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Kangaroo Care and the Ventilated Neonate


Kangaroo Care and the Ventilated Neonate By Karen Black (MNursSci, RNC) Kangaroo Care (also known as Skin-to Skin Contact) Was developed by Rey and Martinez (1983) in ... – PowerPoint PPT presentation

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Title: Kangaroo Care and the Ventilated Neonate

Kangaroo Care and the Ventilated Neonate
By Karen Black (MNursSci, RNC)
Kangaroo Care (also known as Skin-to Skin Contact)
  • Was developed by Rey and Martinez (1983) in
    Bogotá, Columbia as an alternative to incubator
    care (WHO, 2003)
  • Was initially defined as
    The care of preterm
    infants carried skin-to-skin with the mother.
    (WHO, 2003)
  • Its key features were described as
  • Early, continuous and prolonged skin-to-skin
    contact between the mother and the baby.
  • Exclusive breastfeeding (ideally)
  • Being initiated in hospital and continued at home
  • Providing small babies with the opportunity to be
    discharged early.

Current definition of Kangaroo Care
A form of parental caregiving where the newborn
low birthweight or premature infant is
intermittently nursed skin-to-skin in a vertical
position between the mothers breasts or against
the fathers chest for a non-specific period of
(Kenner Lott, 2003)
Benefits of Kangaroo Care
  • Maintaining physiological stability.
  • Increasing immunity.
  • Optimising breastfeeding.
  • Facilitating parent-infant bonding
  • (Shiau and Anderson, 1997 WHO,
    1997 WHO, 2003).

Kangaroo Care as an alternative to cots in rural
In a setting as affluent as our own to what
extent should Kangaroo Care be promoted?
Kangaroo Care and the Intensive Care Infant
  • Cochrane review states that Kangaroo care should
    not be routine practice in the technological
    setting. (Conde-Agudelo, et al, 2003)
  • Decision to Kangaroo infants generally left to
    individual nurses clinical judgment (Nyqvist,
  • Many infants miss out on opportunity to consider
    this practice.

Aims and objectives
  • To examine the application and limitation of
    Kangaroo Care with intubated LBW or very
    premature infants requiring mechanical
  • To critically examine the literature.
  • To provide recommendations for practice.

Physiological Stability
Researcher(s) Type of Study Sample group Findings
Drosten-Brookes (1993) case study 2 ? Infants responded to Kangaroo care with increased quiet sleep and decreased Oxygen requirement. ? Highlight possible benefits and need for further research.
Gale, Frank Lund (1993) Quantitative 25 ? During KC period pulse, oxygen and respiratory rate remained within normal parameters for infants of 30/40 or gt1.2kg. ? Infants lt30/40 or lt1.2kg showed signs of restlessness, tachycardia and decreased oxygenation during prolonged kangaroo care.
Ludington-Hoe, Ferreira Goldstein (1998) case study 1 ?a 27-day old neonate weighing 894g received SIMV at a rate of 12 breaths per minute whilst receiving Kangaroo Care for 45minutes.
Ludington, Ferreira Swinth (1999) Quantitative 12 ?The physiological observations of Infants lt1kg remained stable during KC and decreased oxygen requirement.
Smith (2001) Quantitative 14 ?Infants oxygen requirements increased and body temperature dropped.
Transfer Technique
  • Indicated to be the greatest contributing factor
    to heat loss and increased stress, resulting in
    tachycardia or apnoea (Ludington-Hoe et al, 1998)
  • Lifting commonly associated with oxygen
    desaturation (Danford et al, 1983 Peters, 1992).
  • Physiological disruption occurred in both parent
    and nurse led transfer techniques (Neu et al,
  • Involving 2-3 nurses in transfer minimises the
    risk of extubation or physiological disruption
    (Ludington-Hoe et al, 2003).

  • The diverse range of benefits of breastmilk for
    premature infants are widely documented.
  • Admission to NICU and necessity for intubation
    affects decisions to breastfeed (Jaeger et al,
  • Those who chose to breastfeed often have
    difficulty establishing expression and sufficient
    supply during period of intubation and tube
    feeding (Furman and Kennell, 2000).

Advantages of Kangaroo Care to breastfeeding
  • Stimulates endocrine pathway and enhances flow of
    milk (Bier, 1997 Whitlaw et al, 1998).
  • Reduces harmful anxiety and stress emotions
    (Whitlaw et al, 1998).
  • Promotes family centred care and breaks down
    barriers to expression of milk (Jaeger et al,

Parental benefits of Kangaroo Care
  • Reduction in stress and anxiety improves parents
    perception of the infants admission to NICU and
    subsequent ventilation (Legault Goulet, 1995).
  • Reduces feelings of inadequacy, anxiety and
    frustration experienced by fathers (Neu, 2004).
  • Facilitates closeness and bonding (Neu, 2004).
  • Case reports detail benefits in reducing
    complications associated with maternal eclampsia
    (Anderson et al, 2001) and post-natal depression
    (Dombrowski et al, 2001)

Adverse effects of Kangaroo Care
  • Increased stress on dislodgement of venous or
    arterial lines or accidental extubation.
  • Feelings of guilt if infant becomes
    physiologically unstable during Kangaroo period.

Evaluation of evidence
  • Benefits in breastfeeding, nutrition and parental
    satisfaction if undertaken safely.
  • Practice can benefit physiological stability if
    carried out for an appropriate length of time and
    utilising a safe transfer technique.
  • Kangaroo care can be conducive with mechanical

Limits in research evidence
  • Compatibility of ventilation method.
  • Accessing haemodynamic stability.
  • Drug contraindications.
  • Limit of gestational age or size of infant.
  • Studies from British units.
  • Randomized control trials.

