Kangaroo care for premature babies

Kangaroo Care (KC) is an intervention for premature and low-birth weight infants and their families. This technique comprises prolonged skin-to-skin contact between the parents and the new-born baby. It empowers parents, allowing them to play a significant role in the care and survival of their baby within the Neonatal Intensive Care setting.
Kari Me baby sling has been proved to be instrumental for Kangaroo Care. It can help with keeping baby warm, keeping the right position of baby and any equipment in place and enables the parent to move if necessary. Few neonatal units in UK hospital use Kari Me for this purpose and encourage parents to get a sling to carry their babies once they are ready to go home.
If you would like to learn more about Kangaroo Care please read the article below which summarises available research and Kari Me baby carrier's role in achieving successful and safe Kangaroo care. You can read more about Kangaroo care by visiting our recommended links.

Kangaroo care for Premature Babies and Kari Me baby carrier
Dr. L. Bashan, BSc, MSc Couns. Psy., PhD. Effect Ltd.

History
Kangaroo skin to skin care was developed in Bogota, Columbia in the early 1980s by neonatologists Edgar Rey and Hector Martinez. At the time the mortality rate for premature infants in Bogota, was 70 percent. With lack of power and reliable equipment, Kangaroo Care evolved out of necessity. Mothers of premature infants were given their babies to hold twenty-four hours a day: they slept with them and tucked them under their clothing as if in a kangaroo's pouch. If a baby needed oxygen, it was administered under an oxygen hood placed on the mother's chest. This skin-to-skin care was found to be an inexpensive and very beneficial experience to babies in Bogota. The mortality rate fell from 70 % to 30 %.
After these findings, the world began to take note and do further research on Kangaroo Care. The idea first spread through Europe, and the United States. Now hospitals across the world are offering Kangaroo Care, and countless research studies have documented its benefits.

Benefits
Some hundreds of studies were published in the last 20 years about kangaroo care. The following review is a summary of the main findings. Most studies have proven that Kangaroo Care has a major, positive impact on babies and their parents; some studies have proven there is no change; one reported study suggests some risk in kangaroo care.

Cardio-respiratory benefits:Infants' heart and respiratory rates remained within normal limits during Kangaroo care, which is unlike premature infants in regular conditions. Also, during Kangaroo care, there is less or same occurrence of bradycardia (slow heart rate) episodes. (Cleary, et al, 1997; Hamelin, & Ramachandran, 1993; Ludington-Hoe and Swinth 1996,) heart rate is more regular for kangarooed infants (Gale & Vandenburg, 1998) and there are fewer and shorter episodes of apnea (cessation of breathing) (Hamelin, & Ramachandran, 1993; Ludington-Hoe and Swinth 1996). Ludington (1998) found a four-fold decrease in apnea during Kangaroo Care and mechanically ventilated babies were able to tolerate transfer and position changes without increased oxygen requirements.

Temperature Regulation: Without Kangaroo Care, most preterm infants must be kept in incubators because they cannot regulate their own body temperature. During Kangaroo care the mother and child demonstrate "thermal synchrony" and the infants are kept within their thermal neutral zone (Goldson 1999, Ludington-Hoe et al. 2000). During thermal synchrony, if the infant's temperature increases or decreases, the mother's body temperature changes to compensate for the infants temperature (Goldson, 1999). The range of maternal breast temperatures in the study went from 30.44 to 36.75°C. Maternal breast temperatures initially rose until the infants reached an abdominal temperature of 36.8 °C and then varied by less than .3°C (Ludington-Hoe et al. 2000). During Kangaroo care the infants are kept in their thermal neutral zone and their toe temperatures are significantly warmer during Kangaroo Care and after KC than incubated infants. Extra blankets and monitoring of baby's temperature might be needed when Dad or others practice Kangaroo Care.

