Neuro-endocrine Mechanisms Providing the Benefits of Kangaroo Mother Care - PowerPoint PPT Presentation


Title: Neuro-endocrine Mechanisms Providing the Benefits of Kangaroo Mother Care


1
Neuro-endocrine Mechanisms Providing the Benefits
of Kangaroo Mother Care
  • Dr Elise van Rooyen
  • Department of Paediatrics, University of
    Pretoria,
  • Kalafong Hospital, South Africa

2
Neuro-endocrine Mechanism
  • Many benefits of KMC are related to oxytocin
    secretion which is released by touch, light
    pressure and warmth experienced by the infants in
    the skin-to-skin position and during breastfeeding

3
KMC Effect on Body Temperature
  • KMC maintains adequate temperature for preterm
    and/or LBW infants
  • Infant body temperature rises in KMC
  • Fewer episodes of hypo- and hyperthermia occurs
    during KMC
  • It is safe to take care of infants as small as
    700g in warm environment with cap
  • Mothers are able to maintain their babys
    temperature within a very narrow temperature
    range which is not the case in incubator care
  • WHO KMC practical guide, PEP unit 43
    Principles of KMC

4
Rewarming Infants with Hypothermia KMC vs
Incubator Care
Teaching hospital, Lusaka, Zambia 80 babies with
templt36ºC (low risk hypothermia) 41 treated with
skin-to-skin contact (SSC) 39 treated in
incubator
Reaching 36.5ºC at 2 hours 3 hours 4 hours
SSC 30 70 90
Incubator 21 39 60
  • Adapted from Lancet 19983521115

5
Role of Oxytocin in Temperature Regulation
  • Circulation in the skin overlying the breast is
    increased during suckling resulting in increased
    skin temperature - this makes suckling more
    pleasant for pups Kerstin
    Uvnäs-Moberg TEM 1996
  • Circulating oxytocin and neurological triggered
    vasoactive peptides mediates this cutaneous
    vasodilation Eriksson et al
    1996ab
  • Temperature of breasts and chest increases not
    only during breastfeeding but also when milk
    ejection is triggered psychologically
    Lind et al. 1971

6
KMC Thermal Synchrony
  • A thermal synchrony develops between mom and baby
  • The mothers core temperature may rise 2ºC or
    drop one degree in a short period of time, in
    order to maintain this narrow range

7
Thermal Synchrony in Twins
  • Mothers breasts have the ability to thermally
    accommodate multiple infants simultaneously
  • Each breast acts independently to keep a twin
    warm
  • Case studies by S Ludington

8
KMC Behavioural Effects - Crying
  • Infants cry for a variety of reasons Separation
    from mother, hunger, and in response to pain
  • There was a reduction in crying during KMC
    compared to incubator care (Cochrane
    meta-analysis)
  • KMC reduces crying in response to pain (Weller
    Feldman) (Ludington-Hoe et al. AACN Clin Issues
    2005 16(3) 373387)
  • No crying at all when transporting sick infants
    in KMC position to a distant NICU (Sontheimer et
    al)

9
Research on Crying
  • Compared babies in KMC with babies in cots
  • Number of crying babies at observation periods
    performed every 15 minutes for the first 90
    minutes after birth
  • There was a significant absence or reduction in
    crying in infants receiving KMC compared to
    infants in cots
  • Christensson et al. Acta Paediatr 81488-93. 1992

10
KMC Effect on Neurophysiologic Outcomes
  • Sleep organisation
  • Brain maturation
  • Brain complexity

11
Sleep organisation Sleep Phases
  • NREM (Quiet Sleep)
  • Stage 1 Drowsy
  • Stage 2 Light onset of slow wave sleep
  • Stage 3 Deep slow sleep
  • Stage 4 Deep slow wave sleep
  • Crucial for creation of long term memories
    learning
  • REM (Active Sleep, Dream Sleep)
  • Paradoxical sleep rapid eyelid muscle
    movements
  • ? Heart rate Resp rate
  • Critical component associated with the
    development of the sensory systems

12
Sleep and Sleep Cycles
  • Sleep and sleep cycles are essential for
  • Sensory system development in the fetus and young
    infant
  • Creation of long-term memory and learning
  • Preservation of brain plasticity
  • Sleep deprivation in foetus and neonate has
    profound effects on early sensory development and
    creation of permanent neural circuits for the
    primary sensory systems