Barriers to Kangaroo Care with ventilated
neonates in practice
  • Fear of arterial or venous line dislodgement
  • Fear of accidental extubation
  • Safety issues for very low birthweight infants
  • Inconsistency in technique
  • Nurses feelings that their work load increased.
  • Nursing reluctance.
  • Medical staff reluctance
  • Difficulty administering care during KC
  • Staff concerns for parental privacy
  • Lack of experience with KC
  • Insufficient time for family care during KC
  • Belief that technology is better than KC

(Engler et al, 2002)
(No Transcript)
Recommendations for practice
  • Development of evidence based policy at Trust
  • Incorporate an inter-disciplinary approach.
  • Remain aware of limitations of policy

Recommendations for education
  • Comprehensive education detailing the benefits
    and risks.
  • Up to date evidence based information.
  • Incorporated into new staff induction or learning
    beyond registration study days.
  • Encourage critical reflection on experiences of
    Kangaroo care with ventilated infants.

  • Anderson, et al (2001). Kangaroo care Not just
    for stable preemies anymore. Reflections on
    Nursing Leadership. 14, 3334, 45.
  • Bier et al (1997) Breastfeeding infants who were
    extremely low birthweight. Pediatric. 100
  • Bliss (2004) Available at www.bliss.org.uk
    (Accessed 14.11.04 updated 01.10.04).
  • Conde-Agudelo et al (2003). Kangaroo mother care
    to reduce morbidity and mortality in low
    birthweight infants. The Cochrane Database of
    Systematic Reviews. 2.
  • Drosten-Brooks, F. (1993). Kangaroo Care
    Skin-to-skin contact in the NIVU. Maternal Child
    Nursing. 18(5) 250-253
  • Danford et al . (1983). Effects of routine care
    procedures on transcutaneous oxygen in neonates
    A quantitative approach. Archives of Disease in
    Childhood, 58, 20-23. Bibliographic Links
    External Resolver Basic
  • Dombrowski et al . (2001). Kangaroo
    (skin-to-skin) Care with a postpartum woman who
    felt depressed. MCN, The American Journal of
    Maternal and Child Nursing. 26 214216.
  • Engler, A. et al (2002) Kangaroo Care National
    survey of practice, knowledge barriers and
    perceptions. Maternal and Child Nursing. 27(3)
  • Furman, L. Kennell, J. (2000). Breastmilk and
    skin-to-skin kangaroo care for premature infants.
    Avoiding bonding failure. Acta Paediatrica. 89
  • Gale, et al (1993). Skin-to-skin holding of the
    intubated premature infant. Neonatal Network.
    12(6) 49-57
  • Jaeger MC et al (1997) The impact of prematurity
    and neonatal illness on the decision to
    breast-feed. Journal of Advanced Nursing. 8, 4,
  • Kenner, C. Lott, J.W. (2003). Comprehensive
    Neonatal Nursing. Saunders, USA.
  • Legault, M. Goulet, C. (1995). Comparison of
    kangaroo and traditional methods of removing
    preterm infants from incubators. Journal of
    Obstetric, Gynaecological and Neonatal Nursing.
    24(65) 501-506.
  • Ludington-Hoe et al (1998). Kangaroo Carewith a
    ventilated preterm infant. Acta Paediatrica. 87

References continued
  • Ludington et al (1999). Skin-to-skin contact
    effects on pulmonary function tests in ventilated
    preterm infants. Journal of Investigative
    Medicine. 47(2) 173-177
  • Ludington et al .(2003). Safe criteria and
    procedure for Kangaroo Care with intubated
    preterm infants. Journal of Obstetric,
    Gynaecological and Neonatal Nursing. 32 (5)
  • Neu et al (2000). The Impact of Two Transfer
    Techniques Used During Skin-to-Skin Care on The
    Physiologic and Behavioural Responses of Preterm
    Infants. Nursing Research. 49(4) 214-223
  • Neu, M (2004). Kangaroo Care Is it for Everyone?
    Neonatal Network. 23(5) 47-54.
  • Nyqvist, K.H (2004). How can Kangaroo Mother Care
    and High Technology Care be Compatible? Journal
    of Human Lactation. 20(1) 72-74
  • Peters, K. L. (1992). Does routine nursing care
    complicate the physiologic status of the
    premature neonate with respiratory distress
    syndrome? Journal of Perinatal and Neonatal
    Nursing, 6, 67-84.
  • Shiau, S.H. and Anderson, G.C. (1997). Randomized
    controlled trial of kangaroo care with full-term
    infants effects on maternal anxiety, breast milk
    maturation, breast engorgement, and breastfeeding
    status. Australian Breastfeeding Association,
  • Smith, S.L. (2001). Physiological stability of
    intubated Very Low Birtheight infants during
    skin-to-skin care and incubator care. Advances in
    Neonatal Care. 1(1) 28-40.
  • Swinth et al (2003). Kangaroo care with a Preterm
    Infant Before, During and After Mechanical
    Ventilation. Neonatal Network. 22(6) 33-38
  • Whitelaw et al (1998) Skin-to-skin contact for
    very low birthweight infants and their mothers.
    Archives of Disease in Childhood. 63 137781
  • World Health Organization (WHO) (1997). Thermal
    Control of the Newborn A practical Guide.
    Maternal Health and Safe Motherhood Programme.
    WHO, Geneva
  • World Health Organisation (WHO) (2003). Kangaroo
    Mother Care A Practical Guide. Department of
    Reproductive Health and Research, Geneva.
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