Feeding: In 1998, Gomez, et al found that infants in Kangaroo Care for > 50 minutes were 8 times more likely to breastfeed spontaneously. Kangaroo Care allows for easy access to the breast, and the skin-to-skin contact increases milk let-down.
Wahlberg, Affonso, & Persson (cited in Ludington-Hoe and Swinth 1996) showed that more kangaroo care infants breastfeed at discharge and (82% of KC infants, 45% of control infants) Bier et al (cited in Ludington-Hoe and Swinth 1996) showed that more kangaroo care infants (95%) continue breastfeeding after discharge than control infants (45%).

Stress Reduction: Mooncey et al. (1997) showed a 74% geometric mean decrease in plasma beta-endorphin (a stress indicator) after kangaroo care. Another study (cited in Goldson, 1999) showed that salivary cortisol (yet another stress indicator) levels were lower in infants who received kangaroo care.

State Organisation: State organization involves being able to transition in and out of different stages of sleep smoothly and into alertness (but not crying, which is the highest behaviour state). Premature infants have a very difficult time transitioning from one stage of sleep to another and do not spend enough time in quiet sleep stages. Quiet sleep helps to protect the infants from environmental stimuli and fosters motor organization (Ludington-Hoe & Swinth 1996). Quiet sleep is also characterized by regular breathing patterns, so it leads to a decrease in apnea (Messemer et al. 1997). Crying is very bad for infants because it decreases lung capacity, increases intracranial pressure, re-establishes some fetal circulatory patterns and starts stress reactions within the body (Anderson, 1999). Kangaroo care prevents crying, or at least severely limits crying in infants (Anderson 1999). In addition, it reduces active sleep and significantly increases quiet sleep these findings are presented in tables 1 and 2.

Table 1 effects of KC on quiet sleep, awake time and active sleep (Adapted from Messemer et al. 1997)

Table 2 summary of studies on the effects of KC on sleep and crying (Adapted from Ludington-Hoe & Swinth 1996).

Organisation of Attention: Attention/interaction organisation is demonstrated by the ability to process input from the environment. Even though infants younger than 40 weeks postconceptional age rarely exhibit attentive behaviours, Gale et. al (1993 cited in Ludington-Hoe and Swinth 1996) showed that some infants older than 30 weeks gestational age have been observed gazing at their parent and trying to move their head to look at their parent after 10-15 minutes of Kangaroo Care.

Motor Organisation: Motor organization is shown by control over movements and the absence of purposeless movements. Preterm infants have an especially hard time organising their movements - loud noises or environmental changes cause them to flail their arms, extend their legs, heave their chests and move their heads. These movements use up oxygen and calories, which need to be used for growth and development. Kangaroo care decreases (by up to 50%) purposeless movements and induces relaxation, which improves breathing. In addition, being held between the breasts and hand limits motor activity (Ludington-Hoe and Swinth 1996).

Weight gain and hospital discharge: Holly Richardson (1997) concluded that more rapid weight gain was observed in Kangarooed infants. Kangaroo Care allows the baby to fall into a deep sleep, thereby conserving their energy for far more important things.
This increased weight gain also leads to shorter hospital stays. Charpak et al. (1997) showed a shorter hospital stay in the Kangaroo Care group; primarily in infants <1800 grams. Kangarooed infants can have as much as a 50% shorter hospital stay than babies who aren't Kangarooed. This in turn means less expense for the hospitals and/or parents.

Relationship: Gale and Vandenburg (1998) found an increased intimacy and attachment between baby and parent. Kangaroo Care was found to help a parent feel connected and confident in taking care of the baby. Feldman et. al. (2002) have also found that at 37 weeks GA mothers showed more positive affect, touch, and adaptation to infant cues and also reported less depression. At 3 and 6 months parents of KC infants provided better home environment and infants scored higher on mental and psychomotor development Indexes.

Possible ill effects: A study by Bohnhorst et al. (2001) showed that Kangaroo Care did have some possibly dangerous effects, as shown below. They found that infants did have an increase in non-regular breathing patterns as well as bradycardia and hypoxemia.
However, this study did not place the infants on their parent's chests at a 60 degree recline, which may be partially responsible for the difference in breathing rates between this study and many other studies.