13
Sleep Continue
  • Sleeping is not a passive process
  • Sleep is driven by cholinergic cells which
    stimulate sleep actively (can be inhibited by
    depressant drugs)
  • Each specific EEG wave that occur during REM
    sleep plays a specific role in sensory system
    development (smell, taste, visual, auditory,
    touch, motion, position, emotion, or memory)
  • REM sleep deprivation between 30 wks GA and 4-5
    mnths results in delayed or disordered
    development of any or all of the systems above

14
Sleep Pattern in NICU
  • In the NICU, infants demonstrate a very chaotic
    version of this cycling pattern
  • Incubator Infants only have 10-20 seconds of
    quiet sleep. (HR and RR also does not change)
  • Disrupted sleep due to
  • separation from mother
  • and care giving environment

15
KMC Effect on Sleep Organization
  • Increases quantity of Quiet Sleep
  • Non-chaotic sleep pattern
  • Normal sleep cycling
  • Less sleep arousals
  • HR and RR variation according to sleep cycles
  • Preterm sleep cycles generally require 60 minutes
    to complete and within 5 minutes of the onset of
    KMC, cycling begins

16
Cycling is needed for Normal Growth
  • Formation of Neuronal Synapses and Growth

Sleep Cycling
  • Preemies in incubators demonstrate non-cycled
    sleep patterns throughout hospitalization
  • Result of delay in sleep cycling affect
    post-discharge sleep for up to 2 yrs (Scher,
    1997)

17
Brain Maturity by Complexity
  • Preterm infants who received KMC from 32-40 weeks
    PMA had better brain maturation in all measures
    of complexity
  • Brain maturation was better compared to preemies
    who did not receive KMC
  • Brain maturation was even better compared to full
    term infants

Kaffashi, Scher, Ludington-Hoe et al. Complexity
analysis of neonatal EEG. J Electroencephalography
18
Oxytocins Analgesic Effects
  • Oxytocin administered in mice has an analgesic
    effect in response to (formalin-induced) pain
  • Oxytocin acts on the ?- d-opioid receptors in
    the brain
  • Chronic (X 7 days) administration of oxytocin did
    not produce tolerance

K Reeta, et al. Regulatory Peptides 20061358590
KMC Effect on painful procedures
  • Preterm infants exhibit less audible and
    inaudible (facial grimacing, eye squeezing and
    brow bulging) crying during and after heel pricks
    when in KMC compared to incubator R
    Kostandy, et al. 20089(2)
  • KMC reduces crying associated with painful
    procedures (Weller Feldman)

19
KMC Effects on Nosocomial Infections
  • Infants who received 24/7 KMC had ? infections by
    discharge (3 randomized trials)
  • ? Infections in infants who received KMC
    (Cochrane meta-analysis)
  • ? Nosocomial infections may be due to
  • Enhanced stratum corneum barrier function when
    hydration increases and trans-epidermal water
    loss decreases
  • Improved immunity
  • Oxytocin
  • Less stress
  • Breastmilk

20
KMC reduces Mortality?
  • A meta-analysis shows that KMC reduces neonatal
    mortality amongst preterm babies (birth weight
    lt2000 g) in hospital, and is highly effective in
    reducing severe morbidity, particularly from
    infection
  • Joy Lawn et al. International Journal of
    Epidemiology 201039i144i154
  • Cochrane meta-analysis

21
KMC Effect on Desaturation Events
  • During KMC the number of desaturation events
    decreased in breastfed infants
  • Relationship between desaturation events and
    method of feeds
  • 20 desaturation events occured after bottle
    feeding during KMC
  • None occured during breastfeeding (Chen)

22
Oxytocin Effects on Growth
  • Suckling, massage and warm temperature influence
    the release of GI hormones
    (Uvnas-Moberg et al. 1992)
  • Oxytocin stimulates digestion, weight gain and
    growth by activation of the endocrine system of
    the GIT
  • One study showed that oxytocin injections caused
    increased weight gain in mice

Kerstin Uvnas-Moberg. Massage, Relaxation
Well-being A possible role for Oxytocin E
Bjorkstrand, K. Uvnas-Moberg. Physiol Behav.
199659(4/5)947-952
23
Effects on Growth
  • Another study showed that increased levels of
    oxytocin after massage coincided with a rise of
    GI hormones in the blood
  • A third study suggested that the weight gain
    observed in preterm infants who received massage
    therapy was related to an increase in vagal tone

Kerstin Uvnas-Moberg. E Bjorkstrand, K.
Uvnas-Moberg.. Physiol Behav. 199659(4/5)947-952

