VII International Workshop on Kangaroo Mother Care

The purpose of the Workshop is toadvance the implementation of KMC in Europe and

promote the interchange of information and ideas between professionals on various

aspects of the KMC method.

Uppsala, Sweden

October 8th

Oral Presentations Abstract/Conclusions/Summary

SWEDISH LEGACIES AND MECHANISMS RELEVANT TO KANGAROO MOTHER CARE (KMC) Gene Cranston Anderson, RN, ProfessorCollege of Nursing, University of Florida, GainesvilleSummary

Proffesor Anderson quotes some studies aiming to justify the hypothesis that intermittent hard crying postbirth interferes with PFOanatomical closure and appropriately programmed stress responsivity.

MORBI-MORTALITY OF THE LOW BIRTH WEIGHT INFANT (LBWI) AND KANGAROO MOTHER CARE: THE COLOMBIAN EXPERIENCENathalie Charpak, MD PhD Kangaroo Foundation, Bogota, Colombia.Summary

Evaluation of the efficacy and safety of KMC as applied in Colombia through scientific research: KMC for the stable infant.Evaluation of the performance of a KMC Program in terms of selected health outcomes achieved and compliance with evidence-based processes.Close monitoring of compliance with evidence-based procedures, and frequent feed back may partially explain the success of the program.

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October 8th

Oral Presentations Abstract/Conclusions/Summary

KANGAROO MOTHER CARE (KMC) IMPLEMENTATION IN NIGERIA: THE STORY SO FAROchiawunma Ibe, MD, Senior Manager Orphans and Vulnerable Children USAID Nigeria Maitama Abuja, FCT NigeriaSummary

Key Recommendations:1. Training of health care professionals at all levels provides an impetus for KMC to be fully implemented once introduced in any setting.2. Adequate policy guidance will facilitate implementation.3. Initiation and sustenance of a pilot centre for training and demonstration purposes is required

GROWTH AND DEVELOPMENT IN KMC-NICU GRADUATES Rekha H Udani, MD, Professor, Head Neonatology; Ashish Satpathy, Ruchi N NanavatiSeth G S Medical College & KEM Hospital, D Y Patil Medical college & Hospital, Navi Mumbai, IndiaSummary

Global experience & randomized control trials have shown the benefits of Kangaroo Mother Care (KMC) & it can be applied everywhere including peripheral community hospitals. The evidence related to growth & development in KMC recipient is limited and so the present prospective cohort follow up study was undertaken.Conclusions: Kangaroo Mother Care promotes appropriate growth and development and promotes breastfeeding in NICU Graduates ≤1800g.

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October 8thOral Presentations Abstract/Conclusions/Summary

VALIDATION OF A PREDICTION RULE FOR IDENTIFYING PRETERM INFANTS UNDER KANGAROO MOTHER CARE (KMC) WHO NEED SUPLEMENTATION OF BREASTFEEDINGJuan Gabriel Ruiz-Peláez, MD, MMedSci1, Natalie Charpak MD2 Gloria Sánchez MD MSc (Cand)2 1Departments of Clinical Epidemiology & Biostatistics and Pediatrics, School of Medicine, Pontificia Universidad Javeriana, and 2 Fundación Canguro,Bogotá,Colombia.Summary

Exclusive breastfeeding for premature infants is a controversial and very important issue particularly in developing countries, where supplementing or fortifying breast milk implies manipulation of breast milk, with increased risk of microbiological contamination; besides, delivering fortifiers for breast milk is seldom affordable and practical. Our findings constitute a way of rationalizing the use of preterm Formula, as the almost only available resource for supplementation of direct breast feeding in ambulatory patients in many developing countries. After local validation at each interested place, the prediction rule can be useful in implementing this type of feeding policies, in similar settings.

EFFECT OF KANGAROO POSITION ON PAIN IN PRETERM NEONATESSuman Rao, MD, Associate Professor of NeonatologyDept. of Pediatrics, St. John’s Medical College Hospital, Bangalore Summary

Preterm neonates undergo many invasive procedures without benefit of analgesia. Preventing or minimizing pain is of paramount importance.Subjects and Interventions: Stable preterm neonates were enrolled in the study after written parental informed consent. During Kangaroo care, the Prectl and Beintema behavioral state, the maximum heart rate and the minimum saturations in the 15 sec prior to heel lancing were noted. The neonates were subjected to heel lancing for routine random glucose monitoring while in kangaroo care after half an hour.

October 8thOral Presentations Abstract/Conclusions/Summary

WHO KMC GUIDELINES Jelka Zupan, MD. Intervention about the need to reformulate and update the WHO KMC Guidelines.

