PQCNC Human Milk Well Baby 2 LS2 Kangaroo Care

7/30/2019 PQCNC Human Milk Well Baby 2 LS2 Kangaroo Care

1/28

KANGAROO CARE

SKIN-TO-SKIN CONTACT

KANGAROO MOTHER CARE

Diane Hudson-Barr, PhD, RN

NCCC @UNCH

[email protected]

All photos courtesy of USIKC website


2/28

OBJECTIVE

Review the benefits ofthe use of Kangaroo Care

in the Post-Partum and

NICU Environments. Identify strategies to

increase use of KC in

your clinical setting.


3/28

WHAT IS KANGAROO CARE?

Kangaroo Care, Skin-To-Skin Contact, andKangaroo Mother Care are terms that relate to: the holding of a diaper clad infant bare-chest to bare-

chest, ventral-surface to ventral-surface, by the mother, father, or others.

This snuggling of the infant inside the pouch oftheir parent's shirt, much like a kangaroo's pouch,led to the creation of the term "kangaroo care."


4/28

HOW DID KC COME ABOUT?

In response to the high death rate in preterm babiesseen in Bogota, Columbia, in the late 1970s (70%) .

Babies were dying of infections, respiratory problems,and simply due to lack of attention.

Been studied since 1972 (nearly 500 references):Researchers found that babies who were held close totheir mothers' bodies for large portions of the day, notonly survived, but thrived.

In the U.S., hospitals that encourage kangaroo caretypically have their parents provide skin-to-skin contactfor several hours each day


5/28

HIGHLY RECOMMENDED

WHO, AAP, ACOG, UNICEF, CDC, MOD, and theNIH all recommend its use and deem it ascientifically sound, low cost, and a high impact

developmental intervention for both baby andmother.

New research by Dr Joy Lawn shows thatKangaroo Mother Care is one of the mostpowerful and effective ways to save pretermbabies all over the world.


6/28

HIGHLY RECOMMENDED (LAWN)

Acceptance of the KMC method is increasinglywidespread and it is considered equivalent to

conventional neonatal care for stable preterm

infants and more parent and baby friendly.

There is no doubt this intervention can savelives but the reality is that babies will

continue to die unnecessarily unless weprioritize high-impact care (KMC).


7/28

HIGHLY RECOMMENDED (LAWN)

It is evident that KMC has a substantial mortalityeffect compared with conventional neonatal care,and it is also evident that this mortality benefit is

possible even at large scale. No matter if babies are born in Lilongwe, London

or Los Angeles, preterm babies need extra care tosurvive. Kangaroo Mother Care is low-cost and

feasible, and we now have proof it is one of themost highly effective ways to give more babies thechance to survive and thrive.


8/28

BENEFITS OF KC

The latest studies show a51 percent reduction in newborn mortality

when babies (stable and less than 2 kg) were

kangarooed within the first week after birth andbreastfed by their mothers (Lawn, 2010).


9/28

BENEFITS OF KC TO THE INFANT

receive touch, rhythmand pressure(containment)

soothing and comfortingsounds of parents heart

beat, breathing andrhythmic rocking thatbaby becameaccustomed to


10/28


11/28

PHYSIOLOGIC BENEFITS OF KC TO THE INFANT

Mom has thermal synchrony with infant: temperature of

the mothers breasts actually change so that her baby canbetter maintain his own temperature. Moms temperaturewill change if the baby gets too cold/hot (fathers does not).This even works when twins are kangarooed (Ludington-Hoe,2004).

Flexed position that the baby assumes is a more efficientposition for conserving heat.

Stabilizes heart rate: less Bs & tachycardia rarely occurs Improves oxygen saturation levels (Feldman, 2003) Reduces apnea & uneven breathing: hearing parents

breathing stimulates infant to imitate the pattern.


12/28

ADDITIONAL BENEFITS OF KC TO THE INFANT

- Witheasy access to the breast, mothers experience easier let down, increasedmilk supply (Furman,2002). Mothers are more likely to breastfeedexclusively and have more success with prolonged nursing (Figueroa deLeon).

- If the mother is breastfeeding herbaby, she will raise antibodies in response to all of the microbes that they

come in contact with and transfer them to the baby (Lawn, 2010). Someantibodies can even be transferred skin to skin (Telemo, 1996).

A lack of touch or separation causes high amounts of the stress

hormone to be released. High levels of cortisol may negatively impactimmune function as the body may stop producing leukocytes.

crying in preterms and term infants experiencing KC decreases theamount of cortisol produced.


13/28

LONG TERM OUTCOMES OF KC

High cortisol levels that result frommother baby separation have a negative impact on growth hormone.With mother present to help assist in regulating the babys breathing,heart rate, and temperature, the baby has decreased energy needsand can conserve his energy and calories, and direct it towardgrowth. (Charpak, 1997). In an upright prone position babies alsoregurgitate less (Ludington-Hoe, 1993).

Babies that are practicing KangarooCare can have up to a 50% shorter hospital stay than babies who arenot kangarooed (Charpak, 1997).

- Preterm babies that were givenmany hours of KMC in the early weeks after birth, compared to thosegiven little or no care, scored higher on mental and motordevelopment tests in the first year of life (Charpak et al., 2005).