24
Weight gain associated with Massage Oxytocin
release
  • Increased weight gain was not associated with
    increased food consumption
  • This suggests that the treatments had induced a
    higher metabolic efficiency and that energy was
    used for anabolic metabolism

S Holst, et al. Autonomic Neuroscience Basic and
Clinical 200512073 79
25
Oxytocin Cardiovascular Effects
  • Lower blood pressure
  • Lower pulse rate

CARDIOVASCULAR PROTECTIVE EFFECT
LC Michelini, MC Marcelo, J Amico, M Morris..
American Journal of Physiology - Heart
Circulatory Physiology. 2003284(6)2269-76. Kerst
in Uvnas-moberg. Acta Physiologica Scandinavica
Supplementum.199764038-42
26
KMC Effect on Physiological Stress
  • Cortisol levels has been studied as a sign of
    physiological stress in preterm infants
  • gt60 reduction in cortisol levels in stable
    preterms receiving KMC (gt20 min)

KMC reduces stress in preterm infants most likely
due to the secretion of oxytocin
Mooncey S, Giannakoulopoulos X, Glover V, Acolet
D, Modi N, 1997. Infant Behaviour and development
20(4) 553-557.
27
Role of Oxytocin in
  • Pro-social Behaviour And Disorders due to
    Aberrant Social Interactions

28
Oxytocin Mediates Pro-social Behaviour
  • Oxytocin receptors are distributed in various
    brain regions responsible for the formation of
    normal social attachments and affiliation
  • Oxytocin promotes bonding (maternal, paternal
    pairing)
  • ? the subjective experience of attachment
    security
  • ? trusting trustworthy behaviour (NOT risk
    taking behaviour)
  • ? ability to infer mental state of others from
    facial cues
  • Oxytocin suppresses fear-related activation of
    amygdala in healthy individuals in social
    situations

M Heinrichs et al. Frontiers in
Neuroendocrinology 30 (2009) 548-557
29
KMC Effects on Early Mother-Infant
RelationshipFindings from a Canadian Sample of
Full-Term Infants
  • Newborn infants use much of their energy making
    physiological adjustments to postnatal life
  • Many of their physiological states crying
    sleeping does not allow for taking in information
    from the external world
  • The one exception is the quiet alert state
  • Early skin-to-skin contact increases the infants
    ability to regulate their state organization
  • KMC facilitates infants ability to move into and
    maintain the quiet alert state
  • Researcher Ann Bigelow, Antigonish, Nova
    Scotia

30
KMC Effects on Early Mother-Infant Relationship
Cont.
  • The quiet alert state allow infants to be aware
    of external stimulation from the mother
  • It allows them to participate more actively in
    interactions with their mothers
  • Facilitates the infants own growth and
    development
  • Also fosters early social relations
  • KMC influence mothers to enhance their maternal
    behaviours
  • Mothers demonstrate more sensitivity to their
    infants signals and to their early social
    behaviour

31
Prevent Separation
  • If possible no baby should be separated from
    their mother
  • If there is separation introduce skin-to-skin
    care as soon as possible and as often as possible
  • Commence continuous KMC as soon as infant is
    stable
  • Keep Mothers Babies together!

32
Literature
  • Susan M. Ludington-Hoe, Kathy Morgan, Amel
    Abouelfettoh, A Clinical Guideline for
    Implementation of Kangaroo Care With Premature
    Infants of 30 or More Weeks Postmenstrual Age.
    Advances in Neonatal Care 2008 Vol. 8, No. 3S
  • Evidence-based clinical practice guidelines for
    an optimal use of the kangaroo mother method in
    preterm and/or low birthweight infants at birth.
    Fundación Canguro and Department of Clinical
    Epidemiology and Biostatistics, School of
    Medicine Pontificia, Universidad Javeriana,
    Bogotá, 2005 2007, Juan Gabriel Ruiz P,
    Nathalie Charpak
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Kerstin Uvnas-moberg. Oxytocin Linked Antistress
    Effects The Relaxation And Growth Response.
    Acta Physiologica Scandinavica Supplementum.19976
    4038-42
  • K Uvnas-moberg. Oxytocin A Possible Mediator Of
    Anti-stress Effects Induced By Acupuncture.
    Journal Of Acupuncture In Medicine.
    200220109-110
  • M Hernandez-Reif, M Diego, T Field. Preterm
    Infants Show Reduced Stress Behaviors And
    Activity After 5 Days Of Massage Therapy. Infant
    Behavior Development. 200730 557561