EVALUATION OF CONTINUOUS KMC IN A HIGH TECH NICU Ylva Thernström Blomqvist, RN, PhD Student, Kerstin Hedberg Nyqvist, RN, AssociateProfessor of Pediatric NursingNeonatal unit 95 F, University Hospital, Uppsala, and Dept. of Women’s and Children’s Health,Uppsala University, Uppsala, Sweden Summary

Despite the evidence of positive effects of KMC, and the fact that Swedish parents are guaranteed temporary parental benefit when the newborn infant is sick and/or born preterm, KMC is still underused in Sweden. One possible explanation for this is a belief among hospital staff that mothers in Sweden would not accept this model of carebut the study shows, mothers accepted KMC model very well, on the condition that they were given the help and support they wanted. This study and existing evidence support the view that parents’ chest should be considered the optimal place for provision of infant care, and that care routines at neonatal units should be changed accordingly

Thursday October 9thOral Presentations Abstract/Conclusions/Summary

BIRTH SKIN TO SKIN CARE: HOW MUCH IS ENOUGH? Salahuddin Ahmed, MD Johns Hopkins University, Based in Bangladesh, Dept. of International Health, Baluchar Bangladesh

Summary

We adapted KMC for community-based birth KMC (CKMC) in rural Bangladesh where home birth, low birth weight and newborn mortality (NMR) are high.As Anderson et al (2003) found, Skin-to-Skin is implemented less than recommended.Frequency and duration of birth STS may be sufficient to impart survival benefits, while others find constancy critical to thermal regulation. Additional review is still needed.

MONITORING TIMING, DURATION AND QUALITY OF EARLY SKIN-TO-SKIN CONTACT IN THE HOSPITAL SETTING Laura N. Haiek1, Lydia Rochealeau2 1,2 Direction de santé publique de la Montérégie,1Institut national de santé publique du Québec, 1Department of Family Medicine, McGill University Summary

In order to adequately support hospitals in implementing skin-to-skin contact (SSC) after delivery, Québec’s Montérégie regional public health authority has monitored this best practice in its 9 maternity units. In conclusion, Monitoring data helps individual hospitals revise practices to comply with SCC recommendations. It also allows health authorities to follow the evolution of SCC implementation in response to regional and local actions.

Thursday October 9th

Oral Presentations Abstract/Conclusions/SummaryKANGAROO CARE (SKIN CONTACT) REDUCES CRYING RESPONSE TO PAIN IN PRETERM INFANTSRaouth R. Kostandy1, Susan M. Ludington-Hoe2 1 College of Nursing, University of Akron, Akron, Ohio; 2 Bolton School of Nursing, Case Western Reserve University, Cleveland, OhioSummary

Crying commonly occurs in response to heel stick and adversely affects the infant’s physiologic stability. Kangaroo Care (KC) reduces pain and may reduce crying in response to pain. The purpose of the pilot was to test KC’s effect on the preterm infant’s audible and inaudible crying during heel-stick.Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is next needed prior to making recommendations

EXTREMELY PREMATURE INFANTS’ REACTIONS TO SKIN-TO-SKIN CONTACT Ragnhild Maastrup, RNKnowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitale, Copenhagen, Denmark Summary

The benefits of skin-to-skin contact (sts-contact) for extremely premature infants (<28 weeks gestational age) are not as well supported as for other premature infants. This ongoing study will try to add more evidence to the subject. There are no results yet.

Thursday October 9thOral Presentations Abstract/Conclusions/SummaryEARLIER IS BETTER? : RANDOMIZED CONTROLLED TRIAL (RCT) OF KANGAROO MOTHER CARE (KMC) IN MADAGASCAR S. Nagai1,2, D. Andrianarimanana2, N. Rabesabdratana2, R. Mori1,3,N. Yonemoto3, A. Ramarijaona2, M. E. Raza-fanomezanjanahary2, T.Nakayama1 Kyoto University, School of Public Health, Department of Health Informatics, Japan 1, University hospital of Mahajanga, Madagascar 2, Osaka Medical Center and Research Institute for Maternaland Child Health, Japan 3. Summary

To examine effectiveness of KMC start as soon as possible within 24 hours after birth for the LBW infants and their mothers. To date there are 54 children included in the study with a predicted 100 total by October, 2008, which will provide more conclusive results. The conclusions will be presentable upon the inclusion of up to 100 participants as outlined in the results.

IMPLEMENTING BIRTH KANGAROO CARE FOR FULL-TERM INFANTS: A TRANSLATIONAL RESEARCH PROJECT IN THE U.S. Barbara Morrison, PhD, CNM, FNP; Susan Ludington-Hoe, PhD, CNM, FAAN Case Western Reserve University, Cleveland, Ohio, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA Summary

In 1991, the WHO launched the Baby-Friendly Hospital Initiative and in 1997 Baby-Friendly USA was formed to assist hospital in becoming baby friendly. But hospitals in the U.S. have been slow to become baby-friendly, only 56 hospitals in 2007. Maternity nurses (labor and delivery, postpartum, nursery and home care nurses and lactation consultants) are leading the change in birth practices so routine care includes skin-to-skin contact starting immediately after birth. But there is much resistance and many barriers to changing practice. Initial results of the implementation process including staff and patient satisfaction and breastfeeding outcomes over the first month will be presented.

