3. There is no indicator in human biology which
tells us so much about the past events and the
future trajectory of life.. as the weight of an
infant at birth
4.
5. Causes of NMR(Neonatal Mortality Rate) in India
5
Three causes accounted for 78%
(0.79 M/1.01 M) of all neonatal
deaths in India: prematurity &
low birthweight (0.33 M; 99%CI
0.31-0.35 M), neonatal
infections (0.27 M; 99%CI 0.25-
0.29 M) and birth asphyxia &
birth trauma (0.19 M; 99%CI
0.18-0.21 M).Nov 12, 20
Causes of neonatal and child
mortality in India: nationally
representative mortality survey
For the Million Death Study
Collaborators*
Lancet 2020Nov27,376,1853-1860
Why??
6. Background
2011In an updated Cochrane review Conde Aguldelo,
Diaz Rosello Belizan, assessed 35 studies
There is now sufficient evidence to recommend KMC
as a standard of care for all LBW babies
It can prevent up to half of infant deaths due to LBW
It ensures early discharge
40% less risk of mortality
66% less risk of hypothermia
61% less risk of nosocomial infections
Decreased re-admission rate
15 million preterm babies are born every year in the
world, 95% in developing countries
8 million, 27% are in India
80% neonatal deaths occur in LBW babies
More deaths occur outside the health facilities
Survivors face a life of compromised growth,
disabilities including learning, visual and hearing
handicap
UNICEF,Lawn et al, 2020
7. CREATION OF KMC 1978
Dr. Edgar REY
SANABRIA,
Pediatrician,
Mother and Child
Institute, Columbia
8. KMC-Definition
Kangaroo Mother Care (KMC) is care of newborn infants
secured skin to skin to the mother
KMC is a powerful and easy to use method to promote
health and well being of-
Low birth weight babies with birth weight less than 2500G
Preterm babies born before 37 weeks
9. THREE COMPONENTS OF KMC
• Kangaroo position
• Kangaroo nutrition-Exclusive
breastfeeding
• Kangaroo discharge & follow up
10. Kangaroo position supports physiological
stability and motor development
• Being supine was the worst position for the infant
• Physiological stability especially cardiorespiratory begins
within minutes of KC. Cochrane.
• Improves oxygenation
• Reduces episodes of poor oxygenation
• Improves lung volume
• Head up position improves apnoea and bradycardia
• Helps infants acquire motor milestones earlier and helps prevent
asymmetrical postures
11. EFFECTS OF OXYTOCIN
Myelinated Vagus (Nucleus ambiguous)
Muscle tone
Head & Face
Muscle Tone
Pharynx, soft palate & larynx
Muscle Tone
GIT
Release of GI
enzymes
Eye contact, facial
expression, voice
differentiation
Sucking, swallowing,
breathing
Tone lower
esophageal
sphincter, motility
Improved
digestion
Cues, engagement
with parents
Feeding
Decreased symptoms of reflux,
constipation;
Improved enteral feed tolerance
12. Thermoregulation
• Skin to skin contact is as efficient as incubator to maintain adequate
temperature in preterm /LBW babies. Hence KP can safely be
implemented till baby is able to maintain its own temperature.
• KMC reduces the risk of hypothermia(RR 0.3,95%CI)
• Level of evidence- RCT Strength of evidence –moderate
• Recommendation- Strong recommendation in favor of intervention
13. KMC REDUCES PAIN
Conclusion - KMC is a most
physiological, non-pharmacological
intervention that involves parents to
manage procedural pain that can
be implemented for physiological
and behavioural instability in their
children
All painful procedures viz IV lines, removal of adhesive tape, giving IM injections, ROP
check should be done while baby is receiving KMC
14. APNOEA OF
PREMATURITY
There is direct evidence that KP
prevents incidence or severity of
Apnoea of Prematurity
Preterm infants frequently present with
apnoea which put their lives and
integrity at risk.
Studies show that physiologically
stable infants have less episodes of
apnoea than those in incubators
Level of evidence –RCT, Strength of evidence- moderate
Recommendation- strong recommendation in favour of
KMC
15. Physiological Outcome
KMC in a stable infant maintains and improves vital parameters.
Several authors have studied impact of KMC on physiological stability of preterm infants-
analysing heart rate, vagal tone, respiratory rate,oxygen saturation, desaturation
episodes,cerebral oxygenation, oxygen consumption,metabolic indicators. Their studies
conclude that regardless of heterogenous contions of Preterms/LBWs ,KMC maintains and
improves physiological stability of LBWs
Level of evidence- Randomised Controlled trials, Strength of evidence- moderate
Recommendation- Strong Recommendation in favour of intervention
GRADE table EBG-2017
www.fundacioncanguro.co
16. KMC promotes sleep
KMC induces
- longer duration of quiet sleep
- shorter duration of active sleep
- Decreased arousal from sleep
- Completion of sleep cycle better than being in an
incubator
17. KMC: Effect on Sleep Organization
Increases quantity of Quiet Sleep
Non-chaotic sleep pattern
Normal sleep cycling
Less sleep arousals
HR and RR variation according to sleep
cycles
Preterm sleep cycles generally require 60
minutes to complete and within 5 minutes of
the onset of KMC, cycling begins
18. When to begin KMC?
Ideally KMC begins in LR or OT as soon as baby is born
19. Duration of KMC
• Each session: should be of 90 minutes so effective sleep
cycle of 60 minutes received for better neurodevelopment
out come
Terminology-
Less than 4 hours- short duration
4-6 hours- Extended duration
6-12 hours- long duration
More than 12 hours- continuous
20. Father & other family members can
also provide skin-to-skin care
Father Grandmother
Teaching Aids: ENC KMC- 20
Who can provide KMC?