Practicing Kangaroo Care: In a typical Kangaroo Care session, the mother or father relaxes in a chair while the nurses slowly transfer the baby (wearing only in a diaper and cap), still attached to any tubes or cords, from the bed onto the parent's bare chest. The baby's head is turned to the side so that it's ear is against the parent's heart. Vent tubing and wires are taped to the parent's gown. Holders are advised to sit on a reclining chair or a lean on a pillow to allow a 60 degrees angle. Moms who are six weeks or less postpartum should stand up every hour to hour and a half for several minutes.
Once the baby is settled, the nurse will either place a blanket over the baby's back or help the parent button their shirt around the baby. Sessions usually last from 30 minutes to two hours and are typically done twice a day, although some experts recommend a minimum of one hour and around the clock carrying if possible.
According to Ludington (1993) the baby is naturally immune to Mom's germs - but not to Dad's, so fathers need to "scrub up" before holding the baby.

At Mowbray Maternity Hospital in Cape Town, South Africa, a strip of cloth is positioned underneath the baby's ear. This extends the baby's head and neck and prevents obstructive apnea. The mother then wears a special shirt that wraps around and under the baby's bottom to induce flexion, as in utero. The baby is tied tightly enough so that when the mother breathes, she pushes against the baby's chest and stimulates his breathing

Kari Me baby carrier and Kangaroo Care: In most NICU, where kangaroo care is practiced, parents are not using special clothing or equipment but sit with their naked preemies covered by a blanket. The description of the practice at Mowbray hospital above emphasise the benefits of wrapping the baby with a special strip.
Kari Me baby carrier is a soft cotton cloth which can be warn in different positions that allow safe and comfortable carrying of babies of all ages. Kari Me has a lighter and smaller form which can assist parents with kangaroo care for their premature babies:
1. Kari Me can help with maintaining baby's body temperature by covering all the body parts which are not in skin-to-skin contact with the holder.
2. Kari Me can help with keeping a comfortable and safe positioning of the baby and keeping their head and neck in the right posture.
3. Kari Me can be tied in the right strength, thus holding the preemie close to the holder's body and restricting purposeless movements but it's flexibility allows light movements, as in the womb.
4. Kari Me allows the holder to stand-up if necessary, change position or move while carrying the baby.
5. Kari Me offers a position which is comfortable for breastfeeding.
6. Kari Me is soft and snug and can assist in creating a womb-like warm environment for the preemie.

We believe that these benefits of the Kari Me baby carrier can encourage more parents to provide skin to skin care for their babies and for longer sessions as well.

Links for useful information about premature babies:

Kangaroo care

Kangaroo Care http://kangaroo.javeriana.edu.co/sitio_ingles/index_eng.html

Summary of Kangaroo Care research http://www.geocities.com/roopage/kcresearch.html

More findings on Kangaroo Care
http://www.bio.davidson.edu/people/midorcas/animalphysiology/websites/2001/Vogel/kangaroocare.htm

Express Yourself Mums for information about Kangaroo care, breastfeeding and supporting products http://www.expressyourselfmums.co.uk/article.asp?subcategory_id=49&case_id=93

Premature babies - general links

A parent guide and support to caring for premature baby, packed with information and personal stories http://www.prematurity.org/index.html

BLISS the premature baby charity http://www.bliss.org.uk/

Safety of Car Seats for premature babies

Important safety alert on the use of car seat with premature babies
http://news.bbc.co.uk/1/hi/health/1526517.stm
http://pediatrics.aappublications.org/cgi/content/full/110/2/401?ck=nck

car seat recommendations
http://www.childcarseats.org.uk/carrying_safely/premature.htm

Itching in pregnancy and liver condition

Are you suffering (or have suffered) from itching during your pregnancy? You may have a disorder called Obstetric Cholestasis. This condition, if left undiagnosed and untreated may increase the risk for premature birth, fetal distress and stillbirth. Please follow the links for this life saving information.
Obstetric Cholestasis Support UK http://www.ocsupport.org.uk/
Itchy moms http://www.itchymoms.com/