Friday October 10thOral Presentations Abstract/Conclusions/Summary

EVALUATION OF KANGAROO MOTHER CARE IN MALAWI Anne-Marie Bergh1, Reuben Ligowe2, Evelyn Zimba2, Elise van Rooyen1, Joy Lawn3, GeorgeChiundu2 1 MRC Unit for Maternal and Infant Health Care Strategies and University of Pretoria; 2 Save theChildren Malawi Country Office; 3 Save the Children/Saving Newborn LivesSummary

Kangaroo mother care (KMC) was introduced in Malawi in 1999 and has since been extended to a number of hospitals. A retrospective assessment of KMC was conducted with a view to making recommendations for scaling up KMC to all district hospitals. There are high levels of awareness of the benefits of KMC in Malawi and strong support from Ministry of Health level. It is possible to design and implement a scale-up programme for Malawi to involve all district hospitals. Close monitoring of practices and quality is advised.

KMC IN THE COMMUNITIES OF KANCHANPUR DISTRICT OF NEPAL Neena Khadka1, Meena Sharma2, Chandra Rai3, Judith Moore4 Save the Children US 1, Save the Children US 2, Save the Children US 3. JHPIEGOSummary

In Nepal, around 20% of babies are low birth weight (LBW) and 80% percent are born at home making it necessary to explore the feasibility of initiating KMC at this level. Female Community Health Volunteers (FCHVs) were trained to weigh, identify and support families to practice KMC at home. KMC was acceptable and feasible at the household level with over 50% mothers of LBW babies practicing KMC. FCHVs scored over 80% when assessed in 5 key KMC skills. The major challenge was peripheral health facilities readiness to LBW referred to them.

Friday October 10thOral Presentations Abstract/Conclusions/SummaryKANGAROO MOTHER CARE IN LOW BIRTH WEIGHT BABIES – SAFETY, FEASIBILITY AND ACCEPTABILITYMaria UP (Sr. Lias), Suman Rao PN, Swarnarekha Bhat Division of Neonatology, Dept. of Pediatrics, St. John’s Medical College Hospital, Koramangala,Bangalore, IndiaSummary

To compare the physiological parameters (heart rate, respiratory rate and temperature ) during KMC and conventional care in LBW babies KMC had a beneficial effect in temperature regulation in LBW infants, especially in larger babies cared for in the postnatal ward with the mother. It is very feasible and safe to practice KMC. Mothers gained confidence in handling and taking care of the babies at home.

PROVIDING COMMUNITY-BASED KMC: RECOMMENDATIONS FROM A RECENT CONSULTATIVE MEETING Stephen Wall and Joseph de Graft Johnson Save the Children’s ACCESS & Saving Newborn Lives (US) Summary

Kangaroo Mother Care is an effective intervention for managing low birth weight (LBW) newborns in facilities, but less is known regarding the feasibility and effectiveness of community-based Kangaroo Mother Care (c-KMC). A recent consultative meeting produced recommendations for programs to move forward to include c-KMC. Providing c-KME in programs through integration with ENC requires localunderstanding of optimal methods, and carefully designed monitoring/evaluation of use andeffectiveness. Formative research, integration with ENC, linkages with the health system for referral, and robust monitoring and evaluation are all essential elements.

Friday October 10thOral Presentations Abstract/Conclusions/SummaryINTERACTION ANALYSIS AND VIDEO ETHNOGRAPHY TO IMPLEMENTIMMEDIATE UNINTERRUPTED SKIN-TO-SKIN: A CASE STUDYBrimdyr Kajsa 1, Cadwell Karin 1, Widström Ann-Marie 2 , Svensson Kristin 2, Azza Abul-Fadl 3, Abla el Alfy 3, Cynthia Turner-Maffei 1. The Healty Children Project, Inc., 2 Karolinska Institute, 3 The Egyptian Lactation Consultant Association and the Centre of Social & Preventive Medicine in Cairo University. Summary

In their quest to revitalize the updated BFHI, Egyptian Maternal and Child Health Departments of the Ministry of Health and the Organization of Teaching Hospitals sought the technical assistance of the Healthy Children Project (USA) and research midwives from Karolinska Institut (Sweden) to encourage the implementation of skin-to-skin care in the immediate postpartum period. The presenters will describe a case study in which interaction analysis and video ethnography were used to drive practice change in urban and rural hospitals in Egypt.

