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Inis Kangaroo

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kangaroo care. find the file here: http://www.npeu.ox.ac.uk/downloads/inis/presentations/INIS-Kangaroo.ppt

kangaroo care. find the file here: http://www.npeu.ox.ac.uk/downloads/inis/presentations/INIS-Kangaroo.ppt

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  • Introduce yourself.
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    • 1. Kangaroo Care and the Ventilated Neonate By Karen Black (MNursSci, RNC)
    • 2. Kangaroo Care (also known as Skin-to Skin Contact)
      • Was developed by Rey and Martinez (1983) in Bogotá, Columbia as an alternative to incubator care (WHO, 2003)
      • Was initially defined as: “The care of preterm infants carried skin-to-skin with the mother.” (WHO, 2003)
      • Its key features were described as:
      • Early, continuous and prolonged skin-to-skin contact between the mother and the baby.
      • Exclusive breastfeeding (ideally)
      • Being initiated in hospital and continued at home
      • Providing small babies with the opportunity to be discharged early. (WHO, 2003)
    • 3. Current definition of Kangaroo Care: “ A form of parental caregiving where the newborn low birthweight or premature infant is intermittently nursed skin-to-skin in a vertical position between the mother’s breasts or against the father’s chest for a non-specific period of time.” (Kenner & Lott, 2003)
    • 4. Benefits of Kangaroo Care
      • Maintaining physiological stability.
      • Increasing immunity.
      • Optimising breastfeeding.
      • Facilitating parent-infant bonding
      • (Shiau and Anderson, 1997; WHO, 1997; WHO, 2003).
    • 5. Kangaroo Care as an alternative to cots in rural Tanzania
    • 6. In a setting as affluent as our own to what extent should Kangaroo Care be promoted?
    • 7. Kangaroo Care and the Intensive Care Infant
      • Cochrane review states that Kangaroo care should not be routine practice in the technological setting. (Conde-Agudelo, et al , 2003)
      • Decision to ‘Kangaroo’ infants generally left to individual nurses clinical judgment (Nyqvist, 2004).
      • Many infants miss out on opportunity to consider this practice.
    • 8. Aims and objectives
      • To examine the application and limitation of Kangaroo Care with intubated LBW or very premature infants requiring mechanical ventilation.
      • To critically examine the literature.
      • To provide recommendations for practice.
    • 9. Physiological Stability ● Infants oxygen requirements increased and body temperature dropped. 14 Quantitative Smith (2001) ● The physiological observations of Infants <1kg remained stable during KC and decreased oxygen requirement. 12 Quantitative Ludington, Ferreira & Swinth (1999) ● a 27-day old neonate weighing 894g received SIMV at a rate of 12 breaths per minute whilst receiving Kangaroo Care for 45minutes. 1 case study Ludington-Hoe, Ferreira & Goldstein (1998) ● During KC period pulse, oxygen and respiratory rate remained within normal parameters for infants of ≥30/40 or >1.2kg. ● Infants <30/40 or <1.2kg showed signs of restlessness, tachycardia and decreased oxygenation during prolonged kangaroo care. 25 Quantitative Gale, Frank & Lund (1993) ● Infants responded to Kangaroo care with increased quiet sleep and decreased Oxygen requirement. ● Highlight possible benefits and need for further research. 2 case study Drosten-Brookes (1993) Findings Sample group Type of Study Researcher(s)
    • 10. Transfer Technique
      • Indicated to be the greatest contributing factor to heat loss and increased stress, resulting in tachycardia or apnoea (Ludington-Hoe et al, 1998)
      • Lifting commonly associated with oxygen desaturation (Danford et al, 1983; Peters, 1992).
      • Physiological disruption occurred in both parent and nurse led transfer techniques (Neu et al , 2000).
      • Involving 2-3 nurses in transfer minimises the risk of extubation or physiological disruption (Ludington-Hoe et al, 2003).
    • 11. Breastfeeding
      • The diverse range of benefits of breastmilk for premature infants are widely documented .
      • Admission to NICU and necessity for intubation affects decisions to breastfeed (Jaeger et al , 1997).
      • Those who chose to breastfeed often have difficulty establishing expression and sufficient supply during period of intubation and tube feeding (Furman and Kennell, 2000).
    • 12. Advantages of Kangaroo Care to breastfeeding
      • Stimulates endocrine pathway and enhances flow of milk (Bier, 1997; Whitlaw et al , 1998).
      • Reduces harmful anxiety and stress emotions (Whitlaw et al , 1998).
      • Promotes family centred care and breaks down barriers to expression of milk (Jaeger et al , 1999).
    • 13. Parental benefits of Kangaroo Care
      • Reduction in stress and anxiety improves parents perception of the infants’ admission to NICU and subsequent ventilation (Legault & Goulet, 1995).
      • Reduces feelings of inadequacy, anxiety and frustration experienced by fathers (Neu, 2004).
      • Facilitates closeness and bonding (Neu, 2004).
      • Case reports detail benefits in reducing complications associated with maternal eclampsia (Anderson et al, 2001) and post-natal depression (Dombrowski et al , 2001)
    • 14. Adverse effects of Kangaroo Care
      • Increased stress on dislodgement of venous or arterial lines or accidental extubation.
      • Feelings of guilt if infant becomes physiologically unstable during Kangaroo period.
    • 15. Evaluation of evidence
      • Benefits in breastfeeding, nutrition and parental satisfaction if undertaken safely.
