Inis Kangaroo


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Inis Kangaroo

  1. 1. Kangaroo Care and the Ventilated Neonate By Karen Black (MNursSci, RNC)
  2. 2. Kangaroo Care (also known as Skin-to Skin Contact) <ul><li>Was developed by Rey and Martinez (1983) in Bogotá, Columbia as an alternative to incubator care (WHO, 2003) </li></ul><ul><li>Was initially defined as: “The care of preterm infants carried skin-to-skin with the mother.” (WHO, 2003) </li></ul><ul><li>Its key features were described as: </li></ul><ul><li>Early, continuous and prolonged skin-to-skin contact between the mother and the baby. </li></ul><ul><li>Exclusive breastfeeding (ideally) </li></ul><ul><li>Being initiated in hospital and continued at home </li></ul><ul><li>Providing small babies with the opportunity to be discharged early. (WHO, 2003) </li></ul>
  3. 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. 4. Benefits of Kangaroo Care <ul><li>Maintaining physiological stability. </li></ul><ul><li>Increasing immunity. </li></ul><ul><li>Optimising breastfeeding. </li></ul><ul><li>Facilitating parent-infant bonding </li></ul><ul><li>(Shiau and Anderson, 1997; WHO, 1997; WHO, 2003). </li></ul>
  5. 5. Kangaroo Care as an alternative to cots in rural Tanzania
  6. 6. In a setting as affluent as our own to what extent should Kangaroo Care be promoted?
  7. 7. Kangaroo Care and the Intensive Care Infant <ul><li>Cochrane review states that Kangaroo care should not be routine practice in the technological setting. (Conde-Agudelo, et al , 2003) </li></ul><ul><li>Decision to ‘Kangaroo’ infants generally left to individual nurses clinical judgment (Nyqvist, 2004). </li></ul><ul><li>Many infants miss out on opportunity to consider this practice. </li></ul>
  8. 8. Aims and objectives <ul><li>To examine the application and limitation of Kangaroo Care with intubated LBW or very premature infants requiring mechanical ventilation. </li></ul><ul><li>To critically examine the literature. </li></ul><ul><li>To provide recommendations for practice. </li></ul>
  9. 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. 10. Transfer Technique <ul><li>Indicated to be the greatest contributing factor to heat loss and increased stress, resulting in tachycardia or apnoea (Ludington-Hoe et al, 1998) </li></ul><ul><li>Lifting commonly associated with oxygen desaturation (Danford et al, 1983; Peters, 1992). </li></ul><ul><li>Physiological disruption occurred in both parent and nurse led transfer techniques (Neu et al , 2000). </li></ul><ul><li>Involving 2-3 nurses in transfer minimises the risk of extubation or physiological disruption (Ludington-Hoe et al, 2003). </li></ul>
  11. 11. Breastfeeding <ul><li>The diverse range of benefits of breastmilk for premature infants are widely documented . </li></ul><ul><li>Admission to NICU and necessity for intubation affects decisions to breastfeed (Jaeger et al , 1997). </li></ul><ul><li>Those who chose to breastfeed often have difficulty establishing expression and sufficient supply during period of intubation and tube feeding (Furman and Kennell, 2000). </li></ul>
  12. 12. Advantages of Kangaroo Care to breastfeeding <ul><li>Stimulates endocrine pathway and enhances flow of milk (Bier, 1997; Whitlaw et al , 1998). </li></ul><ul><li>Reduces harmful anxiety and stress emotions (Whitlaw et al , 1998). </li></ul><ul><li>Promotes family centred care and breaks down barriers to expression of milk (Jaeger et al , 1999). </li></ul>
  13. 13. Parental benefits of Kangaroo Care <ul><li>Reduction in stress and anxiety improves parents perception of the infants’ admission to NICU and subsequent ventilation (Legault & Goulet, 1995). </li></ul><ul><li>Reduces feelings of inadequacy, anxiety and frustration experienced by fathers (Neu, 2004). </li></ul><ul><li>Facilitates closeness and bonding (Neu, 2004). </li></ul><ul><li>Case reports detail benefits in reducing complications associated with maternal eclampsia (Anderson et al, 2001) and post-natal depression (Dombrowski et al , 2001) </li></ul>
  14. 14. Adverse effects of Kangaroo Care <ul><li>Increased stress on dislodgement of venous or arterial lines or accidental extubation. </li></ul><ul><li>Feelings of guilt if infant becomes physiologically unstable during Kangaroo period. </li></ul>
  15. 15. Evaluation of evidence <ul><li>Benefits in breastfeeding, nutrition and parental satisfaction if undertaken safely. </li></ul><ul><li>Practice can benefit physiological stability if carried out for an appropriate length of time and utilising a safe transfer technique. </li></ul><ul><li>Kangaroo care can be conducive with mechanical ventilation. </li></ul>
