measure:
breastfeeding rates on
discharge and 6 weeks after
discharge, transfer to NICU and analysis
patient satisfaction ratings
signs, birth weight, length, head Pearson chi-square test, Fisher
circumference. Mode of feeding,
duration of KMC, feeding
characteristics during hospital
discharge
Pain assessment using PIPP Scale, ANOVA, Kruskal-Wallis test, post
neurobehavioral components
using Prechtl’s classifications
Primary outcome measure: PIPP
score at 30 seconds after heeling
lancing
Secondary outcome measures:
other components of PIPP Scare
using the time each component
returned to baseline
Primary outcome measure:
weight gain from the time of
randomization to term gestational “intent to treat” analysis
age.
Quantitative data: ANOVA, Apgar There were significant benefits to Rating: Level III
score, Fisher’s exact test, Pearson kangaroo care such as shorter
chi-square test, Mann-Whitney
Test
Qualitative data: thermatic
Student t test, Mann-Whitney U,
exact test, chi-square test, “intent practices in LBW infants during
to treat” analysis
hoc paired t-test with Bonferroni or KC before heel lancing resulted Strength: A power analysis was
correction
Chi-square test or Fisher’s exact
test, t test, nonparametric test,
hospital stay and more exclusive
breastfeeding on discharge.
Strengths: A power analysis was
performed. The resulting data was
relevant to the research question
and was reliable for use in the
healthcare setting.
Limitation: A RCT was ruled out
as a feasible design during the
process. The duration of each
kangaroo care was undetermined,
participants were unable to score
their experience with KMC due to
misunderstanding of the
definition of KMC, and data was
missing for the feeding outcomes
for the 6-week follow-up.
There were significant benefits to Rating: Level 1
early KMC on human milk feeding Strengths: The sample size was
the hospital stay and after
adequate and the results were
relevant and useful for the
discharge. Infants initiated on
early KMC had less frequent
nursing profession
Limitations: There was an
episodes of apnea. Early skin-to-
skin contact significantly
attrition rate. The study was
limited to infants born at 28
increases earlier breastfeeding weeks gestation or more, affecting
achievement. There was no the generalizability of the study.
significant benefit to early KMC on This also affects the reliability and
mortality, growth, and transferability of the information.
morbidities.
Neonates that were provided KMC Rating: Level III
in better pain reduction with performed. The findings were
faster returns to baseline relevant to the research study and
measures, compared to the reliable for nursing practice in
neonates that were swaddled. The that type of setting.
neonates that were swaddled had Limitation: the reliability and
higher heart rates after the heel generalizability cannot be
lancing compared to neonates determined for other populations
that were provided KMC and KC. and settings.
Early kangaroo care and Rating: Level II
conventional care has the same Strengths: No attrition rate, and
growth improvement rates. KMC 100% follow-up until completion
can have an impact on saving of the study. The sample size was

BACKGROUND
the growth velocity in preterm Setting: Fernandez Hospital, Second outcome measure: weight, more newborns and improving appropriate for this study, and the
infant with birth weight <1100 g: Hyderabad, India DV2: Infants length growth length, head circumference at quality care. KMC should be results will benefit the nursing
randomized control trial. term gestational age and post initiated early after delivery to practices of maternal and neonate

NURSING SITUATION
DV3: Infants head circumference randomization; breastfeeding improve the well being of the care.
growth rates at discharge, at term, and neonate.
Kangaroo care is a method of holding an infant that involves readmission to the NICU Limitations: the study lacked the
ability to maintain prolonged
KMC, lack of data on KMC before
skin-to-skin contact. The infant is laid on the parent’s bare chest randomization and post discharge
and lack of effect on breastfeeding
and a blanket is placed over them to keep the infant’s back rates.

warm. Edgar Rey is labeled as the one who proposed and

developed kangaroo mother care (KMC) at Instituto Materno
Infantil in Santa Fe de Bogotá, Colombia in 1978. His idea
originated from the lack of incubators, high rate of nosocomial
infections, and the occurrence of infant abandonment at the
local hospital. At the time, the death rate for premature infants
was 70 percent. Researchers later discovered that infants held to
the bare chest of their mother or father had a higher chance of
survival. The purpose of this study is to determine if early
initiation of kangaroo care is more beneficial for infants than
being directly admitted into the NICU.
CONCLUSION
Based on the research, there are significant benefits in implementing kangaroo care promptly after birth, compared to bringing neonates straight to the NICU.
Immediate kangaroo care helps the infant grow and develop by creating the maternal and infant relationship early on. It was also found that kangaroo care
resulted in more successful feeding which positively affected both physical and cognitive development in the neonates. Research says that infants with birth
weights, below 1100kg, are able to prolong transfer to the NICU in order to receive kangaroo care or skin-to-skin contact with the mother. These findings
demonstrate that underweight premature infants under 37 weeks’ gestation can benefit from immediate kangaroo care, rather than prompt transfer to the
NICU. We recommend that the nursing staff implement kangaroo care to premature infants with gestational ages ranging from extremely premature (<28
weeks) to very premature (28 to <32 weeks) and to preterm (<37 weeks). Special attention should be given to infants born with very low birth weights
(<1100g). Kangaroo care can be initiated immediately after birth, despite low birth weights, before the neonates are transferred to intensive care. The birth
weights, feeding quantity, growth, and physical and cognitive development of the neonates will be measured continuously throughout a 3-week period in the
NICU.

REFERENCES
Cleveland Clinic. (2017). Kangaroo Care. Retrieved November 06, 2017, from https://my.clevelandclinic.org/health/articles/newborn- (Links to an external site.)Links to an external site.
Conde-Agudelo, A., & Díaz-Rossello, JL. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd002771.pud4.
Gregson, S., & Blacker, J. (2011). Kangaroo care in pre-term or low birth weight babies in a postnatal ward. British Journal of Midwifery,19(9), 568-577. doi:10.12968/bjom.2011.19.9.568
Jayaraman, D., Mukhopadhyay, K., Bhalla, A. K., & Dhaliwal, L. K. (2017). Randomized Controlled Trial on Effect of Intermittent Early Versus Late Kangaroo Mother Care on Human Milk Feeding in Low-Birth-Weight Neonates. Journal of Human Lactation, 33(3), 533-539. doi:10.1177/0890334416685072
Murmu, J., Venkatnarayan, K., Thapar, R. K., Shaw, S. C., & Dalal, S. S. (2017). When alternative female Kangaroo care is provided by other immediate postpartum mothers, it reduces postprocedural pain in preterm babies more than swaddling. Acta Paediatrica,106(3), 411-415. doi:10.1111/apa.13716
Sharma, D., Murki, S., & Pratap, O. T. (2016). The effect of kangaroo ward care in comparison with “intermediate intensive care” on the growth velocity in preterm infant with birth weight <1100 g: randomized control trial. European Journal of Pediatrics,175(10), 1317-1324. doi:10.1007/s00431-016-2766-y