33
References
  • Kerstin Uvnas-Moberg. Touch - Chapter 12
    Massage, Relaxation And Well-being A Possible
    Role For Oxytocin
  • E Bjorkstrand, K. Uvnas-Moberg. Central oxytocin
    increases food intake and daily weight gain in
    rats. Physiol Behav. 199659(4/5)947-952
  • S Holst, I Lund, M Petersson, K Uvnas-Moberg.
    Massage-like stroking influences plasma levels of
    gastrointestinal hormones, including insulin, and
    increases weight gain in male rats. Autonomic
    Neuroscience Basic and Clinical 200512073 79
  • R Kostandy, et al. Pain Management Nursing.
    Kangaroo care (skin contact) reduces crying
    response to pain in preterm neonates pilot
    results. 20089(2)
  • LC Michelini, MC Marcelo, J Amico, M Morris.
    Oxytocinergic regulation of cardiovascular
    function studies in oxytocin-deficient mice.
    American Journal of Physiology - Heart
    Circulatory Physiology. 2003284(6)2269-76.
  • R Kostandy, et al. Pain Management Nursing.
    Kangaroo care (skin contact) reduces crying
    response to pain in preterm neonates pilot
    results. 20089(2)
  • K Reeta, et al. Role of ?- and d-opioid receptors
    in the antinociceptive effect ofoxytocin in
    formalin-induced pain response in mice.
    Regulatory Peptides 20061358590

34
References cont.
  • S HolstT, I Lund, M Petersson, K Uvnas-Moberg.
    Massage-like stroking influences plasma levels of
    gastrointestinal hormones, including insulin, and
    increases weight gain in male rats. Autonomic
    Neuroscience Basic and Clinical 200512073 79
  • Trends Endicrinol Metab 19967126-131
  • M Heinrichs, B von Dawans, G Domes. Oxytocin,
    vasopressin, and human social behavior. Frontiers
    in Neuroendocrinology 30 (2009) 548-557
  • Brain Research. 20051049234 239
  • Review of medical physiology. 20th ed. Publisher
    Lang Medical Books. W Ganong
  • M Peterssona. Oxytocin increases the density of
    high affinity a2-adrenoceptors within the
    hypothalamus, the amygdala and the nucleus of the
    solitary tract in ovariectomized rats. Brain
    Research. 20051049234 239
  • E Bjorkstrand, K. Uvnas-Moberg. Central oxytocin
    increases food intake and daily weight gain in
    rats. Physiol Behav. 199659(4/5) 947-952
  • Juan Gabriel Ruiz P, Nathalie Charpak.
    Evidence-based clinical practice guidelines for
    an optimal use of the kangaroo mother method in
    preterm and/or low birthweight infants at birth.
    Fundación Canguro and Department of Clinical
    Epidemiology and Biostatistics, School of
    Medicine Pontificia, Universidad Javeriana,
    Bogotá, 2005 2007,

35
References cont.
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T,
    Gutman J, Wilson D, Scher MS. Neurophysiologic
    assessment of neonatal sleep organization
    Preliminary results of a randomized controlled
    trial of skin contact with preterm infants.
    Pediatrics 2006117(5) e909-e923.
  • Woods DL, Principles of Kangaroo Mother Care unit
    43 in Woods DL (ed) Mother and baby friendly
    care, Cape Town Perinatal education programme
    2005
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Mirmiran Ariagno Role of REM sleep in brain
    development and plasticity)
  • Graven SN, Browne JV. 2008Volume 8(4),
    www.nainr.com
  • Scher MS, Ludington-Hoe S, et al Clinical
    Neurophysiology 120 (2009) 1812-1818
  • Development of fetal and neonatal sleep and
    circadian rhythms
  • M Mirmiran, YG.H. Maas, RL. Ariagno Sleep
    Medicine Reviews, Vol. 7, No. 4, p. 321334, 2003

36
References cont.
  • Stanley N. Graven, J V. Browne, Sleep and Brain
    Development The Critical Role of Sleep in Fetal
    and Early Neonatal Brain Development. Newborn
    Infant Nursing Reviews, December 2008 Vol 8,
    Number 4 173-179
  • Mooncey S, Giannakoulopoulos X, Glover V, Acolet
    D, Modi N, 1997. The Effect of Mother-Infant
    Skin-to-Skin Contact on Plasma Cortisol and
    beta-endorphin Concentrations in Preterm
    Newborns. Infant Behaviour and development 20(4)
    553-557.
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Title: Neuro-endocrine Mechanisms Providing the Benefits of Kangaroo Mother Care


