KANGAROO MOTHER CARE:

KANGAROO MOTHER CARE:

Skin
Skin
-
-
to
to
-
-
skin Global
skin Global
Recommendations
Recommendations
Presented by
Presented by
Cindy C. Martin, RN, MSN, IBCLC, CKC
Cindy C. Martin, RN, MSN, IBCLC, CKC
OBJ ECTIVES
OBJ ECTIVES

Learn the history of Kangaroo Care

Learn the history of Kangaroo Care

Learn about thermal regulation between

Learn about thermal regulation between
mother and infant
mother and infant

Explain how this Kangaroo Care can foster

Explain how this Kangaroo Care can foster
family centered care in the Neonatal
family centered care in the Neonatal
Intensive Care Unit and result in shortened
Intensive Care Unit and result in shortened
length of hospital stay
length of hospital stay
OBJ ECTIVES
OBJ ECTIVES

Review the process of selecting an infant

Review the process of selecting an infant
and family that would benefit from
and family that would benefit from
Kangaroo Care
Kangaroo Care

Discuss how Kangaroo Care assists in the

Discuss how Kangaroo Care assists in the
establishing of milk production and
establishing of milk production and
encouraging nuzzling and breastfeeding
encouraging nuzzling and breastfeeding
continued
OUTLINE
OUTLINE
I.
I.
Definition & History of Kangaroo
Definition & History of Kangaroo
Care
Care
II.
II.
Physical & Psychological responses
Physical & Psychological responses
III.
III.
Intubated infants
Intubated infants
IV.
IV.
Applying K.C.
Applying K.C.
V.
V.
Kangaroo Care and Lactation
Kangaroo Care and Lactation
KANGAROO CARE
KANGAROO CARE

Skin to skin contact that assists neonates

Skin to skin contact that assists neonates
in a self
in a self
-
-
regulatory state of care,
regulatory state of care,
respiratory, thermal regulation and an
respiratory, thermal regulation and an
enhanced bonding process
enhanced bonding process

Assists lactation process

Assists lactation process
KANGAROO CARE HISTORY
KANGAROO CARE HISTORY

Bogota, Columbia: Physicians utilized this

Bogota, Columbia: Physicians utilized this
concept from necessity due to lack of
concept from necessity due to lack of
equipment for care of neonates
equipment for care of neonates

They observed the stabilization of

They observed the stabilization of
neonates who were having mild
neonates who were having mild
respiratory distress
respiratory distress

They observed self

They observed self
-
-
regulatory process of
regulatory process of
improved temperature stability
improved temperature stability
KANGAROO CARE HISTORY
KANGAROO CARE HISTORY

They have been criticized for their

They have been criticized for their
methodology, population, and
methodology, population, and
documented poorly
documented poorly

MANY have now studied this theory with

MANY have now studied this theory with
the same or similar hypothesis as the
the same or similar hypothesis as the
Colombian
Colombian

s and found the outcomes to

s and found the outcomes to
be the same.
be the same.
continued
COUNTRIES THAT IMPLEMENT
COUNTRIES THAT IMPLEMENT
KANGAROO CARE
KANGAROO CARE

Scandinavia
Scandinavia

Third World Countries

Third World Countries

U.S. A
U.S. A
APPLYING KANGAROO
APPLYING KANGAROO

Normal Newborn
Normal Newborn
Temp stabilizer
Temp stabilizer
Slow respiratory rate
Slow respiratory rate
Early breastfeeding
Early breastfeeding
Early attachment
Early attachment
process
process
Less crying
Less crying

NICU
NICU
Thermal regulation
Thermal regulation
Less A
Less A

s & B
s & B

s
s
Weight gain
Weight gain
Bonding
Bonding
Parent involvement
Parent involvement
with care of baby
with care of baby
Earlier discharge
Earlier discharge
Physical & Psychological
Responses from
Skin To Skin Contact
Infant
&
Maternal
Heat Production
Heat Production
Thermal Regulation
Thermal Regulation

Between the breast
Between the breast
concentrates heat and
concentrates heat and
decreased air flow making a
decreased air flow making a

heated sink
heated sink

Sympathetic Nervous
Sympathetic Nervous
System
System
is activated when
is activated when
the infants skin has contact
the infants skin has contact
by another persons skin.
by another persons skin.

During activation dilation of
During activation dilation of
skin blood vessel and
skin blood vessel and
increased uptake of heat is
increased uptake of heat is
conducted to the infant.
conducted to the infant.
THERMAL REGULATION
THERMAL REGULATION

Neutral thermal zone

Neutral thermal zone
-
-
the temperature
the temperature
range at which a baby has minimal oxygen
range at which a baby has minimal oxygen
needs.
needs.