  16. 16. Limits in research evidence <ul><li>Compatibility of ventilation method. </li></ul><ul><li>Accessing haemodynamic stability. </li></ul><ul><li>Drug contraindications. </li></ul><ul><li>Limit of gestational age or size of infant. </li></ul><ul><li>Studies from British units. </li></ul><ul><li>Randomized control trials. </li></ul>
  17. 17. Barriers to Kangaroo Care with ventilated neonates in practice <ul><li>Fear of arterial or venous line dislodgement </li></ul><ul><li>Fear of accidental extubation </li></ul><ul><li>Safety issues for very low birthweight infants </li></ul><ul><li>Inconsistency in technique </li></ul><ul><li>Nurses’ feelings that their work load increased. </li></ul><ul><li>Nursing reluctance. </li></ul><ul><li>Medical staff reluctance </li></ul><ul><li>Difficulty administering care during KC </li></ul><ul><li>Staff concerns for parental privacy </li></ul><ul><li>Lack of experience with KC </li></ul><ul><li>Insufficient time for family care during KC </li></ul><ul><li>Belief that technology is better than KC </li></ul>(Engler et al , 2002)
  18. 19. Recommendations for practice <ul><li>Development of evidence based policy at Trust level. </li></ul><ul><li>Incorporate an inter-disciplinary approach. </li></ul><ul><li>Remain aware of limitations of policy implementation </li></ul>
  19. 20. Recommendations for education <ul><li>Comprehensive education detailing the benefits and risks. </li></ul><ul><li>Up to date evidence based information. </li></ul><ul><li>Incorporated into new staff induction or learning beyond registration study days. </li></ul><ul><li>Encourage critical reflection on experiences of Kangaroo care with ventilated infants. </li></ul>
  20. 21. References <ul><li>Anderson, et al (2001). Kangaroo care: Not just for stable preemies anymore. Reflections on Nursing Leadership . 14, 33–34, 45. </li></ul><ul><li>Bier et al (1997) Breastfeeding infants who were extremely low birthweight. Pediatric . 100: 773–812. </li></ul><ul><li>Bliss (2004) Available at: (Accessed 14.11.04 updated 01.10.04). </li></ul><ul><li>Conde-Agudelo et al (2003). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic Reviews . 2. </li></ul><ul><li>Drosten-Brooks, F. (1993). Kangaroo Care: Skin-to-skin contact in the NIVU. Maternal Child Nursing . 18(5): 250-253 </li></ul><ul><li>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 </li></ul><ul><li>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. </li></ul><ul><li>Engler, A. et al (2002) Kangaroo Care National survey of practice, knowledge barriers and perceptions. Maternal and Child Nursing . 27(3): 146-153. </li></ul><ul><li>Furman, L. & Kennell, J. (2000). Breastmilk and skin-to-skin kangaroo care for premature infants. Avoiding bonding failure. Acta Paediatrica . 89: 1280-1283. </li></ul><ul><li>Gale, et al (1993). Skin-to-skin holding of the intubated premature infant. Neonatal Network . 12(6): 49-57 </li></ul><ul><li>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. </li></ul><ul><li>Kenner, C. & Lott, J.W. (2003). Comprehensive Neonatal Nursing . Saunders, USA. </li></ul><ul><li>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. </li></ul><ul><li>Ludington-Hoe et al (1998). Kangaroo Carewith a ventilated preterm infant . Acta Paediatrica . 87: 711–713. </li></ul>
  21. 22. References continued <ul><li>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 </li></ul><ul><li>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. </li></ul><ul><li>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 </li></ul><ul><li>Neu, M (2004). Kangaroo Care: Is it for Everyone? Neonatal Network. 23(5): 47-54. </li></ul><ul><li>Nyqvist, K.H (2004). How can Kangaroo Mother Care and High Technology Care be Compatible? Journal of Human Lactation . 20(1): 72-74 </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Swinth et al (2003). Kangaroo care with a Preterm Infant Before, During and After Mechanical Ventilation. Neonatal Network . 22(6): 33-38 </li></ul><ul><li>Whitelaw et al (1998) Skin-to-skin contact for very low birthweight infants and their mothers . Archives of Disease in Childhood . 63: 1377–81 </li></ul><ul><li>World Health Organization (WHO) (1997). Thermal Control of the Newborn: A practical Guide. Maternal Health and Safe Motherhood Programme. WHO, Geneva </li></ul><ul><li>World Health Organisation (WHO) (2003). Kangaroo Mother Care: A Practical Guide . Department of Reproductive Health and Research, Geneva. </li></ul>