1
Neuro-endocrine Mechanisms Providing the Benefits
of Kangaroo Mother Care
  • Dr Elise van Rooyen
  • Department of Paediatrics, University of
    Pretoria,
  • Kalafong Hospital, South Africa

2
Neuro-endocrine Mechanism
  • Many benefits of KMC are related to oxytocin
    secretion which is released by touch, light
    pressure and warmth experienced by the infants in
    the skin-to-skin position and during breastfeeding

3
KMC Effect on Body Temperature
  • KMC maintains adequate temperature for preterm
    and/or LBW infants
  • Infant body temperature rises in KMC
  • Fewer episodes of hypo- and hyperthermia occurs
    during KMC
  • It is safe to take care of infants as small as
    700g in warm environment with cap
  • Mothers are able to maintain their babys
    temperature within a very narrow temperature
    range which is not the case in incubator care
  • WHO KMC practical guide, PEP unit 43
    Principles of KMC

4
Rewarming Infants with Hypothermia KMC vs
Incubator Care
Teaching hospital, Lusaka, Zambia 80 babies with
templt36ºC (low risk hypothermia) 41 treated with
skin-to-skin contact (SSC) 39 treated in
incubator
Reaching 36.5ºC at 2 hours 3 hours 4 hours
SSC 30 70 90
Incubator 21 39 60
  • Adapted from Lancet 19983521115

5
Role of Oxytocin in Temperature Regulation
  • Circulation in the skin overlying the breast is
    increased during suckling resulting in increased
    skin temperature - this makes suckling more
    pleasant for pups Kerstin
    Uvnäs-Moberg TEM 1996
  • Circulating oxytocin and neurological triggered
    vasoactive peptides mediates this cutaneous
    vasodilation Eriksson et al
    1996ab
  • Temperature of breasts and chest increases not
    only during breastfeeding but also when milk
    ejection is triggered psychologically
    Lind et al. 1971

6
KMC Thermal Synchrony
  • A thermal synchrony develops between mom and baby
  • The mothers core temperature may rise 2ºC or
    drop one degree in a short period of time, in
    order to maintain this narrow range

7
Thermal Synchrony in Twins
  • Mothers breasts have the ability to thermally
    accommodate multiple infants simultaneously
  • Each breast acts independently to keep a twin
    warm
  • Case studies by S Ludington

8
KMC Behavioural Effects - Crying
  • Infants cry for a variety of reasons Separation
    from mother, hunger, and in response to pain
  • There was a reduction in crying during KMC
    compared to incubator care (Cochrane
    meta-analysis)
  • KMC reduces crying in response to pain (Weller
    Feldman) (Ludington-Hoe et al. AACN Clin Issues
    2005 16(3) 373387)
  • No crying at all when transporting sick infants
    in KMC position to a distant NICU (Sontheimer et
    al)

9
Research on Crying
  • Compared babies in KMC with babies in cots
  • Number of crying babies at observation periods
    performed every 15 minutes for the first 90
    minutes after birth
  • There was a significant absence or reduction in
    crying in infants receiving KMC compared to
    infants in cots
  • Christensson et al. Acta Paediatr 81488-93. 1992

10
KMC Effect on Neurophysiologic Outcomes
  • Sleep organisation
  • Brain maturation
  • Brain complexity

11
Sleep organisation Sleep Phases
  • NREM (Quiet Sleep)
  • Stage 1 Drowsy
  • Stage 2 Light onset of slow wave sleep
  • Stage 3 Deep slow sleep
  • Stage 4 Deep slow wave sleep
  • Crucial for creation of long term memories
    learning
  • REM (Active Sleep, Dream Sleep)
  • Paradoxical sleep rapid eyelid muscle
    movements
  • ? Heart rate Resp rate
  • Critical component associated with the
    development of the sensory systems

12
Sleep and Sleep Cycles
  • Sleep and sleep cycles are essential for
  • Sensory system development in the fetus and young
    infant
  • Creation of long-term memory and learning
  • Preservation of brain plasticity
  • Sleep deprivation in foetus and neonate has
    profound effects on early sensory development and
    creation of permanent neural circuits for the
    primary sensory systems

13
Sleep Continue
  • Sleeping is not a passive process
  • Sleep is driven by cholinergic cells which
    stimulate sleep actively (can be inhibited by
    depressant drugs)
  • Each specific EEG wave that occur during REM
    sleep plays a specific role in sensory system
    development (smell, taste, visual, auditory,
    touch, motion, position, emotion, or memory)
  • REM sleep deprivation between 30 wks GA and 4-5
    mnths results in delayed or disordered
    development of any or all of the systems above

