Alleviation: An International Journal of Nutrition, Gender & Social Development, ISSN 2348-9340 Volume 1, Number 1 (2014), pp. 1 - 8
© Arya PG College, Panipat & Business Press India Publication, Delhi
www.aryapgcollege.com
Kangaroo Mother Care: Boon To Preterm and Low Birth Weight (LBW) Babies
Indu Bansal, Priyanka Singh, Monika
Prof. & Dean, Faculty of Home Science, Ph.D Research Scholars
Faculty of Home Science
Banasthali Vidyapith, Tonk (Rajasthan), India
E – Mail: mannusingh.singh3@gmail.com
Introduction
Generally baby born on proper time after pregnancy do well. This is because their organs are more mature. Their lungs are better prepared for breathing and have more strength for sucking and feeding. Delivery occurring before 37 weeks of gestational age is called premature birth. Most premature babies arrive after 32 weeks of pregnancy and have a good chance of surviving and growing up healthy (National Statistics 2007). But chance of survival is less if babies have low birth weights (premature by weight), weight at birth of less than 2500 gm, irrespective of gestational age has an adverse effect on child survival and development. World-wide, twenty-five million low birth weight (LBW) infants are born each year, the great majority (96%) of them in developing countries. Low birth weight and premature newborns are extremely fragile individuals that need special care including increased warmth, greater efficiency in the detection and treatment of infections, additional help with nourishment, more contact with their mothers and families, and finally, the special attention of health care professionals and high-quality health services. Thus interventions that reduce neonatal morbidity, mortality and costs are important advancement in care for LBW infants.
Conventional neonatal care of LBW infants is expensive and needs both trained personnel and permanent logistic support. In developing countries, financial and human resources for neonatal care are limited and hospital wards for LBW infants are often overcrowded. Thus interventions that reduce neonatal morbidity, mortality and costs are important advancement in care for LBW infants. The Kangaroo Mother Care (KMC) for premature and low birth weight newborns is child care module that can be beneficial in the reduction of this dire problem, significantly reducing the infant mortality rates during the first year of life.
The Kangaroo Mother Care (KMC)
Kangaroo Mother Care defined as early, prolonged and continuous skin-to-skin contact between a mother and her newborn low birth weight infant, both in hospital and after early discharge, until at least the 40th week of postnatal gestational age is one of the special ways of caring of low birth weight babies. Important components of effective KMC are thermal control, breastfeeding, infection prevention and support for the mother-infant pair bonding.
KMC was first suggested in 1978 by Dr Edgar Rey in Bogotá, Colombia .The term kangaroo care is derived from practical similarities to care-giving by kangaroos to their newborns, i.e. the premature infant is kept warm in the maternal pouch and close to the breasts for unlimited feeding. Kangaroo care (Also kangaroo maternal care or skin to skin contact and breastfeeding) is a method used to restore the unique mother –infant bond following the sudden separation during the birth experience particularly in premature births. The kangaroo position provides ready access to nourishment. The mothers’ body responds to the needs of the infant directly, helping to regulate temperature more smoothly than an incubator, her milk adjusts to the nutritional and immunological need of her fragile infant, and the baby sleeps more soundly.
Components of KMC
Kangaroo position: The kangaroo position consists of skin-to-skin contact (SSC) between the mother and the infant in a strictly vertical position, between the mother’s breasts and under her clothes. SSC should be started as early as possible after birth and can be of two types depending upon the duration: Continuous or Intermittent
The continuous modality is usually employed as an alternative to minimal care in an incubator for infants who have already overcome major problems while adapting to extra-uterine life, are able to suck and swallow properly and are thriving in neutral thermal environment. To replace incubators, the kangaroo position should be maintained as long as possible, ideally 24hr/day. The provider must sleep in a semi- reclining position to avoid the reflux in more preterm infants. The kangaroo position is maintained until the infant no longer tolerates it- he sweats and refuses the Kangaroo position. When continuous care is not possible then, The kangaroo position can be used intermittently, providing the proven emotional and breastfeeding promotion benefits. The kangaroo position must be offered for as long as possible (1-2 hrs at least), provided the infant tolerates it well. This 1-2 hour span is important as it provides the stimulation that the mother needs to increase the milk volume and facilitate milk let-down.