Baby
Baby

s temp rises quickly in the first 10

s temp rises quickly in the first 10
minutes and then stabilizes to
minutes and then stabilizes to
their neutral
their neutral
thermal zone
thermal zone
for the remainder of K.C.
for the remainder of K.C.
session
session
THERMAL REGULATION
THERMAL REGULATION

Excessive body temperature will burn

Excessive body temperature will burn
calories, use up oxygen, speed metabolic
calories, use up oxygen, speed metabolic
process, and create breathing problems
process, and create breathing problems

Immature thermal regulatory system of

Immature thermal regulatory system of
babies in incubators demonstrate the
babies in incubators demonstrate the
ability to self
ability to self
-
-
regulate outside their isolette.
regulate outside their isolette.
Earlier weaning to open crib.
Earlier weaning to open crib.
continued
Thermal Regulation
Thermal Regulation
Signs and Symptoms of Hypothermia Signs and Symptoms of Hypothermia
Apnea Apnea
Bradycardia Bradycardia
Respiratory distress Respiratory distress
Hypoglycemia Hypoglycemia
Central Cyanosis Central Cyanosis
Irritability Irritability
Pulmonary Vasoconstriction Pulmonary Vasoconstriction
Peripheral Vasoconstriction Peripheral Vasoconstriction
Lethargy Lethargy
Weak cry or suck Weak cry or suck
Feed Intolerance Feed Intolerance
Acidosis Acidosis
Hypoxia Hypoxia
Hypotonic Hypotonic
Increases Metabolic Rate Increases Metabolic Rate
Conde Conde- -Agudelo et al., 2003 Agudelo et al., 2003
INFANT RESPONSE
INFANT RESPONSE
CARDIAC
CARDIAC

Increased heart rate 5

Increased heart rate 5
-
-
10 beats per
10 beats per
minute, as the baby
minute, as the baby

s temperature rises
s temperature rises
and stabilizes
and stabilizes

Heart rate of 140

Heart rate of 140
-
-
160 is stable in K.C.
160 is stable in K.C.

Increased regular heart rate while

Increased regular heart rate while
sleeping in K.C.
sleeping in K.C.
INFANT RESPONSE
INFANT RESPONSE
CARDIAC
CARDIAC
CARDIAC STABILITY CARDIAC STABILITY - - blood flow is steady and blood flow is steady and
sustained to the brain with oxygen when there is less sustained to the brain with oxygen when there is less
variability of heart rate variability of heart rate
Babies with episodes of bradycardia Babies with episodes of bradycardia may may not have not have
bradycardia with Kangaroo Care bradycardia with Kangaroo Care
K.C. improves post K.C. improves post- -extubation cardiorespiratory extubation cardiorespiratory
parameters after open heart surgery parameters after open heart surgery
continued
OXYGENATION
OXYGENATION

Increased oxygenation
Increased oxygenation
With increased blood flow through the
With increased blood flow through the
vessels the oxygenation is increased.
vessels the oxygenation is increased.

Tools to assess
Tools to assess
Clinical assessment of baby
Clinical assessment of baby
Transcutaneous
Transcutaneous
pressure of oxygen
pressure of oxygen
(TCPO2), pulse oximeter , carbon dioxide
(TCPO2), pulse oximeter , carbon dioxide
monitor or blood gases.
monitor or blood gases.
RESPIRATORY RATE
RESPIRATORY RATE

Stabilizes a preemie
Stabilizes a preemie

s breathing.
s breathing.
Rate 35
Rate 35
-
-
50 per minute
50 per minute

Depth of each breath becomes more even

Depth of each breath becomes more even

Apnea
Apnea
decreases fourfold
decreases fourfold
or is absent
or is absent
during KC
during KC

Length of apnea episode diminishes

Length of apnea episode diminishes

Periodic breathing is significantly

Periodic breathing is significantly
decreased with normal breathing taking
decreased with normal breathing taking
over.
over.
INFANT RESPONSES
INFANT RESPONSES

Increased regular sleep

Increased regular sleep

Increase states of alertness

Increase states of alertness

Self
Self
-
-
regulatory feeding: relax & feed,
regulatory feeding: relax & feed,
frequently repeat pattern, this aids in
frequently repeat pattern, this aids in
sustained blood glucose levels
sustained blood glucose levels

Early opportunity to learn suckling and

Early opportunity to learn suckling and
breathing coordination. This can save
breathing coordination. This can save
calories thus better weight gain
calories thus better weight gain
Full Term Studies
Full Term Studies

Breastfeeding Difficulties
Breastfeeding Difficulties
-
- 2003 Anderson & Chiu 2003 Anderson & Chiu
Found 30 Found 30 - -90 minutes of KC before anticipated feeding: 90 minutes of KC before anticipated feeding:
Increased latch Increased latch- -on on
Increased mothers perception of getting enough Increased mothers perception of getting enough
Display of cues associated with breastfeeding Display of cues associated with breastfeeding

Thermal Regulation
Thermal Regulation
-
- Chiu Chiu et.al et.al, 2005 , 2005 and and Durand et al, 1997 Durand et al, 1997
Infants breastfed in the KC position stay warm and are w Infants breastfed in the KC position stay warm and are warmer armer
that those breastfed while swaddled or in a cot (bed). that those breastfed while swaddled or in a cot (bed).