14
Sleep Pattern in NICU
  • In the NICU, infants demonstrate a very chaotic
    version of this cycling pattern
  • Incubator Infants only have 10-20 seconds of
    quiet sleep. (HR and RR also does not change)
  • Disrupted sleep due to
  • separation from mother
  • and care giving environment

15
KMC Effect on Sleep Organization
  • Increases quantity of Quiet Sleep
  • Non-chaotic sleep pattern
  • Normal sleep cycling
  • Less sleep arousals
  • HR and RR variation according to sleep cycles
  • Preterm sleep cycles generally require 60 minutes
    to complete and within 5 minutes of the onset of
    KMC, cycling begins

16
Cycling is needed for Normal Growth
  • Formation of Neuronal Synapses and Growth

Sleep Cycling
  • Preemies in incubators demonstrate non-cycled
    sleep patterns throughout hospitalization
  • Result of delay in sleep cycling affect
    post-discharge sleep for up to 2 yrs (Scher,
    1997)

17
Brain Maturity by Complexity
  • Preterm infants who received KMC from 32-40 weeks
    PMA had better brain maturation in all measures
    of complexity
  • Brain maturation was better compared to preemies
    who did not receive KMC
  • Brain maturation was even better compared to full
    term infants

Kaffashi, Scher, Ludington-Hoe et al. Complexity
analysis of neonatal EEG. J Electroencephalography
18
Oxytocins Analgesic Effects
  • Oxytocin administered in mice has an analgesic
    effect in response to (formalin-induced) pain
  • Oxytocin acts on the ?- d-opioid receptors in
    the brain
  • Chronic (X 7 days) administration of oxytocin did
    not produce tolerance

K Reeta, et al. Regulatory Peptides 20061358590
KMC Effect on painful procedures
  • Preterm infants exhibit less audible and
    inaudible (facial grimacing, eye squeezing and
    brow bulging) crying during and after heel pricks
    when in KMC compared to incubator R
    Kostandy, et al. 20089(2)
  • KMC reduces crying associated with painful
    procedures (Weller Feldman)

19
KMC Effects on Nosocomial Infections
  • Infants who received 24/7 KMC had ? infections by
    discharge (3 randomized trials)
  • ? Infections in infants who received KMC
    (Cochrane meta-analysis)
  • ? Nosocomial infections may be due to
  • Enhanced stratum corneum barrier function when
    hydration increases and trans-epidermal water
    loss decreases
  • Improved immunity
  • Oxytocin
  • Less stress
  • Breastmilk

20
KMC reduces Mortality?
  • A meta-analysis shows that KMC reduces neonatal
    mortality amongst preterm babies (birth weight
    lt2000 g) in hospital, and is highly effective in
    reducing severe morbidity, particularly from
    infection
  • Joy Lawn et al. International Journal of
    Epidemiology 201039i144i154
  • Cochrane meta-analysis

21
KMC Effect on Desaturation Events
  • During KMC the number of desaturation events
    decreased in breastfed infants
  • Relationship between desaturation events and
    method of feeds
  • 20 desaturation events occured after bottle
    feeding during KMC
  • None occured during breastfeeding (Chen)

22
Oxytocin Effects on Growth
  • Suckling, massage and warm temperature influence
    the release of GI hormones
    (Uvnas-Moberg et al. 1992)
  • Oxytocin stimulates digestion, weight gain and
    growth by activation of the endocrine system of
    the GIT
  • One study showed that oxytocin injections caused
    increased weight gain in mice

Kerstin Uvnas-Moberg. Massage, Relaxation
Well-being A possible role for Oxytocin E
Bjorkstrand, K. Uvnas-Moberg. Physiol Behav.
199659(4/5)947-952
23
Effects on Growth
  • Another study showed that increased levels of
    oxytocin after massage coincided with a rise of
    GI hormones in the blood
  • A third study suggested that the weight gain
    observed in preterm infants who received massage
    therapy was related to an increase in vagal tone

Kerstin Uvnas-Moberg. E Bjorkstrand, K.
Uvnas-Moberg.. Physiol Behav. 199659(4/5)947-952

24
Weight gain associated with Massage Oxytocin
release
  • Increased weight gain was not associated with
    increased food consumption
  • This suggests that the treatments had induced a
    higher metabolic efficiency and that energy was
    used for anabolic metabolism