MATERNAL RELAXATION DURING SKIN-TO-SKIN CONTACT (KMC) Sheau-Huey Chiu 1, Gene Cranston Anderson1College of Nursing, University of Florida, Gainesville 1 Summary

KMC has many benefits, including reduced infant crying and improved breastfeeding. Mothers often say they feel relaxed, a phenomenon observed by researchers and clinicians but not yet documented. Importantly, relaxation reduces sympathetic activity and stress. Data collection is underway to complete analyses by September. If successful, this protocol will be used to study healthy infants, vulnerable populations (e.g., depressed mothers, preterms, minorities), dyadic synchrony/asynchrony in latency, and effects of various environments.

4 Groups worked during the Workshop

* Group 1: KMC in the neonatal intensive care environment. KMC in the intermediate neonatal care environment * Group 2: KMC in low income settings and in the community (maternal and newborn health strategies) Psycho-social aspects of KMC, infants’ family and social network; KMC at home: with whom, where and when. KMC in the maternity unit * Group 3: Education and training in KMC * Group 4: KMC monitoring and quality evaluation

Friday October 11th

Presentations of the reports of the 4 working groupsGroup 1KMC in the neonatal intensive care environment. KMC in the intermediate neonatal care environment Report

Group 2KMC in low income settings and in the community (maternal and newborn health strategies) Psycho-social aspects of KMC, infants’ family and social network; KMC at home: with whom, where and

when. KMC in the maternity unit Report 1 Report 2

Group 3Education and training in KMC Report 1KMC universalityList of participants

Group 4KMC monitoring and quality evaluationModerators: Nils Bergman y Juan Gabriel RuizSecretary: Carolina MelcherUwe EwaldVeronique PrevostLaura HaiekMaria AngelGene AndersonReport

Poster Presentations

Poster PresentationsP 1. EFFECT ON VITAL SIGNS OF PREMATURE NEWBORNS IN MECHANICAL VENTILATION, IN KANGAROO MOTHER CAREVívian M.G.O Azevedo Sofia Feldman Hospital 1, Federal University of Minas Gerais 2, BrazilSummaryP 2. LESSONS LEARNED FROM THE INTRODUCTION AND EXPANSION OF KANGAROO MOTHER CARE SERVICES IN SELECTED DEVELOPING COUNTRIESJoseph de Graft-Johnson1,2, Steve Wall1, Pat Daly1, Winifred Mwebesa1 and Kate Kerber1 1 Save the Children Federation; 2 ACCESS ProgramSummaryP 3. HOW TO MOTIVATE FAMILY TO CONTINUE KANGAROO MOTHER CARE (KMC) AT HOME IN MADAGASCARD. Andrianarimanana1, S. Nagai1,2, N. Rabesandratana1, R. Mori2,3,N. Yonemoto3, A. Ramarijaona1, M. E. Raza-fanomezanjanahary1, T.Nakayama2University hospital of Mahajanga, Madagascar 1, Kyoto University, School of Public Health, Japan2, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan 3.Summary

P 4. TRAINING IN KANGAROO MOTHER CARE – IDEAL AND REALITYAnne-Marie Bergh, Elise van Rooyen, Karen DavyMRC Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, South Africa SummaryP 5. KANGAROO CARE (SKIN CONTACT) REDUCES CRYING RESPONSE TO PAIN IN PRETERM INFANTSRaouth R. Kostandy1, Susan M. Ludington-Hoe2 1 College of Nursing, University of Akron, Akron, Ohio; 2 Bolton School of Nursing, Case Western Reserve University, Cleveland, OhioSummaryP 6. AMBULATORY MANAGEMENT AND OUTCOMES AT ONE YEAR OF 2092 PRETERM/LBW INFANTS DISCHARGED HOME WHILE RECEIVING OXYGEN. THE EXPERIENCE OF THE KANGAROO FOUNDATION IN BOGOTA, 2003-2008Maria Isabel Angel, RN1, Nathalie Charpak, MD1,2 on behalf of the KMCP research group 1. Kangaroo Foundation, Bogota, Colombia. 2. Integral Kangaroo Mother Care Program, San Ignacio teaching hospital, Javeriana University, Bogota, ColombiaSummary

Poster PresentationsP 7. ESTABLISHING A CENTER OF EXCELLENCE FOR KMC IN RWANDA: MUHIMA DISTRICT HOSPITALBaribwira C1, Aissatou Lo A. 2, de Graft – Johnson J 2 , Mwebesa W2 , Mac Dowell J 2 Kigali Teaching Hospital/Belgium Technical Cooperation, Rwanda1, ACCESS2SummaryP 8. PHYSICAL, NEUROLOGICAL AND COGNITIVE DEVELOPMENT OF PRETERM INFANTS AT 5 YEARS OLDMartha Cristo, MSc , Psychologist, 1,2 & Zita Figueroa MD, Pediatrician1,2 1 Kangaroo Mother Care Program, Hospital San Ignacio, Bogotá, Colombia 2Kangaroo Foundation, BogotáSummaryP 9. SKIN TO SKIN CONTACT REDUCES POSTPARTUM DEPRESSION ANDINCREASES MATERAL SENSITIVITY DURING FEEDINGAnn E. Bigelow1, Michelle Power1, Marion Alex1, Janis MacLellan-Peters1, Judith Cormier1,Penny Fuller2, Terry Penny2, Magdy Fouad3, Ann Marie Murdock3, Doris Gillis1, Claudette McDonald4, Kim MacLean1, Clare Fawcett1, Sherry Bowman1St. Francis Xavier University, Antigonish, Nova Scotia, Canada 1, St. Martha’s Regional Hospital, Antigonish, Nova Scotia, Canada 2, Aberdeen Regional Hospital, New Glasgow, Nova Scotia, Canada 3, Colchester East Hants Health Authority, Truro, Nova Scotia, Canada 4.Summary