Exclusive Breastfeeding
Exclusive Breastfeeding
-
- Mikiel Mikiel- -Kostryra Kostryra et al. 2002 et al. 2002
KC promotes exclusive BF >20 minutes of KC is significant KC promotes exclusive BF >20 minutes of KC is significant predictor predictor
of exclusive BF duration, the more KC they have, the longer the of exclusive BF duration, the more KC they have, the longer the
mother will exclusive BF. mother will exclusive BF.
STARTING THE PROCESS OF
STARTING THE PROCESS OF
KANGAROO CARE
KANGAROO CARE

MD order to begin Kangaroo Care

MD order to begin Kangaroo Care

Educate family
Educate family
-
-
video, educational
video, educational
materials
materials

Prepare baby
Prepare baby
-
-
hat & diaper only, secure
hat & diaper only, secure
lines preoxygenate
lines preoxygenate

Mother or father bare chest, comfortable

Mother or father bare chest, comfortable
chair, privacy screens
chair, privacy screens

Baseline assessment, preoxygenate prn,

Baseline assessment, preoxygenate prn,
silence alarms
silence alarms
STARTING THE PROCESS OF
STARTING THE PROCESS OF
KANGAROO CARE
KANGAROO CARE

Prepare ventilator tubing and all lines

Prepare ventilator tubing and all lines

Place baby on bare check between

Place baby on bare check between
breasts with ear toward chest
breasts with ear toward chest

Cover baby with blanket

Cover baby with blanket

Assess baby
Assess baby

s tolerance and document

s tolerance and document

Vital signs every 15 minutes x2, q 30

Vital signs every 15 minutes x2, q 30
second hour, and hourly thereafter.
second hour, and hourly thereafter.
Continue to chart baby
Continue to chart baby

s and families
s and families
response
response
continued
FAMILIES WHO BENEFIT
FAMILIES WHO BENEFIT
FROM KANGAROO CARE
FROM KANGAROO CARE
All families benefit from Kangaroo Care
All families benefit from Kangaroo Care

Fathers & Support Persons

Fathers & Support Persons

Teen Parents
Teen Parents

Adoptive Families
Adoptive Families

Substance Abuse Mothers

Substance Abuse Mothers

Grandparents
Grandparents

Siblings
Siblings
FAMILY CENTERED CARE
FAMILY CENTERED CARE

Earlier and increased bonding with

Earlier and increased bonding with
mother
mother

Earlier parental involvement with care of

Earlier parental involvement with care of
the baby
the baby

Parents become more

Parents become more

in tune
in tune

with
with
their baby
their baby

s cues and responses

s cues and responses

Increase in parents readiness to care

Increase in parents readiness to care
for infant
for infant
NON
NON
-
-
NUTRITIVE SUCKING
NUTRITIVE SUCKING

Regular heart rate
Regular heart rate

Strengthen jaw and
Strengthen jaw and
oral muscles
oral muscles

Satisfies reflex to
Satisfies reflex to
suck
suck

Improves oxygenation
Improves oxygenation
during tube feedings
during tube feedings

Enhanced weight gain
Enhanced weight gain

Encourages earlier,
Encourages earlier,
organized sucking
organized sucking

Promotes earlier and
Promotes earlier and
faster feedings
faster feedings

Encourages earlier
Encourages earlier
discharge
discharge
KANGAROO CARE AND
KANGAROO CARE AND
LACTATION BENEFITS
LACTATION BENEFITS

Skin to skin promotes hormone response

Skin to skin promotes hormone response
in mother to trigger increased milk
in mother to trigger increased milk
production
production

Milk Ejection Reflex (MER) frequently

Milk Ejection Reflex (MER) frequently
occurs in Kangaroo Care
occurs in Kangaroo Care

Babies will find their way to the breast for

Babies will find their way to the breast for
a little
a little

licking and loving

licking and loving

Nuzzling at the breast progressing on to

Nuzzling at the breast progressing on to
breastfeeding
breastfeeding
SIGNALS OF STRESS
SIGNALS OF STRESS

