Kangaroo Care

 

 Reviewed by Charge Nurse Newborn
December 2007
Clinical Guidelines Back Newborn Services Home Page
Definition Criteria Benefits Steps & Preparation
Stable Infant on CPAP Stable Ventilated Infant Criteria for return Infant in cot/INC
  Other Related Document References  

Kangaroo Care (KC)

Kangaroo care (KC) is defined as a method of holding a diaper-clad infant in skin-to-skin contact, prone and upright on the chest of the parent. The infant is enclosed in the parent’s clothing in order to maintain temperature stability. It is recommended that KC should be employed regularly and consistently with medically stable premature infants and their parents due to its beneficial effects.

Criteria for Administering Kangaroo Care

        Exclusion Criteria

Benefits of Kangaroo Care

Infant Outcomes
  • Decreased variation in heart and respiratory rates, improved oxygenation, less bradycardia, fewer and shorter apnoeic episodes.
  • Maintains skin and core temperatures through conduction of heat from the parent.
  • Promotes optimal infant growth and development.
  • Beneficial effects on the sleep-awake state organisation in infants.

Maternal Outcomes
  • Improves parent-infant bonding process.
  • Increases mother’s milk production ( an oxytocin-releasing agent) and unlimited access to breast.
  • Enhances parental emotional and psychological wellness.
  • Promotes parent/infant attachment.

Steps and Preparation

All Infants

Step

Preparation
1 Ensure baby and parent are prepared:
  • Offer parent information on KC (link to info?)
  • Provide a quiet, calm environment
  • Offer screen and handheld mirror
2 Parent Preparation:
  • Plan with parents a suitable time for kangaroo care (as infant’s condition allows).
  • Advise to bring a drink, go to the toilet prior to kangaroo cuddle and express breasts prior to kangaroo cuddle.
  • Offer to change top clothes with a hospital gown (with its opening in front)
3 Infant preparation:
  • Check infant’s temperature. Secure skin temperature
    probe to monitor infant’s temperature if appropriate.
  • Suction if necessary.
  • Remove infant’s clothing except for the diaper
4 Ideally, allow infant to remain on KC for at least 1 hour (or longer) if physiologically stable and parent comfortable.
5 Document infants intolerance of KC

Stable Infant in Cot or Incubator

Step

Preparation
1 Wrap the infant with a cloth nappy or leave the infant in a snuggle- up
2 Mother/father picks infant up and places infant on the chest, with legs and arms in a flexed position and head to one side
3 Nurse assists with taking out IV fluids lines and/ ECG leads
4 Parent reclines back on the lazy boy chair/ breastfeeding chair with a foot stool
5 Cover infant with blanket and apply hat to maintain body temperature
6 If the baby is >30 wks gestation and requiring no ventilatory support, allow baby to nuzzle at the breast while up, as this is a step towards initiating lactation and breastfeeding

Stable Infants on Hudson CPAP

Step

Preparation
1 Wrap the infant with a cloth nappy or leave the infant in a snuggle- up
2 Parent sits in lazy boy chair/breastfeeding chair (Or consider standing transfer)
3 Disconnect CPAP tubing (blue & white) from infant, reconnect tubing through the side port hole of incubator. Check water is cleared from CPAP tubing
4 Nurse assists transfer by holding baby in one hand and CPAP tubing in the other hand
5 Position infant comfortably with legs and arms flexed and head on the side once placed on parent’s chest
6 Cover infant with a blanket and cover head with a hat and close mother’s gown around baby
7 Secure CPAP tubing to parent’s clothing at shoulder height to prevent disconnection

Stable Ventilated Baby

Step

Preparation
1 Wrap the infant with a cloth nappy or leave the infant in a snuggle- up
2 Parent sits in lazy boy chair/breastfeeding chair (Or consider standing transfer)
3 Briefly disconnect from ventilation for more stable infants where appropriate. Check and clear ventilator tubes of water
4 One nurse holds baby (wrapped/ in snuggle up). Another nurse supports ETT tubes/ lines/ cardio/respiratory leads
5 Both nurses transfer infant and connections at the same time. Place infant vertically on the mother/father’s chest. Secure ventilator tubings at parent’s clothing at shoulder height using tape. Monitor cardio-respiratory throughout transfer
6 Position infant comfortably with legs and arms flexed and head on the side once placed on parent’s chest
7 Cover infant with a blanket and cover head with a hat and close mother’s gown around baby
8 Inform parents how to recognise changes in colour
9 Assess stability of infant as to length of time up for cuddle

