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Kangaroo Care as Standard Practice in the Special-Care Nursery

Kangaroo care (KC ), or skin-to-skin holding, is a developmental intervention that has been shown to benefit the infant in a variety of ways, including the following:
  • Promotes infant autonomic and physiologic stability
  • Increases periods of quiet sleep
  • Minimizes pain
  • Enhances state transitions and behavior organization
  • Decreases both infant and maternal stress
  • Improves lactation and prefeeding behaviors of infants
  • Supports successful parental attachment
Infant Eligibility for Kangaroo Care, General Guidelines:
  • KC should be encouraged for all infants, regardless of gestational age or weight.
  • Skin-to-skin holding rather than traditional holding is recommended for all infants 1,500 grams or less for temperature and physiologic stability.
  • KC is not recommended for infants on hypothermia protocol for 72 hours and while rewarming. Traditional holding is encouraged while rewarming.

The isolette is a standard feature in any nursery providing special care to infants who were born prematurely, at low birth weight or who are struggling to transition to extrauterine life. An isolette can ensure a controlled temperature and offer an environment that greatly reduces the extraneous stress of drafts and other external simulation. With the use of an isolette, an infant’s environment is only altered for short periods of time, during which all necessary interventions are grouped together—a process called “cluster care.” This process has become a standard of care in nurseries in the United States.

Some infants require a rigidly controlled isolette environment early in their stay in a nursery. But even these infants, as they grow and improve, can be connected to a more organic and long-term beneficial source of heat and positive stimulation— their mothers and fathers—through kangaroo care (KC).

Kangaroo care was developed in the late 1970s as a solution to an overcrowded neonatal intensive care unit (NICU) in Bogota, Columbia.

The NICU lacked the isolette space needed to maintain thermoregulation in the unit’s population of low birth-weight infants. To
compensate for this, mothers were used as the heat sources for their babies. Each mother reclined comfortably in a chair with her gown or shirt opened to the front. And each mother’s infant, wearing only a diaper, was placed in an upright, prone position on his or her mother's chest for one- to three-hour segments. A blanket draped over mother and baby helped to provide thermal stability and privacy.

The infants held by their mothers in this way began to gain weight more quickly and maintain their body temperatures sooner than infants who didn’t experience this kind of care.

These improvements led to shorter stays in the NICU. As the practice expanded, KC grew to include healthy, term infants and now includes fathers, grandparents and siblings as KC providers. Though it began as a temporary solution to a practical problem, KC now holds a respected place in current practice due to the many benefits it provides to infants, families and health care providers.

The most prominent challenge in caring for a preterm infant is providing the optimal artificial environment to replicate intrauterine life. KC not only offers infants a heat source, it provides the stability and comfort of a human heartbeat and voice, and a familiar scent. The conductive heat offered via normothermic skin-to-skin contact is more direct than heat provided by a warmed isolette. Infants receiving KC learn to maintain more consistent body temperatures earlier by taking cues from the regulated heart rate and respiratory rate of the KC provider. A study by Ludington-Hoe, et al. (2004), found that infants who received KC maintained heart rates, respiratory rates and oxygen saturation within normal limits during KC. None of the infants had apneic or bradycardic events during KC.

KC has been associated with increased ability in self-soothing and relaxation, especially when infants who have received KC are exposed to pain. Kashaninia, et al. (2008), found a significant decrease in the amount of pain expressed by infants who experienced KC for 10 minutes prior to an intramuscular injection. These infants maintained a relaxed breathing pattern and stayed relaxed or even asleep for the procedure. They demonstrated remarkably less facial grimace and crying. Keeping infants calm during their hospital stay prevents a loss of calories due to futile stress and preserves them for use in growth and development.

The mother/infant couplet benefits from the breast-feeding support provided by KC. The prolonged, direct contact between the infant and the mother’s chest that occurs during KC provides increased stimulation to produce larger, more consistent volumes of breast milk during feedings and pumping sessions. During KC, infants can easily access their mothers’ breasts for feeding. This access reduces the number of barriers that arise between an infant demonstrating hunger cues and latching (e.g., changing locations from isolette to crib, frequent feedings, achieving privacy). It helps reinforce a strong feeding pattern and builds confidence in breast-feeding for the dyad.

In a study by Hake-Brooks and Anderson (2008), mother/infant pairs who participated in KC reported significantly higher rates of exclusive breast-feeding at discharge as well as at 1.5, 3 and 6 months of age.

It is often difficult to provide families with bonding time when physical and process barriers prevent family members from touching and holding their infant. In providing stable thermoregulation through KC, the isolette, a major barrier to bonding, is unnecessary and can be removed. KC further fosters the bonding process by offering the familiar parental act of holding an infant at a time when most of the “normal” new-parent experience has been altered.

Parents feel empowered when they provide KC for their infant.

Johnson (2007) found that they appreciate the “satisfaction in ‘being needed by nurses,’” as well as playing an important role in an infant’s care. Both infants and parents are able to form the attachment that typically begins at birth.

Though KC is a healthy intervention for infants and their parents, it also can be a helpful intervention for nursing staff. The person participating in KC with an infant can enhance the plan of care by providing information about the infant’s state that a nurse caring for multiple infants may not have observed. The one-on-one time accomplished during KC allows the nursing professional to allocate her time more easily between patients. She can support parent activities as needed, such as feeding or soothing, rather than providing them to each infant.

The practice of KC also promotes educational opportunities: Parents can be coached on normal newborn behaviors and care more readily than when the infant is viewed through the windows of an isolette.

As caregivers gain confidence through holding and providing care, they feel more capable of learning to care for their infant independently and move more quickly toward discharge.

KC is an inexpensive intervention that provides ample benefits to infants, families and medical staff. It can be a helpful tool in improving NICU/special-care nursery treatment, ultimately decreasing the length of stay.

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