Increased needs for
Increased needs for
O
O
2 2

Apnea or bradycardia
Apnea or bradycardia

B/P changes
B/P changes

White knuckles
White knuckles

Finger splay
Finger splay

Sagging checks and
Sagging checks and
chin
chin

Furrowed brow
Furrowed brow

Spitting up
Spitting up

Stop sign
Stop sign

Air sitting
Air sitting

Arching back
Arching back

Head turning
Head turning

Hyperalertness
Hyperalertness

Gaze aversion
Gaze aversion

Yawning, hiccuping
Yawning, hiccuping
MATERNAL RESPONSES
MATERNAL RESPONSES
Bonding to baby Bonding to baby - - aids in attachment aids in attachment
process for neonates that can already be process for neonates that can already be
difficult to bond with. difficult to bond with.
Increased sense of comfort with Increased sense of comfort with
parenting and caring for their baby at parenting and caring for their baby at
discharge. discharge.
Strongly identify with their infants and felt Strongly identify with their infants and felt
confidence in meeting their infants confidence in meeting their infants
needs. needs.
continued
MATERNAL RESPONSES
MATERNAL RESPONSES

Milk production
Milk production
-
-
increased prolactin
increased prolactin
levels with skin to skin
levels with skin to skin

Milk ejection reflex (MER)

Milk ejection reflex (MER)
-
-
Letdown
Letdown
Increased oxytocin levels
Increased oxytocin levels
Mother more relaxed and confident
Mother more relaxed and confident

Lactation longevity
Lactation longevity
SUBSTANCE ABUSED
SUBSTANCE ABUSED
MOTHERS
MOTHERS

Increased closeness contributed to their

Increased closeness contributed to their
motivation to visit more frequently
motivation to visit more frequently

Increased ability to demonstrate parenting

Increased ability to demonstrate parenting
skills to health care professionals
skills to health care professionals

More mothers are able to meet and

More mothers are able to meet and
maintain their custody agreements
maintain their custody agreements
KANGAROO CARE
KANGAROO CARE
AND THE DYING BABY
AND THE DYING BABY
For some families it can be comforting to
For some families it can be comforting to
hold their baby until death occurs.
hold their baby until death occurs.
This can provide the family with a sense of
This can provide the family with a sense of
comfort and bonding that may not have
comfort and bonding that may not have
been established due to the baby
been established due to the baby

s
s
critical status.
critical status.
Assists in the grieving process for the
Assists in the grieving process for the
family.
family.
Questions
Questions
Thank you for your time.
Thank you for your time.
Enjoy lunch!
Enjoy lunch!
Contact information
Contact information
Cindy Martin
Cindy Martin
martinsrq@aol.com
martinsrq@aol.com
Extra slides if needed.
Extra slides if needed.
INTUBATED INFANTS
INTUBATED INFANTS
SELECTING A PATIENT
SELECTING A PATIENT

Select infant based on stability:

Select infant based on stability:
-
-
low oxygen requirement
low oxygen requirement
-
-
breathing spontaneously with a low
breathing spontaneously with a low
ventilatory rate
ventilatory rate
-
-
tolerates stimulation, movement,
tolerates stimulation, movement,
hands on, noise changes
hands on, noise changes
INTUBATED INFANTS
INTUBATED INFANTS
SELECTING A PATIENT
SELECTING A PATIENT

Physician support
Physician support

Begin with very stable babies that will

Begin with very stable babies that will
build staff confidence and trust for the
build staff confidence and trust for the
safety and quality of interaction with
safety and quality of interaction with
mother and others
mother and others

Look for those nurses who will initiate

Look for those nurses who will initiate
on all shifts
on all shifts

Parent feedback of the encounter for

Parent feedback of the encounter for
them with their baby
them with their baby
continued
INTUBATED INFANTS IN
INTUBATED INFANTS IN
KANGAROO CARE
KANGAROO CARE

EDUCATE
EDUCATE
-
-
Staff should be educated first
Staff should be educated first
and their acceptance of this type of care in
and their acceptance of this type of care in
their unit
their unit

Select the right nurses and family to begin

Select the right nurses and family to begin
in your unit. Have RT or MD stand by to
in your unit. Have RT or MD stand by to
re
re
-
-
intubate
intubate

Transfer with 2 nurses. Have equipment

Transfer with 2 nurses. Have equipment
ready and chair close to platform
ready and chair close to platform
EXCEPTION TO
EXCEPTION TO
KANGAROO CARE
KANGAROO CARE

Baby at risk for IVH

Baby at risk for IVH

Baby with immature skin

Baby with immature skin

Baby on vasopressor drugs

Baby on vasopressor drugs

Babies with art lines

Babies with art lines