Running head: APPRASING THE EVIDENCE 1 9 Permission was received by student to share this paper on July 15th, 2015 --NG Kangaroo Care vs. Infant Warmers in Reducing Mortality in Low Birth Weight Infants XXXXXXXXXXXX School Class Date Kangaroo Care vs. Infant Warmers in Reducing Mortality in Low Birth Weight Infants Clinical Question The specific clinical question guiding the search for a quantitative article is: In low birth weight babies, does kangaroo mother care improve heart rate, oxygen saturation, respiration, and temperature? The specific clinical question guiding the search for a qualitative article is: In mothers of premature infants in the NICU, what is the experience of kangaroo holding. Problem The problem this paper addresses is whether kangaroo care is an effective measure in increasing thermoregulation among low birth weight infants, thus reducing infant mortality. The significance of this problem is that low birth weight infants are less likely to achieve thermoregulation on their own and require specific interventions in regulating their body temperature. The World Health Organization (WHO) supported a study in Nepal in which an increased mortality was noted across all grades of hypothermia, and the risk was twelve times higher among preterm babies (Bera, et al., 2014). Interventions that may help reduce infant mortality related to ineffective thermoregulation include kangaroo care or infant warmers. According to Nimbalkar, et al. (2014), early skin to skin contact (SSC) can reduce the incidence of hypothermia in newborns within the first 48 hours of life and can contribute in the reduction of neonatal mortality due to hypothermia. The major pathophysiology of hypothermia in the newborn is the disturbance of its regulated temperature inside the womb to the sudden exposure to the colder environment outside the mother’s womb. At birth, newborns have limited control over regulating their own body temperature and require assistance through other means to help keep their body temperature up. The first 24 to 48 hours of life, especially in low birth weight infants, is the most crucial in preventing hypothermia, thus reducing the possibility of death.   The purpose of this paper is to interpret the quantitative and qualitative articles identified to see whether they are or are not important to our group topic. The paper will compare and contrast the main components of the matrix table. Description of Findings Concepts The independent variable studied between both quantitative and qualitative articles is kangaroo care.The quantitative describes how kangaroo care can impact a low birth weight infant and the 4 physiological parameters: heart rate, oxygen saturation, respiration, and temperature, which is the dependent variable. The variable of interest studied in the qualitative article is the mother’s reactions and/or experiences of kangaroo holing their preterm infant in the NICU. The concept of this stu ...

1. Running head: APPRASING THE EVIDENCE 1
9
Permission was received by student to share this paper on July
15th, 2015 --NG
Kangaroo Care vs. Infant Warmers in Reducing Mortality in
Low Birth Weight Infants
XXXXXXXXXXXX
School
Class
Date
Kangaroo Care vs. Infant Warmers in Reducing Mortality in
Low Birth Weight Infants
Clinical Question
The specific clinical question guiding the search for a
quantitative article is: In low birth weight babies, does
kangaroo mother care improve heart rate, oxygen saturation,
respiration, and temperature?

2. The specific clinical question guiding the search for a
qualitative article is: In mothers of premature infants in the
NICU, what is the experience of kangaroo holding.
Problem
The problem this paper addresses is whether kangaroo care is an
effective measure in increasing thermoregulation among low
birth weight infants, thus reducing infant mortality. The
significance of this problem is that low birth weight infants are
less likely to achieve thermoregulation on their own and require
specific interventions in regulating their body temperature. The
World Health Organization (WHO) supported a study in Nepal
in which an increased mortality was noted across all grades of
hypothermia, and the risk was twelve times higher among
preterm babies (Bera, et al., 2014). Interventions that may help
reduce infant mortality related to ineffective thermoregulation
include kangaroo care or infant warmers. According to
Nimbalkar, et al. (2014), early skin to skin contact (SSC) can
reduce the incidence of hypothermia in newborns within the
first 48 hours of life and can contribute in the reduction of
neonatal mortality due to hypothermia. The major
pathophysiology of hypothermia in the newborn is the
disturbance of its regulated temperature inside the womb to the
sudden exposure to the colder environment outside the mother’s
womb. At birth, newborns have limited control over regulating
their own body temperature and require assistance through other
means to help keep their body temperature up. The first 24 to 48
hours of life, especially in low birth weight infants, is the most
crucial in preventing hypothermia, thus reducing the possibility
of death.
The purpose of this paper is to interpret the quantitative and
qualitative articles identified to see whether they are or are not
important to our group topic. The paper will compare and
contrast the main components of the matrix table.
Description of Findings
Concepts
The independent variable studied between both quantitative and