 

 

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Criteria for Returning Infant to the Incubator

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References

1 Abdulwadud, O. (2001). Is Kangaroo Care Better Than Standard Care For Low Birth Weight Infants? Centre for Clinical Effectiveness, Monash Institute of Health Services Research. Vic, Australia: Monash Medical Centre, Clayton.
2 Albright, L. (2001). Kangaroo Care: Restoring the Original Paradigm for Infant Care and Breastfeeding. Leaven Index, Report on 2001 LLL1 Conference Session. 37(5), 106-107.
3 Bakewell-Sachs, S. (2001). Commentary: the impact of two transfer techniques used during skin-to-skin care on the physiologic and behavioural responses of preterm infants (towards evidence-based practice). The American Journal of Maternal and Child Nursing, 26(2), 109.
4 Bauer, J., Sonthaimer, D., Fischer, C. and Linderkamp, O. (1996). Metabolic Rate and Energy Balance in Very Low Birth Weight Infants During Kangaroo Holding by their Mothers and Fathers. The Journal Of Paediatrics. 129(4), 608-611.
5 Beal, J. A. and Wood, S. H. (2001). Toward Evidence-based Practice: Implications of Kangaroo Care for Growth and Development in Preterm Infants. The American Journal of Maternal/Child Nursing: 30(5), 338-338.
6 Bergman, N. (2005).Kangaroo Mother Care Promotions: Overview – Physiology and Research of Kangaroo Mother Care.
7 Bosque, E. M., Brady, J. P., Affonso, D. D. and Wahlberg, V. (1995). Physiologic Measures of Kangaroo versus Incubator Care in a Tertiary-Level Nursery. Journal of Obstetrical Gynaecological and Neonatal Nursing. 24(3), 219-226.
8 Bowden, V., Greenberg, C. and Donaldson, N. (2000). Developmental care of the newborn. [CINAHL] Accession Number: 2001029526 www.kangaroomothercare.com.
9 Charpak, N., Ruiz-Pelaez, J., FIGUEROA, Z. and Charpak, Y. (1997). Kangaroo Mother versus Traditional Care for Newborn Infants =<2000 grams: A Randomized, Controlled Trial. Paediatrics. 100(4), 682-688.
10 Di Menna, L. (2006). Considerations for Implementation of a neonatal Kangaroo Care Protocol. Neonatal Network, 25(6) 405-412.
11 Fieldman, R., Eidelman, A. I., Sirota, L.,Weller, A. (2002). Comparison of skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development. Official Journal of the American Academy of Pediatrics. 110(1), 16-26.
12 Larimer, K.(2000).Premature Baby, Surviving The NICU: Kangaroo Care Benefits., www.prematurity.org.
13 Legault, M., Goulet, C. (1995). Comparison of Kangaroo Care and Traditional Methods of Removing Preterm Infants from Incubators. Journal of Obstetrical Gynaecological and Neonatal Nursing. 24(6), 501- 506.
14 Ludington, S.(1990). Energy Conservation during Skin-to-Skin contact between premature infants and their mothers. Heart and Lung. . 19(5), 445-451.
15 Ludington- Hoe, S., Hosseini, R. Torowicz, A. and Deborah L., (2005). Skin-to-Skin Contact (Kangaroo Care) Analgesia for Preterm Infant Heel Stick. AACN Clinical Issues Advanced Practice in Acute and Critical Care, 16(3).
16 Ludington- Hoe, S., Anderson, G. and Hollingsead, A. (1999) Birth-related Fatigue in 34-36 week Preterm Neonates: Rapid Recovery withVery Early Kangaroo (Skin-to-Skin) Care. ). Journal of Obstetrical Gynaecological and Neonatal Nursing. 28(1), 94-100.
17 Ludington- Hoe, S. M., Ferreira, C., Swinth, J., and Ceccardi, J.J. (2003). Safe criteria and procedure for kangaroo care with intubated preterm infants. Journal of Obstetrics and neonatal Nursing. 32 (2),579-588.
18 Richarson, H. (1997). Midwifery Today. Kangaroo Care: Why Does It Work? Issue 44. www.midwiferytoday.com.
19 Tessier, R., C, M., Velez, S., Giron, M., Figueroa De Calume, Z., Ruiz-Palaez, J. G., Charpak, Y. and Charpak, N. (1998). Paediatrics. Kangaroo Mother Care and the Bonding Hypothesis. Journal of Obstetrical Gynaecological and Neonatal Nursing. 102(2), 390-391.