P 10. A COMPARISON OF NURSE AND MOTHER ATTITUDES REGARDING MATERNAL SKIN-TO-SKIN CARE AS A PAIN RELIEVING STRATEGY DURING HEEL LANCE FOR PRETERM NEONATESCampbell-Yeo, Marsha1, Johnston, Celeste 2, Filion, Francoise2, McNaughton, Kate2 IWK Health Centre Halifax, Nova Scotia1, McGill University Montreal, Quebec2 CANADASummaryP 11. OXYGEN DEPENDENT INFANTS: SAVED AT THE NEONATAL UNIT, FORGOTTEN AFTER DISCHARGE. THE PARADOX OF ACCESS TO TECHNOLOGY IN RESOURCE CONSTRAINED SETTINGSNathalie Charpak, MD1 and Juan G Ruiz, MD MMedSci1,2 1Research group, Kangaroo Foundation, Bogota, DC, Colombia 2Clinical Epidemiology, Universidad Javeriana, Bogota, DC, ColombiaSummaryP 12. CLINICAL COURSE AND PROGNOSIS AT ONE YEAR OF 827 COLOMBIAN INFANTS BORNED BEFORE 31 WEEKS AND DISCHARGED HOME IN KANGAROO POSITION.Nathalie Charpak, MD 1,2, Maria Isabel Angel RN1 on behalf of the KMCP research group1Kangaroo Foundation, Bogota, Colombia2Integral Kangaroo Mother Care Program, San Ignacio teaching hospital, Javeriana University,Bogota, Colombia.Summary

Poster PresentationsP 13. Massage therapy during the NICU period: A pilot study Vo Thi Thanh Tra1, Laurie Dubois2, Luong Kim Chi3, Réjean Tessier41 -Tu Du Hospital, Ho Chi Minh City, Vietnam; 2- School of psychology ,Université Laval, Québec,Canada, ; 3- Tu Du Hospital, Ho Chi Minh City, Vietnam; 4- School of psychology, Université Laval, Québec, CanadaSummaryP 14. MOTHERS’ RESPONSE ON KANGAROO MOTHER CARE (KMC): AN ASSESSMENT IN ESTABLISHING KMC PROGRAM IN INDONESIA Bernie Endyarni, Rosalina Roeslani, Soedjatmiko, Rinawati Rohsiswatmo Department of Child Health, Faculty of Medicine, University of Indonesia – Cipto MangunkusumoHospital, Jakarta, IndonesiaSummaryP 15. PROMOTING KANGAROO CARE – INTERVENTION USED AT LEVEL 3 NICU Aino Ezeonodo RN, CEN (Certified Emergency Nurse), CPN (Certified Pediatric Nurse), CNICN (Certified Neonatal Intensive Care Nurse), MHC (Master of Health Care), PäiviLuukkainen MD, PhD, Pediatrician, Neonatologist Helsinki University Central Hospital (HUCH), Children’s Hospital, Dept for Neonatology, Neonatal Intensive Care Unit, K7Summary

P 16. SKIN-TO-SKIN CONTACT FOR PAINFUL PROCEDURES: THE EXPERIENCE OF MOTHERS OF PRETERM INFANTS Ananda Fernandes1, Elvira Santos1, Céleste Johnston2 Coimbra College of Nursing Coimbra College of Nursing, Coimbra, Portugal 2McGill UniversitySummaryP 17. PHYSICAL, NEUROLOGICAL AND COGNITIVE DEVELOPMENT OF PRETERM INFANTS AT 5 YEARS OLDMartha Cristo, MSc , Psychologist, 1,2 & Zita Figueroa MD, Pediatrician1,2 Kangaroo Mother Care Program, Hospital San Ignacio, Bogotá, Colombia. 2Kangaroo Foundation, BogotáSummaryP 18. STAKES OF A PILOT CENTER FOR THE DIFFUSION OF THE KANGAROO MOTHER CARE METHOD IN AFRICA: THE CASE OF THELAQUINTINIE HOSPITAL IN DOUALA (CAMEROON)Odette N. Guifo, MD1 ; Beatrice Moudze-Kaptué, MD2 ; Kevine - Laure Nkaghere, MD31: Paediatrician, Chief of Paediatric Department, Kangaroo Mother Care Unit, HLD, Email;2: Pediatrician, kangaroo mother care Unit HLD, 3: General practitioner, Kangaroo Mother Care Unit, Laquintinie Hospital of DoualaSummary