14/28

BENEFITS OF KC TO THE PARENTS

- feelings of closeness withtheir babies (Dodd, 2005)

-Holding baby close reduces stress among parents& family (Feldman et al., 2002, 2003). Parents areempowered as they can do something incrediblybeneficial & positive for their infants

that babies are well cared for


15/28

ADVICE FOR PARENTS

Do not smoke or wear smoke-scented clothing. Remove your bra and wear a blouse or shirt that

opens in the front. (A hospital gown that opens in

the front can be made available for your use.)Screens will be provided for your privacy.

The baby, wearing only a diaper and hat, will beplaced on your bare chest in an upright position.

Cover the baby with your shirt, gown, or a blanket.


16/28

ADVICE FOR PARENTS

Now simply relax and enjoy this unique bondingexperience.

Plan on holding your baby for at least one hourfour or more times a week.

Let your baby rest. This is not a time to play withyour baby.

Fathers can provide kangaroo care for their babiestoo. The different feel of the father's body will

provide different stimulation to the baby.


17/28

NURSING CONSIDERATIONS

Inform parents as soon as posible about KC becausethe earlier they know about it, the increases their useof KC.

28 weeks need heating unit over them during KC toprevent cold stress.

Standing transfer is much less stressful than sittingtransfer.

Monitor for 5-15 minutes after transfer to ensure VSreturned to pre-transfer baseline. Position prone with flexed extremities.


18/28

NURSING CONSIDERATIONS

Position head in very slight extension to prevent airwayocclusion.

KC within the first hour of delivery and then dailypromotes HM production and letdown reflex.

Head caps should be worn by all 1000 g or who are 6 hours of age.

Ideally should last for at least one hour (to allow forcomplete sleep cycle).

RCT receiving phototherapy via bili blanket + KC for 1hour/day did not adversely effect the decline in bilinor # of infants experiencing rebound (Ludington-Hoe &Swinth, 2001).


19/28

FACTORS INFLUENCING RN USE OF KC

Johnson (2007): Survey results from 67 RNs in 70 bed Level III SCNin Delaware:

Assessed physiologic stability of the infant (stated by 98.5% ofnurses),

Adequate staffing patterns, Maternal readiness, and Encouragement from management. Clinical Implications: Nurses in this study identified

management support as an essential factor in utilizing KC,including "educational programs," "adequate staffing" (so

coworkers could help if necessary), and "encouragement" frommanagement as factors that support the practicing nurse ininstituting KC.


20/28

FACTORS INFLUENCING RN USE OF KC

Engler (2002): > 1100 units received survey, > 500completed: Major barriers:

infant safety concerns,reluctance by nurses, physicians, and families to

initiate or participate in KC,Many NICUs do not permit KC for certain types of

infants (e.g., those on vasopressors or high-frequency ventilation),

Over 60% of respondents agreed that lowgestational age or weight were notcontraindications.


21/28

AUDIENCE PARTICIPATION (REVISED AFTER PRESENTATION TO INCLUDE RESPONSES)

How have you tried to increase use of KC Include siblings in KC Talk to mom/family in prenatal class about KC Talk to mom/family in L&D before actual delivery Have mom KC when she is waiting for a visit from the

Lactation Consultant

When rounding with family, talk to them about KC(nurse leadership rounding)

Design a large flyer with a kangaroo on it and themessage Ask your nurse to have you Kangaroo Care


22/28

AUDIENCE PARTICIPATION (REVISED AFTER PRESENTATION TO INCLUDE RESPONSES)

What didnt work/Where should we focus ourattention?

Main response was how to keep it going beyondL&D, beyond the early stages in the NICU


23/28

RESEARCH QUESTIONS SUGGESTED BY

LUDINGTON

How can we reduce the amount of time it takesfor starting KC in the fragile ELBW?

What has to be done to have successful 24hour/day, 7 days/week KC in the U.S.?


24/28

UNITED STATES INSTITUTE FOR KANGAROO

CARE (USIKC)

Located at the Frances Payne Bolton SON, CWRU,Cleveland, OH

The mission of the United States Institute for KangarooCare (USIKC) is to promote the Family Friendly Hospital

Initiative and utilization of Kangaroo Care for allnewborns in the Americas by providing education,resources, links to additional resources, consultation, acomprehensive annotated bibliography of all

publications about Kangaroo Care from around theworld, and recognition of excellence in Kangaroo Care bycertification.


25/28

UNITED STATES INSTITUTE FOR KANGAROO

CARE (USIKC)

The USIKC is the only authorized certifying entity in theAmericas. Next course is in March/April 2013: 2 day conference Early bird $300, regular $325 Plus $75 for textbook Sponsors have applied for CE credits

www.kangaroocareusa.org/ ______________________________________________ Kangaroo Care Transfer Technique poster can bepurchased from NANN for $9 each (members) or $15

(nonmembers)


26/28

CONCLUSION

Best practice is to KC as soon as possible foras long as possible and as uninterrupted as

possible!

(Nyqvist et al, 2010, May Acta Paediatrica)


27/28


28/28

REFERENCES

See USIKC site for comprehensive bibliography:http://www.kangaroocareusa.org/education.html

(updated May 2012)

Johnson, AN (2007). Factors influencingimplementation of kangaroo holding in a specialcare nursery, MCN, 32(1), 25-29.

(Engler et al, 2002). Kangaroo Care: Nationalsurvey of practice, knowledge, barriers, andperceptions. MCN, 27(3), 146-53.

PQCNC Human Milk Well Baby 2 LS2 Kangaroo Care

Documents

Transcript of PQCNC Human Milk Well Baby 2 LS2 Kangaroo Care