3. qualitative articles is kangaroo care.The quantitative describes
how kangaroo care can impact a low birth weight infant and the
4 physiological parameters: heart rate, oxygen saturation,
respiration, and temperature, which is the dependent variable.
The variable of interest studied in the qualitative article is the
mother’s reactions and/or experiences of kangaroo holing their
preterm infant in the NICU. The concept of this study was for
the mothers to express any behaviors or interactions while
kangaroo holding.
Methods
The methods used between the quantitative and qualitative
articles are studied differently from one another.The study
design used in the quantitative article is a quasi-experimental
with before and after subjects serving as their own control.
Before the mothers participated they were counseled on the
benefits of kangaroo mother care and then volunteer mothers
demonstrated kangaroo mother care (Bera et al., 2014). Once
mothers signed the consent to participate, they were asked to
wear an open front dress with their babies in nothing but a cap.
socks, and nappy. The mothers then placed their infant in a
“frog like” position on their bare chest, with the baby in a
flexed position. Using this method, data were obtained on days
1 with one hour of kangaroo mother care, day 2 with two hours
of kangaroo care, and day 3 with three hours of kangaroo
mother care. This procedure continued for as long as the mother
felt comfortable during kangaroo mother care. Mothers who felt
uncomfortable were allowed another demonstration and ones
that failed after multiple demonstrations were withdrawn
(Johnson, 2007).
The study design collected for the qualitative article was
phenomenology. This method was used to describe the lived
experiences of mothers and how kangaroo holding impacted
their understanding of the advantage and importance it serves to
preterm infants. The mothers were interviewed after their third
sixty minute session of kangaroo holding in the NICU (Johnson,
2007). From then, data was collected from the mother’s

4. behavior and interactions that were observed unobtrusively and
then analyzed and recorded for the content analysis.
Participants
The participants studied in the quantitative article included low
birth weight babies that were born at the Institute of
Postgraduate Medical Education and Research, Kolkata and its
associated SSKM Hospital, and mothers of these babies (Bera et
al., 2014). The sample included 265 mother-baby pairs that were
selected through purposive sampling over 3 years to collect the
accurate amount of data needed to conduct the research. In
comparison, the qualitative article interviewed eighteen mothers
who kangaroo held their premature infants in the NICU over 5
months (Johnson, 2007). The difference between the
quantitative study and the qualitative study is the quantitative
studies both the mother and the baby and the effect kangaroo
care has on the physiological parameters, whereas the
qualitative article only focuses on the mother’s interactions and
thoughts on kangaroo holding their preterm infants.
Instruments
The instruments used in the quantitative study are the 4
physiological parameters; heart rate, oxygen saturation,
respiration, and temperature. The physiological parameters were
assessed immediately before and after kangaroo mother care
was implemented in 3 consecutive days. When assessing the
babies, axillary temperature was used by a digital thermometer
in degrees Celsius, respirations were observed by chest rise and
fall for one minute, where heart rate and oxygen saturation were
measured through the pulse-oximeter (Bera et al., 2014). In
comparison, the instrument used in the qualitative study was
open-ended, transcribed audiotaped, face to face interviews.
The interviews conducted were transcribed word for word by
the investigator, but to ensure accuracy of each interview the
audiotapes were played a second time while transcriptions were
being read aloud. Once accuracy was assured, “transcriptions
were then coded by descriptive phrases that conveyed the
meaning of each section for the content analysis” (Johnson,