Poster Presentations

P 19. KANGAROO MOTHER CARE (KMC) IN LBW INFANTS: A WESTERN RAJASTHAN EXPERIENCE Mukesh Gupta (1), Rakesh Jora (2), Chandra K Singhal (3) 1. Prof. Pediatrics 2. Ass. Prof. Pediatrics 3. Prof. & Head Obs. & Gyn. Medical College, Jodhpur (Rajasthan). IndiaSummaryP 20. KANGAROO MOTHER CARE FOR PAIN IN PRETERM NEONATES: RESULTS OF THREE STUDIESCéleste Johnston, RN PhD, Professor School of Nursing, McGill University, Montreal, CanadaSummaryP 21. ACADEMIC DETAILING TO ENHANCE BREASTFEEDING COUNSELLING AND BABY-FRIENDLY COMPLIANCE IN A LOCAL SERVICES NETWORK IN QUEBECStéphane Groulx, Laura N. Haiek, Céline Lafrenière, Christian Viens 1,2 Direction de santé publique de la Montérégie, 1Institut national de santé publique du Québec,1Department of Family Medicine, McGill University, Québec, CanadaSummary

P 22. THE EFFECT OF KANGAROO MOTHER CARE (KMC) ON BREASTFEEDING AT THE TIME OF NICU DISCHARGE.M. Heidarzadeh1, MB. Hosseini2, M Ershadmanesh3, M Gholamitabar4 Neonatal health office, ministry of health, Iran 1, Department of Pediatrics, Tabriz Medical Science University, Tabriz, Iran 2, Neonatal research center, Tabriz Medical Science University, Iran 3, Department of midwifery, Tabriz midwifery center, Tabriz, Iran 4SummaryP 23. KMC IN THE COMMUNITIES OF KANCHANPUR DISTRICT OF NEPALNeena Khadka1, Meena Sharma2, Chandra Rai3, Judith Moore4 Save the Children US 1, Save the Children US 2, Save the Children US 3. JHPIEGOSummaryP 24. KANGAROO FEEDING AND NUTRITIONRoshanak, Vakilian-Health adviser, Midwife, Master science, Bibi Malihe Nazarie, Public health expert, Dr. Soheila Khazaei, MD, Professor, Super specialist of pediatric infectious diseases, Medical assistant professor, Health adviser Iran Ministry of health, Teheran, IranSummary

Poster PresentationsP 25. DESCRIPTIVE ANALYSIS OF THE PROGRAM KANGAROO IN THE MATERNITY CONCEPTION PALACES (2002-2007) CARACAS, VENEZUELA Eunice Lample1, Maria E Torres1, Freddy Bello Department Neonatology, 2 Department Obstetrics, Maternity Conception Palaces, Caracas, VenezuelaSummary

P 27. INFORMATION TO PARENTS ABOUT SKIN-TO-SKIN CONTACT IN THE NICURagnhild Maastrup, RN Knowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen, DenmarkSummary

P 28. KNOWLEDGE CENTRE FOR BREASTFEEDING INFANTS WITH SPECIALNEEDS, RIGSHOSPITALET, DENMARKRagnhild Maastrup, RNKnowledge Centre for Breastfeeding Infants with Special Needs, Rigshospitalet, Copenhagen,DenmarkSummary

P 29. THE “SOFT” EXPERIENCE: FROM ACONYM TO ACCOMPLSHMENTSCarol Lopez Melcher, RNC, CLE, MPH, Clinical Director Perinatal Services Network of Loma Linda University Children’s Hospital, Loma Linda, California, USASummary

P 30. BEST PRACTICE GUIDELINES FOR MOTHER-INFANT ATTACHMENT IN THEHOSPITALCarol Lopez Melcher, RNC, CLE, MPH, Clinical Director Perinatal Services Network of Loma Linda University Children’s Hospital, Loma Linda, California, USASummary

P 31. KANGAROO CARE AND THE FULLTERM DYAD: EVOLUTIONARY CARE & THE NEURO-ENDOCRINE CONNECTIONBarbara Morrison, PhD, RN, FNP, CNM, Assistant Professor of Nursing Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USASummary