S Holst, et al. Autonomic Neuroscience Basic and
Clinical 200512073 79
25
Oxytocin Cardiovascular Effects
  • Lower blood pressure
  • Lower pulse rate

CARDIOVASCULAR PROTECTIVE EFFECT
LC Michelini, MC Marcelo, J Amico, M Morris..
American Journal of Physiology - Heart
Circulatory Physiology. 2003284(6)2269-76. Kerst
in Uvnas-moberg. Acta Physiologica Scandinavica
Supplementum.199764038-42
26
KMC Effect on Physiological Stress
  • Cortisol levels has been studied as a sign of
    physiological stress in preterm infants
  • gt60 reduction in cortisol levels in stable
    preterms receiving KMC (gt20 min)

KMC reduces stress in preterm infants most likely
due to the secretion of oxytocin
Mooncey S, Giannakoulopoulos X, Glover V, Acolet
D, Modi N, 1997. Infant Behaviour and development
20(4) 553-557.
27
Role of Oxytocin in
  • Pro-social Behaviour And Disorders due to
    Aberrant Social Interactions

28
Oxytocin Mediates Pro-social Behaviour
  • Oxytocin receptors are distributed in various
    brain regions responsible for the formation of
    normal social attachments and affiliation
  • Oxytocin promotes bonding (maternal, paternal
    pairing)
  • ? the subjective experience of attachment
    security
  • ? trusting trustworthy behaviour (NOT risk
    taking behaviour)
  • ? ability to infer mental state of others from
    facial cues
  • Oxytocin suppresses fear-related activation of
    amygdala in healthy individuals in social
    situations

M Heinrichs et al. Frontiers in
Neuroendocrinology 30 (2009) 548-557
29
KMC Effects on Early Mother-Infant
RelationshipFindings from a Canadian Sample of
Full-Term Infants
  • Newborn infants use much of their energy making
    physiological adjustments to postnatal life
  • Many of their physiological states crying
    sleeping does not allow for taking in information
    from the external world
  • The one exception is the quiet alert state
  • Early skin-to-skin contact increases the infants
    ability to regulate their state organization
  • KMC facilitates infants ability to move into and
    maintain the quiet alert state
  • Researcher Ann Bigelow, Antigonish, Nova
    Scotia

30
KMC Effects on Early Mother-Infant Relationship
Cont.
  • The quiet alert state allow infants to be aware
    of external stimulation from the mother
  • It allows them to participate more actively in
    interactions with their mothers
  • Facilitates the infants own growth and
    development
  • Also fosters early social relations
  • KMC influence mothers to enhance their maternal
    behaviours
  • Mothers demonstrate more sensitivity to their
    infants signals and to their early social
    behaviour

31
Prevent Separation
  • If possible no baby should be separated from
    their mother
  • If there is separation introduce skin-to-skin
    care as soon as possible and as often as possible
  • Commence continuous KMC as soon as infant is
    stable
  • Keep Mothers Babies together!

32
Literature
  • Susan M. Ludington-Hoe, Kathy Morgan, Amel
    Abouelfettoh, A Clinical Guideline for
    Implementation of Kangaroo Care With Premature
    Infants of 30 or More Weeks Postmenstrual Age.
    Advances in Neonatal Care 2008 Vol. 8, No. 3S
  • Evidence-based clinical practice guidelines for
    an optimal use of the kangaroo mother method in
    preterm and/or low birthweight infants at birth.
    Fundación Canguro and Department of Clinical
    Epidemiology and Biostatistics, School of
    Medicine Pontificia, Universidad Javeriana,
    Bogotá, 2005 2007, Juan Gabriel Ruiz P,
    Nathalie Charpak
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Kerstin Uvnas-moberg. Oxytocin Linked Antistress
    Effects The Relaxation And Growth Response.
    Acta Physiologica Scandinavica Supplementum.19976
    4038-42
  • K Uvnas-moberg. Oxytocin A Possible Mediator Of
    Anti-stress Effects Induced By Acupuncture.
    Journal Of Acupuncture In Medicine.
    200220109-110
  • M Hernandez-Reif, M Diego, T Field. Preterm
    Infants Show Reduced Stress Behaviors And
    Activity After 5 Days Of Massage Therapy. Infant
    Behavior Development. 200730 557561

