Kangaroo Mother Care is a low cost, comprehensive method of care of stable Low Birth Weight Infants. The baby is placed between mother’s breasts in direct skin to skin contact and breastfed exclusively. It fosters their health and well being by promoting effective thermal control, breastfeeding, infection prevention and bonding. Skin-to-skin-contact promotes lactation and facilitates the feeding interaction.
Benefits of Kangaroo Mother Care (KMC)
Research has proved beyond any doubt regarding benefits of KMC to baby, mother, family & community. Prolonged skin-to-skin contact between the mother and her preterm/ LBW infant provides effective thermal control with a reduced risk of hypothermia. Mothers are less stressed during kangaroo care as compared with a baby kept in an incubator and report a stronger bonding with the baby, increased confidence, and a deep satisfaction due to active involvement in the care of the baby. Additionally, KMC reduces the health care cost significantly as it saves money on equipment, medicines, artificial feeds, & prolonged hospital stay required during conventional care.
All mothers can provide KMC, irrespective of age, parity, education, culture, and religion. KMC can use any front-open gown, shirt, light dress or blouse and sari as per the local culture. A suitable apparel that can secure the baby for an extended period of time can be adapted locally. The mother should maintain good hygiene: daily bath/sponge, change of clothes, hand washing with short and clean fingernails. Family members should also be encouraged to provide KMC when mother wishes to take rest.
The baby should be placed between the mother’s breasts in an upright position. Baby is suitably dressed in cap, socks, nappy, and front-open sleeveless shirt. The baby’s chest is not covered to allow the skin to skin contact. The head should be turned to one side & in a slightly extended position which helps to keep the airway open and allows eye to eye contact between the mother & her baby. The hips should be flexed and abducted in a “frog” position; the arms should also be flexed. Baby’s abdomen should be at the level of the mother’s epigastrium. Mother’s heartbeats & breathing stimulate the baby, thus reducing the occurrence of apnea. Baby should receive most of the necessary care including feeding while in Kangaroo position. They need to be removed from skin to skin contact only for changing diapers & clinical assessment. A comfortable chair with adjustable back may be useful to provide KMC during sleep and rest.
Time of initiation
All stable LBW babies are eligible for KMC. However, very sick babies needing special care should have cared under radiant warmer initially. Babies with severe illnesses or requiring special treatment should be managed according to the unit protocol. Kangaroo Mother Care can be started as soon as the baby is stable. Short sessions of KMC can be initiated during the recovery with ongoing medical treatment via orogastric tube or on oxygen therapy.
Duration of KMC
Skin-to-skin contact should start in the nursery, with a smooth transition from conventional care to continuous KMC. Sessions that last less than one hour should be avoided because frequent handling may be stressful for the baby. The length of skin-to-skin contacts should be gradually increased up to 24 hours a day, interrupted only for changing diapers.
Monitoring attains special significance in KMC. The mother should be involved in observing the baby during KMC so that she herself can continue monitoring at home. Nursing staff should make sure that baby’s neck position is neither too flexed nor too extended, the airway is clear, breathing is regular, color is pink and baby is maintaining temperature. Monitoring growth is mandatory. The mother should be educated to recognize danger signs & to report to health care facility immediately.
The standard policy of the unit for discharge from the hospital should be followed. Generally, the following criteria are accepted at most centres :
Baby’s general health is good and no evidence of infection
Feeding well and receiving exclusively breast milk.
Gaining weight (at least 15-20gm/kg/day for at least three consecutive days)
Maintaining body temperature satisfactorily at room temperature.
The mother and family members are confident to take care of the baby in KMC and are motivated to come for follow-up visits regularly.
When should KMC be discontinued?
KMC should be continued until the baby reaches 40 weeks postconceptional age or attains a weight of 2500 gms. The baby starts wriggling to indicate that she is uncomfortable, pulls her limbs out, cries and fusses every time the mother tries to put her back in the skin to skin contact. This is the time to wean the baby from KMC. Mothers can continue to provide skin to skin contact occasionally after giving the baby a bath and during cold nights.