5. 2007, pg. 570). Once this was implemented, the common
meanings of each interview were grouped into the main themes
from the interview content.
Evidence
In the article written by Bera et al., the researcher was able to
assess the low birth weight babies physiological parameters;
heart rate, oxygen saturation, respiration, and temperature.
Table 1 in the quantitative article states the 4 physiological
parameters that were measured and the mean values of before
and after kangaroo mother care was implemented on 3
consecutive days. To give a better understanding, the mean
temperature on day 1 before kangaroo mother care was 36.5+
0.12 and after kangaroo mother care the mean value was 36.9+
0.15. This shows there was a statistical increase in temperature
after the implementing kangaroo mother care. On day 1, the
inferential statistic using temperature on pre and post kangaroo
mother care had a mean value of 0.34+ 0.17, a confidence
interval of 0.320-0.36, and a P value of <0.001, making the
results statistically significant.
In the article written by Johnson, the themes that were
conducted by the analysis of data were maternal-infant benefits
of kangaroo holding, need for support for holding, and the
satisfaction with interactions. From the main themes, sub-
themes were provides to expand on further evidence of the
importance of kangaroo holding by the mothers. Although the
sample size is small and only studies the mothers at a particular
hospital on a particular floor, the experiences the mother had
are still useful for this article. The evidence this article
provides will benefit our group’s topic with supporting details
of the mother’s experience, not just how the baby responded to
this intervention, like the quantitative article explains.
The next step for our group would be to see what articles are
most relevant to our overall group topic and answering our
clinical question. We can depict the information that we need to
help support our topic while identifying pertinent information
and data that should be used. Another step for our group is to

6. see if the articles we have provide enough evidence to answer
the clinical questions from all the research articles each one of
us found. The two articles I found are relevant to support and
provide a better understanding to our group topic, and can add
much detail on the effects of kangaroo care on preterm or low
birth weight babies.
Conclusion
The purpose statement from the quantitative article supports the
results of this study by assessing the 4 physiological parameters
on low birth weight babies. The data collected from the research
states that the physiological parameters showed improvements
on the three consecutive days kangaroo mother care was
implemented. The study found that there was a rise in
temperature, a small but significant rise in heart rate and a huge
impact on oxygen saturation. Since the study had its limitations
because it was observational, not randomized and some mothers
could not correctly demonstrate kangaroo mother care, it is
stated that they cannot claim that the improvements would work
in any setting. Aside from the limitations, it is concluded that
low birth weight babies who received kangaroo mother care
show a significant increase in all physiological parameters in
this particular setting.
The purpose statement from the qualitative article supports the
results from the interviews that were conducted because it
increased the mothers understanding of the experiences and
advantages of kangaroo holding. The main limitations to the
study conducted are that the sample size was small, and only
relative to the hospital, unit, and location for this specific
research, and that mothers were only interviewed once, with the
thought that their opinions might change over time. With these
limitations, the results did add importance to the way new
mothers interacted and felt towards using kangaroo holding for
their preterm infants. The participants also stated that because
of the experiences they had with kangaroo holding, they

7. continued the intervention long after the study was conducted.
This is essential in the fact that nurses in the NICU continue to
encourage and educate their new mothers of the benefits
kangaroo holding has on their infants.
References
Bera, A., Ghosh, J., Singh, A. K., Hazra, A., Som, T., &
Munian, D. (2014). Effect of kangaroo mother care on vital
physiological parameters of the low birth weight newborn.
Indian Journal of Community Medicine, 39(4), 245-249.
doi:10.4103/0970-0218.143030
Johnson, A. (2007). The maternal experience of kangaroo
holding. JOGNN: Journal of Obstetric, Gynecologic & Neonatal
Nursing, 36(6), 568-573. doi:10.1111/j.1552-6909.2007.00187.x
Nimbalkar, S., Patel, V., Patel, D., Nimbalkar, A., Sethi, A., &
Phatak, A. (2014). Effect of early skin-to-skin contact following
normal delivery on incidence of hypothermia in neonates more
than 1800 g: Randomized control trial. Journal of Perinatology,
34, 364-368. doi:10.1038/jp.2014.15
Points
Possible
Points Earned
Comments
Problem
20
20
· Group topic identified
· Significance of the problem justified
· Purpose of the paper explicitly given
Description of Findings: Summary

8. 20
20
· Matrix table content was complete
· Matrix table content was accurate
Description of Findings: Description
60
60
· Variables/informants were accurately identified
· Research designs were appropriately designated
· Sampling design and sample were described
· Data collection methods were defined
· Answer to clinical question given
· Steps needed to complete group work articulated
Description of Findings: Conclusion
20
20
· Major findings described with sufficient detail
Format
30
30
· Paper written with professional style using correct grammar
and spelling
· Headings used for each section: Problem, Synthesis of the
Literature, Conclusion
· Rare errors in APA style
· Length of paper appropriate to content
Total
150
Total Points earned = 150