      • Practice can benefit physiological stability if carried out for an appropriate length of time and utilising a safe transfer technique.
      • Kangaroo care can be conducive with mechanical ventilation.
    • 16. Limits in research evidence
      • Compatibility of ventilation method.
      • Accessing haemodynamic stability.
      • Drug contraindications.
      • Limit of gestational age or size of infant.
      • Studies from British units.
      • Randomized control trials.
    • 17. Barriers to Kangaroo Care with ventilated neonates in practice
      • Fear of arterial or venous line dislodgement
      • Fear of accidental extubation
      • Safety issues for very low birthweight infants
      • Inconsistency in technique
      • Nurses’ feelings that their work load increased.
      • Nursing reluctance.
      • Medical staff reluctance
      • Difficulty administering care during KC
      • Staff concerns for parental privacy
      • Lack of experience with KC
      • Insufficient time for family care during KC
      • Belief that technology is better than KC
      (Engler et al , 2002)
    • 18.  
    • 19. Recommendations for practice
      • Development of evidence based policy at Trust level.
      • Incorporate an inter-disciplinary approach.
      • Remain aware of limitations of policy implementation
    • 20. Recommendations for education
      • Comprehensive education detailing the benefits and risks.
      • Up to date evidence based information.
      • Incorporated into new staff induction or learning beyond registration study days.
      • Encourage critical reflection on experiences of Kangaroo care with ventilated infants.
    • 21. References
      • Anderson, et al (2001). Kangaroo care: Not just for stable preemies anymore. Reflections on Nursing Leadership . 14, 33–34, 45.
      • Bier et al (1997) Breastfeeding infants who were extremely low birthweight. Pediatric . 100: 773–812.
      • Bliss (2004) Available at: www.bliss.org.uk (Accessed 14.11.04 updated 01.10.04).
      • Conde-Agudelo et al (2003). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic Reviews . 2.
      • Drosten-Brooks, F. (1993). Kangaroo Care: Skin-to-skin contact in the NIVU. Maternal Child Nursing . 18(5): 250-253
      • Danford et al . (1983). Effects of routine care procedures on transcutaneous oxygen in neonates: A quantitative approach. Archives of Disease in Childhood , 58, 20-23. Bibliographic Links External Resolver Basic
      • Dombrowski et al . (2001). Kangaroo (skin-to-skin) Care with a postpartum woman who felt depressed. MCN, The American Journal of Maternal and Child Nursing . 26: 214–216.
      • Engler, A. et al (2002) Kangaroo Care National survey of practice, knowledge barriers and perceptions. Maternal and Child Nursing . 27(3): 146-153.
      • Furman, L. & Kennell, J. (2000). Breastmilk and skin-to-skin kangaroo care for premature infants. Avoiding bonding failure. Acta Paediatrica . 89: 1280-1283.
      • Gale, et al (1993). Skin-to-skin holding of the intubated premature infant. Neonatal Network . 12(6): 49-57
      • Jaeger MC et al (1997) The impact of prematurity and neonatal illness on the decision to breast-feed. Journal of Advanced Nursing . 8, 4, 112-117.
      • Kenner, C. & Lott, J.W. (2003). Comprehensive Neonatal Nursing . Saunders, USA.
      • Legault, M. & Goulet, C. (1995). Comparison of kangaroo and traditional methods of removing preterm infants from incubators. Journal of Obstetric, Gynaecological and Neonatal Nursing . 24(65): 501-506.
      • Ludington-Hoe et al (1998). Kangaroo Carewith a ventilated preterm infant . Acta Paediatrica . 87: 711–713.
    • 22. References continued
      • Ludington et al (1999). Skin-to-skin contact effects on pulmonary function tests in ventilated preterm infants. Journal of Investigative Medicine . 47(2): 173-177
      • Ludington et al .(2003). Safe criteria and procedure for Kangaroo Care with intubated preterm infants. Journal of Obstetric, Gynaecological and Neonatal Nursing. 32 (5): 579-586.
      • Neu et al (2000). The Impact of Two Transfer Techniques Used During Skin-to-Skin Care on The Physiologic and Behavioural Responses of Preterm Infants. Nursing Research . 49(4): 214-223
      • Neu, M (2004). Kangaroo Care: Is it for Everyone? Neonatal Network. 23(5): 47-54.
      • Nyqvist, K.H (2004). How can Kangaroo Mother Care and High Technology Care be Compatible? Journal of Human Lactation . 20(1): 72-74
      • Peters, K. L. (1992). Does routine nursing care complicate the physiologic status of the premature neonate with respiratory distress syndrome? Journal of Perinatal and Neonatal Nursing, 6, 67-84.
      • Shiau, S.H. and Anderson, G.C. (1997). Randomized controlled trial of kangaroo care with full-term infants: effects on maternal anxiety, breast milk maturation, breast engorgement, and breastfeeding status. Australian Breastfeeding Association, Sydney.
      • Smith, S.L. (2001). Physiological stability of intubated Very Low Birtheight infants during skin-to-skin care and incubator care. Advances in Neonatal Care . 1(1): 28-40.
      • Swinth et al (2003). Kangaroo care with a Preterm Infant Before, During and After Mechanical Ventilation. Neonatal Network . 22(6): 33-38
      • Whitelaw et al (1998) Skin-to-skin contact for very low birthweight infants and their mothers . Archives of Disease in Childhood . 63: 1377–81
      • World Health Organization (WHO) (1997). Thermal Control of the Newborn: A practical Guide. Maternal Health and Safe Motherhood Programme. WHO, Geneva
      • World Health Organisation (WHO) (2003). Kangaroo Mother Care: A Practical Guide . Department of Reproductive Health and Research, Geneva.

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