Kangaroo nutrition: Kangaroo nutrition is the delivery of nutrition to “kangarooed” infants as soon as oral feeding is possible. It is based on exclusive breastfeeding by direct sucking, whenever possible. Goal is to provide exclusive or nearly exclusive breastfeeding with fortification if needed. Breastfeeding is an integral component of KMC and it might contribute to significant gains in neurological development and IQ. Breast-feeding eliminates early contact of the baby with non-potable water used in infant formulas for the feeding of premature babies and, consequently, prevents diarrhea and other infections which are responsible for a significant number of infant deaths.
Kangaroo discharge and follow up: Early home discharge in the kangaroo position from the neonatal unit is one of the original components of the KMC intervention. If not safely possible, the mother-infant dyad can room-in together in a minimal care facility (Kangaroo wards) until safe discharge is possible. Mothers at home require adequate support and follow up, hence a follow-up program and access to emergency services must be ensured. Finally it is a gentle and effective method that avoids agitation routinely experienced in a busy ward with preterm infants. Keeping this in mind a project was planned with the objectives (i) to find out causes of low birth weight infants (ii) to provide education to families and (iii) to study impact of KMC on infants.
Methodology
The study was carried out in three phases:
• Data on reasons of LBW were collected through interviews and five years hospital records as well as records available with Asha Sahyogins in Tonk District of Rajasthan state.
• An Information and Readiness Programme was developed for expectant mothers diagnosed with low weight foetus. Since in our conventional society, decision about care of neonate and mother are many times taken by other members of the family, mostly by mother-in-laws /mothers /husbands or so called other experienced adults. Moreover a mother cannot successfully provide KMC all alone and requires counseling along with supervision from care-providers, and assistance and cooperation from her family members. Mothers, mother-in-laws, expected caretakers or husbands of pregnant ladies and Asha health workers were also included in the programme. Discussions and Audio- visual presentations were held on topics such as -
• Care during pregnancy.
• Importance of exclusive breast feeding.
• Correct method of breast feeding.
• Immunization, nutritional care.
• Characteristics or specific needs of premature newborn that require attention for its development and growth ( e.g. Low iron and calorific reserves, fast metabolism, high protein expenditure, increased necessity for glucose and fat, slower intestine peristalsis and low production of digestive enzymes).
• Awareness regarding different mother care programmes and benefits of Kangaroo mother care.
• KMC randomized control trials were also carried out on 20 mothers of LBW babies in three years duration. Infants were considered for KMC if they were low birth weight but in a stable condition.
Conclusions
Followings are the outcomes of the present study:
Different reasons regarding low birth weight of infants were: having a previous premature birth, pregnancy with twins, triplets or other multiples, an interval of less than six months between pregnancies, conception under treatment, some infections, particularly of the amniotic fluid and lower genital tract.
Some chronic conditions, such as high blood pressure and diabetes, being underweight or overweight before pregnancy, stressful life events, such as the death of a loved one or domestic violence, multiple miscarriages or abortions, physical injury or trauma, unusual shape of the uterus, cervical weakness, pregnancy under 16, the type of job if it involves long hours and strenuous activity, can affect chances of having a baby early.
Being underweight is also linked with problems that can cause premature birth. Problems with the uterus, cervix or placenta, poor nutrition, a bacterial infection in the vagina - if unusual vaginal discharge, heavy bleeding during the pregnancy, an abnormality of the uterus (Womb), and operation occur due to lack of oxygen in foetus, due to waters breaking early are some of the other reasons of early labor.
Information and readiness programme is important: to support parents in their roles as father and the mother as well as combat feeling of anxiety and fear. It is advisable to include other family members and significant adults in the community as well as health workers in all the educational and training programmes, since mother cannot successfully provide KMC all alone. As long as mothers remains in the maternity ward, they are given instructions and help in providing care to the premature child, the feeding, hygiene etc., reducing the incidence of infant mortality from sickness. She would require counseling along with supervision from care-providers, and assistance and cooperation from her family members. It is also helpful in providing support to the mother in hospital and at home. Post-discharge follow up KMC can be continued at home after early discharge from the hospital with the support of family members. Ashas are helpful in regular follow up and access to health providers for solving problem which is crucial to ensure safe and successful KMC at home.