33
References
  • Kerstin Uvnas-Moberg. Touch - Chapter 12
    Massage, Relaxation And Well-being A Possible
    Role For Oxytocin
  • E Bjorkstrand, K. Uvnas-Moberg. Central oxytocin
    increases food intake and daily weight gain in
    rats. Physiol Behav. 199659(4/5)947-952
  • S Holst, I Lund, M Petersson, K Uvnas-Moberg.
    Massage-like stroking influences plasma levels of
    gastrointestinal hormones, including insulin, and
    increases weight gain in male rats. Autonomic
    Neuroscience Basic and Clinical 200512073 79
  • R Kostandy, et al. Pain Management Nursing.
    Kangaroo care (skin contact) reduces crying
    response to pain in preterm neonates pilot
    results. 20089(2)
  • LC Michelini, MC Marcelo, J Amico, M Morris.
    Oxytocinergic regulation of cardiovascular
    function studies in oxytocin-deficient mice.
    American Journal of Physiology - Heart
    Circulatory Physiology. 2003284(6)2269-76.
  • R Kostandy, et al. Pain Management Nursing.
    Kangaroo care (skin contact) reduces crying
    response to pain in preterm neonates pilot
    results. 20089(2)
  • K Reeta, et al. Role of ?- and d-opioid receptors
    in the antinociceptive effect ofoxytocin in
    formalin-induced pain response in mice.
    Regulatory Peptides 20061358590

34
References cont.
  • S HolstT, I Lund, M Petersson, K Uvnas-Moberg.
    Massage-like stroking influences plasma levels of
    gastrointestinal hormones, including insulin, and
    increases weight gain in male rats. Autonomic
    Neuroscience Basic and Clinical 200512073 79
  • Trends Endicrinol Metab 19967126-131
  • M Heinrichs, B von Dawans, G Domes. Oxytocin,
    vasopressin, and human social behavior. Frontiers
    in Neuroendocrinology 30 (2009) 548-557
  • Brain Research. 20051049234 239
  • Review of medical physiology. 20th ed. Publisher
    Lang Medical Books. W Ganong
  • M Peterssona. Oxytocin increases the density of
    high affinity a2-adrenoceptors within the
    hypothalamus, the amygdala and the nucleus of the
    solitary tract in ovariectomized rats. Brain
    Research. 20051049234 239
  • E Bjorkstrand, K. Uvnas-Moberg. Central oxytocin
    increases food intake and daily weight gain in
    rats. Physiol Behav. 199659(4/5) 947-952
  • Juan Gabriel Ruiz P, Nathalie Charpak.
    Evidence-based clinical practice guidelines for
    an optimal use of the kangaroo mother method in
    preterm and/or low birthweight infants at birth.
    Fundación Canguro and Department of Clinical
    Epidemiology and Biostatistics, School of
    Medicine Pontificia, Universidad Javeriana,
    Bogotá, 2005 2007,

35
References cont.
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Ludington-Hoe SM, Johnson MW, Morgan K, Lewis T,
    Gutman J, Wilson D, Scher MS. Neurophysiologic
    assessment of neonatal sleep organization
    Preliminary results of a randomized controlled
    trial of skin contact with preterm infants.
    Pediatrics 2006117(5) e909-e923.
  • Woods DL, Principles of Kangaroo Mother Care unit
    43 in Woods DL (ed) Mother and baby friendly
    care, Cape Town Perinatal education programme
    2005
  • World Health Organization. Kangaroo mother care
    a practical guide. Geneva World Health
    Organization, Department of Reproductive Health
    and Research 2003
  • Mirmiran Ariagno Role of REM sleep in brain
    development and plasticity)
  • Graven SN, Browne JV. 2008Volume 8(4),
    www.nainr.com
  • Scher MS, Ludington-Hoe S, et al Clinical
    Neurophysiology 120 (2009) 1812-1818
  • Development of fetal and neonatal sleep and
    circadian rhythms
  • M Mirmiran, YG.H. Maas, RL. Ariagno Sleep
    Medicine Reviews, Vol. 7, No. 4, p. 321334, 2003

36
References cont.
  • Stanley N. Graven, J V. Browne, Sleep and Brain
    Development The Critical Role of Sleep in Fetal
    and Early Neonatal Brain Development. Newborn
    Infant Nursing Reviews, December 2008 Vol 8,
    Number 4 173-179
  • Mooncey S, Giannakoulopoulos X, Glover V, Acolet
    D, Modi N, 1997. The Effect of Mother-Infant
    Skin-to-Skin Contact on Plasma Cortisol and
    beta-endorphin Concentrations in Preterm
    Newborns. Infant Behaviour and development 20(4)
    553-557.
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