Poster PresentationsP 32. SKIN TO SKIN IN FULLTERM NEWBORNS: AN ITALIAN EXPERIENCEP. Sarni, MD, A. Pessi, S. Laghi, P. Zucchinetti Neonatal Medicine Unit, St.Charles Hospital, Genoa, ItalySummaryP 33. A CRITICAL ASSESSMENT OF THE KANGAROO MOTHER CARE UNIT’S ACTIVITY IN THE LAQUINTINIE HOSPITAL (HLD) IN DOUALA (CAMEROON) Beatrice Moudze-Kaptué, MD1; Odette N. Guifo, MD2 ; Edwige Ndap, MD3 ; Mireille Happi Fossi, MD4 ; Olive Etogo, NP5 ; Angelique Tchagou, NP6 ; Bertine Wakia, NP7 1: Paediatrician, kangaroo mother care Unit HLD, 2: Paediatrician, Chief of the Paediatric Department, Kangaroo Mother Care Unit, HLD, 3, 4, 5, 6, 7: (Kangaroo Mother Care Unit, Laquintinie Hospital of Douala)SummaryP 34. CLINICAL PRACTICE GUIDELINES DEVELOPMENT FOR KANGAROO CARE IN JAPAN –JAPANESE CONSENSUS UPON AVAILABLE EVIDENCE –Kangaroo Care Guideline Working Group Yoriko Nishizawa1, Shuko Nagai1, Shigeru Ohki2, Rintaro Mori1, Kenji Shirai2, Shinichi Watabe3 Osaka Medical Center and Research Institute for Maternal and Child Health, Japan 1, SeireiHamamatsu General Hospital 2, Kurashiki Central Hospital 3.Summary

P 35. PSYCHOAFFECTIVE EXPERIENCE OF PREMATURITY AND KANGAROO MOTHER CARE: A CONTEXTUAL STUDY IN THE LAQUINTINIE HOSPITAL OF DOUALA (CAMEROON). Erero F. Njiengwé PhD1; Odette N. Guifo MD2 ; Hilaire Ngoumela3; Medical and Paramedical staff of the Premature UnitSummaryP 36. EVALUATION OF THE KANGAROO MOTHER CARE (KMC) STUDY TOUR FOR INDONESIAN HEALTH PROFESSIONALS TO SOUTH AFRICA Hadi Pratomo1, Ella N. Hadi2, and Berni Endyarti3 1Professor of the Faculty of Public Health, the University of Indonesia and Health Service Program (HSP)/USAID Consultant; 2) Department of Health Promotion, Faculty of Public Health, the University of Indonesia; 3The Indonesian Pediatric Society (IDAI) and also Chairperson of the Participants of the Study TourSummaryP 37. EVALUATION OF A 2 DAY KANGAROO MOTHER CARE (KMC) TRAINING BY THE INDONESIAN PERINATAL SOCIETY (PERINASIA) Hadi Pratomo1, Uud Uhudiah2, and Hesti Tobing31Professor of the Faculty of Public Health, the University of Indonesia, Chairman of the Board ofPlanning Program, Perinasia, 1) Vice-Chairperson for KMC Training Team, Perinasia; 3ResearchStaff of PerinasiaSummary

Poster Presentations

P 38. THE OBSTACLES TO IMPLEMENT CONTINUOUS KANGAROO MOTHER CARE (KMC) AT HOSPITAL IN MADAGASCARN. Rabesandratana1 , S. Nagai1,2, D. Andrianarimanana1, R. Mori2,3, N. Yonemoto3, A. Ramarijaona1, M. E. Raza-fanomezanjanahary1, T.Nakayama2 University hospital of Mahajanga, Madagascar 1, Kyoto University, School of Public Health, Japan 2, Osaka Medical Center and Research Institute for Maternal and Child Health, JapanSummaryP 39. KANGAROO BABY IN TROTRO AN-KODITRA PROGRAMYvonne Ranaivoson, G. Ramahandridona, A. SambanyCHU Befelatanana Maternity, Antananarivo, MadagascarSummaryP 40. KANGAROO MOTHER CARE FOR LOW BIRTH WEIGHT INFANTS: A RANDOMIZED- CONTROLLED TRIALSuman Rao P N MD, Associate Professor of Neonatology, Rekha Udani MD: Professor &HOD, Ruchi Nanavati MD, Associate ProfessorSt. John’s Medical College & Hospital, Bangalore; Seth GS Medical College & KEM Hospital, Mumbai; D Y Patil Medical College & Hospital, Navi Mumbai, IndiaSummary