This is a step to initiate existence of a leader, someone who decides to innovate, to break with the inertia that exists in the normal and usual procedures of a social problem. It increases the possibility of repetition of any new way of addressing social problems or, if necessary, adaptation to similar situations.
KMC as a way of caring LBW babies: There is sufficient evidence to make the following general statements about KMC:
• It is initiated in hospital and can be continued at home with adequate support and follow-up making shorter hospital stay. It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward It is an attractive model to hospitals with small maternity wards and /or small neonatal units because it does not need sophisticated equipments, large investments, can be applied almost anywhere, contain no extra costs and brings about a shorter hospital stay for the infants. It deals basically with acquiring ability. Once this ability is acquired, medical care can be provided for a large number of mothers and babies for it allows the incubators to be freed for the use of other babies, reducing the total cost of care for the premature child.
• Babies can be saved from the presence of diverse stress factors, like lack of oxygen, infection, respiratory disturbances, intensive care unit noises, injections, tubes, catheters, interrupted sleep, separation and lack of contact with parents. Although KMC does not improve survival, it reduces the incidence of respiratory tract and other infections. Its adoption actually diminishes the necessity to utilize equipment. For all of these reasons, it can be concluded that Kangaroo Mother Program has growing positive effect on low income communities.
• Initially infants gain weight much faster in the kangaroo position because they maintain thermal control (Kangaroo position provides a neutral thermal environment that provides immature infants with optimal thermal regulation, which is the same or better than provided by an incubator), sleep well, show better tolerance of oral feeding, and show improved breathing. Heart and respiratory rates, respiration, oxygenation, oxygen consumption, blood glucose,(Blood sugar) sleep patterns and tend to be similar to or better than those observed in infants separated from their mothers. KMC infants showed a slightly larger daily weight gain during first month but there was no significant difference between the groups in growth indices during the 6- month follow-up.
• This method also ensures physiological and psychological warmth and bonding with a reduced risk of hypothermia, improved mobility of mother, in¬creased milk production and duration of breastfeeding, KMC helps reduce maternal postpartum depression symptoms and increases parental sensitivity to infant cues and an increase in maternal feeling of empowerment. All infants need love and care to flourish, but very preterm babies need even more attention to be able to develop normally since they have been deprived of an ideal intrauterine environment for weeks or even months. KMC is an ideal method since the baby is cuddled, and listens to the different voices while mother performs her routine day to day activities. It enhances bonding and attachment of preterm and LBW infants to their parents and families. Family members have an important role to play in encouraging mothers and fathers to express their emotions and love to their babies.
• Periodical visits of health workers will be helpful in deciding duration of skin-to-skin contact, position, clothing, body temperature, and support for the mother and the baby. If the baby is not showing signs of intolerance they can encourage the mother and family to continue KMC as much as possible. However, if the baby has other problems due to preterm birth or its complications, health workers can advise on hygiene if the baby is taking formula supplements or other foods, and to reinforce the mother’s awareness of danger signs that need prompt care and can suggest for additional treatment ,if necessary.
Consequently, the Kangaroo Mother Care, associated with adequate medical assistance, can improve the health conditions and development of premature babies.
References
Cattaneo A, Davanzo R, Worku B (1998) Kangaroo Mother Care for Low Birth Weight Infants: A Randomized Controlled Trial in Different Settings. Acta Pediatr 1998; 87: 976-85.
Ludington-Hoe SM, Hadeed AJ, Anderson GC (1991). Physiological Response To Skin to Skin Contact In Hospitalized Premature Infants. J Perinatol 11: 19-24.
Ramanathan K, Paul VK, Deorari AK, Taneja U, George G (2001) Kangaroo Mother Care in Very Low Birth Weight Infants. Indian J Pediatr 68(11):1019-23.
Rao PN, Udani R, Nanavati R (2008) Kangaroo Mother Care For Low Birth Weight Infants: A Randomized Controlled Trial. Indian Pediatr 45(1):17-23.
http://www.mchip.net/sites/default/files/MCHIP%20KMC%20Guide_English.pdf