P 41. THE IMPLEMENTATION OF CONTINUOUS KANGAROO MOTHER CARE (KMC) AT THE NATIONAL TOP REFERRAL HOSPITAL (RSCM) IN JAKARTAYeni Rustina, BN, MAppSc., PhD¹, Rosalina DRoeslani2 , Nining Caswini3, Mimin Mintarsih4Faculty of Nursing, the University of Indonesia/Perinatology Division, Depok Campus, West Java, and dr Cipto Mangunkusumo Hospital (RSCM), Jakarta; ²,3Perinatology Division, dr Cipto Mangunkusumo Hospital (RSCM), Jakarta; Department of Obstetric and Gynecology, dr Cipto Mangunkusumo Hospital (RSCM)SummaryP 42. EVIDENCE-BASED GUIDELINES FOR THE USE OF THE KANGAROO MOTHER CARE (KMC) METHOD IN STABLE LBW INFANTS IN COLOMBIA.Juan G Ruiz, MD MMedSci, Professor1,2 and Nathalie Charpak, MD2. 1Clinical Epidemiology, Universidad Javeriana, Bogota, DC, Colombia and 2Research group, Kangaroo Foundation, Bogota, DC, ColombiaSummaryP 43. COMMUNITY KANGAROO MOTHER CARE: THE WAY FORWARDNancy L. Sloan,1 Salahuddin Ahmed21 Dept. oc Community Medicine, Mount Sinai School of Medicine, New York; 2 John Hopkins University, Dhaka;Summary

Poster PresentationsP 45. EVALUATION OF KANGAROO MOTHER CARE DURATION AND ITS OUTCOMERekha H Udani, Aloke V.R., Ruchi N NanavatiSeth G S Medical College & KEM Hospital, Mumbai, India D Y Patil Medical college & Hospital, Navi Mumbai, IndiaSummary

P 46. KANGAROO MOTHER CARE AND GROWTH INHIGH RISK LOW BIRTH WEIGHT BABIESRekha H Udani, Aloke V.R., Ruchi N NanavatiSeth G S Medical College & KEM Hospital, Mumbai ,India D Y Patil Medical college & Hospital, Navi Mumbai, India

Summary

P 47. AN INTRODUCTION TO TRAINING MANUAL ON KANGAROO MOTHER CARERekha H. Udani, Ruchi N. Nanavati, Suman Rao, Naveen Bajaj, Tushar Parikh, DharmeshShah, Shrinivas Chinta. Seth G S Medical College & KEM Hospital, Mumbai, India; D Y Patil Medical college & Hospital, Navi Mumbai, IndiaSummary

P 48. ANALGESIC EFFECT OF SKIN - TO - SKIN CONTACT IN KANGAROOPOSITION IN PRETERM NEWBORNS Kiran Kumar BV, Rekha H. Udani Seth G S Medical College & KEM Hospital, Mumbai, IndiaD Y Patil Medical college & Hospital, Navi Mumbai, IndiaSummary

P 49. EFFECT OF EXPRESSED BREAST MILK AND SKIN TO SKIN CONTACT IN KANGAROO POSITION ON PAIN RELATED BEHAVIOR IN PRETERM INFANTS DURING HEEL LANCINGKiran Kumar BV, RH UdaniSeth G S Medical College & KEM Hospital, Mumbai, India D Y Patil Medical college & Hospital, Navi Mumbai, IndiaSummary

P 50. KANGAROO MOTHER CARE INITIATIVE IN INDIA YEAR 2005, WHERE ARE WE?Rekha H Udani. Ruchi N Nanavali., Ashish Satpathy, Tushar Parikh, Suman Rao Department of Neonatology, KEM Hospital and Seth G. S. Medical College, Mumbai – 400012, INDIASummary

Poster Presentations

P 51. INNOVATION – K.E.M. KANGAROO BAG FOR KANGAROO MOTHER CARERekha H. Udani , Ruchi N. Nanavati,A V Mauskar, Suman Rao,T Kulkarni Department of Neonatology , Seth GS Medical College & KEM Hospital , Mumbai, IndiaSummaryP 52. EVALUATION OF KANGAROO MOTHER CARE (KMC) TRAINING IN METROPOLITAN OF JAKARTA, INDONESIAUut Uhudiah1, Hadi Pratomo2 and Ely Sawitri3 Uut Uhudiah1, Hadi Pratomo2 and Ely Sawitri3 1) Vice-Chairman for KMC Training Team, Perinasia (The Indonesian Society for Perinatology); 2Professor of the Faculty of Public Health, University of Indonesia, Chairman of the Board of Planning Program, Perinasia, 3Research Staff of Perinasia Jakarta, IndonesiaSummaryP 53. THE UNDERSTANDING AND PERCEPTIONS OF MOTHERS PRACTICING KANGAROO MOTHER CARE AT KALAFONG HOSPITALElise van Rooyen1, Anne-Marie Bergh2, Rachel Mkhondo3 Kalafong hospital, Department of Paediatrics1, University of Pretoria, The Medical Research Council Unit for Maternal and Infant Health Care Strategies2 3, South AfricaSummary

P 54. AN ONGOING AUDIT OF KANGAROO MOTHER CARE AT KALAFONG HOSPITALElise van Rooyen1, RC Pattinson2 Kalafong Hospital,Department of Paediatrics1, University of Pretoria,The MRC Unit for Maternal and Infant Health Care Strategies2, South AfricaSummary