Any family member. Hence renamed - Kangaroo Family Care(KFC)
Any family member
21. Benefits to the Mother Benefits in infancy and
childhood
Benefits to the Hospital
• Increased confidence and
satisfaction
• Better bonding
• Empowerment
• Better milk production
• Early discharge
• Lower Stress
• Lower post partum
depression
• Growth
• Neurodevelopment
• Increased IQ
• Better Executive Function
• Physiologic organization
• Lower Stress
• Better Parent Infant Interaction
• Lower Admission Rate
• Early Discharge
• Significant cost saving as
well as better outcome
• Less dependence on
incubators
• Less nursing staff
necessary
• Improved Morale and
quality care
• Better survival
• Decreased Readmission
Rate
• Decreased Biomedical
waste
DECREASED SEPSIS DECREASED ANTIBIOTICS
22. WHEN TO STOP
KANGAROO MOTHER CARE?
• Continue KMC as long as the mother and
baby are comfortable (in the hospital & at
home).
• Wean the baby gradually from KMC –
– When s/he starts wriggling to show that
s/he is uncomfortable
– Pulls her/his limbs out
– Cries and fusses every time the mother
tries to put her skin-to-skin contact
23.
24.
25.
26.
27.
28.
29.
30. KMC during COVID-19 pandemic
WHO/UNICEF: COVID-19 Guidance:Maternal & Child health
Early skin to skin contact- between mother & baby should be promoted, soon after birth
excepting those neonates who require resuscitation or any other immediate lifesaving
interventions
Mothers & infants should be enabled to remain together/zero separation
Practise rooming-in throughout the day and night, especially immediately after birth during
establishment of breastfeeding, whether they or their infants have suspected, probable or
confirmed COVID-19 virus infection.
Mother should observe suitable precautions like
Respiratory hygiene
Hand hygiene including proper hand washing before & after feeding & touching any
surfaces
Cleaning surfaces & other measures of infection prevention & control of COVID 19
infection.
33. Kangaroo Mother Care
33
Humane, low cost method of
care for LBWI
Significant reduction in
neonatal morbidity & mortality
with KMC
Most of the needs & problems
of LBWI are answered directly
or indirectly by Kangaroo Care
KMC is life-saving, cost-saving
& brain-saving
Courtesy-Nair Hospital,
Mumbai Dr S Malik
34. Advantages of KMC in COVID pandemic
Maintaining this most coveted bonding is especially important & challenging for PT /LBW
babies. Now, the COVID-19 pandemic has made this bonding even more challenging
The admission to the NICU frequently is stressful for a family. This is especially
significant as we battle Covid-19.
Kangaroo Care can help to decrease this high stress & foster bonding & healing &
an overall sense of wellbeing for our families.
In low birthweight newborns (< 2000 g) & in preterms who are clinically stable, KMC
reduces mortality
39. A healthy world begins with a healthy woman
HOME VISITS TO COUNSEL MOTHERS FOR CARE OF lBWs
40. Results
Data Period: April 2020 till Oct 2021
• Low Birth weight Babies identified- 94
• Total Deliveries- 936
• Prevalence- 10.04%
41. BNMC direct intervention- LBW Babies Analyzed data- April’21 to Oct’21
Data Points Data Percentage
Total newborns with LBW identified 94
Total Newborn in whom first examination form filled 78
83%
Total Newborn in whom follow-up form is filled 91
97%
Below indicators- Denominator is number of children in whom follow up form was filled
KMC -less than 6 hours 44 48%
KMC -6-12 hours 37 41%
KMC-more than 12 hours 5 5%
KMC data not available 5 5%
New-born gained weight 58 64%
New-born lost weight 1 1%
Newborn whose weight remained constant 0
0%
Newborn in whom current weight is not available 32
35%
43. 1998-Bagota Declaration
Kangaroo Mother Care is a basic right of the new-born and
should be an integral part of the management of low birth
weight and full term infants in all settings at all levels of
care in all communities
44. WHO- iKMC trial
Methods
We conducted a randomized, controlled trial in five
hospitals in Ghana, India, Malawi, Nigeria, and
Tanzania involving infants with a birth weight
between 1.0 and 1.799 kg who were assigned to
receive immediate kangaroo mother care
(intervention) or conventional care in an incubator
or a radiant warmer until their condition stabilized
and kangaroo mother care thereafter (control). The
primary outcomes were death in the neonatal
period (the first 28 days of life) and in the first 72
hours of life.
.
Conclusions
Among infants with a birth weight between 1.0
and 1.799 kg, those who received immediate
kangaroo mother care had lower mortality at 28
days than those who received conventional care
with kangaroo mother care initiated after
stabilization; the between-group difference
favoring immediate kangaroo mother care at 72
hours was not significant
46. Kangaroo Mother Foundation of India April 2022
Joint declaration of KMFI with NNF, IAP,BPNI to promote
and support KMC and policy of zero separation of LBW
and mother
48. Carry home messages
• Covid 19 Pandemic is here to stay but if this window of opportunity of
KMC/Exlusive BF is lost, benefits of both will be lost.
• KMC when started after stabilization reduces neonatal mortality by
55%
• KMC when started soon after birth reduces sepsis by another 18%
• KMC when started soon after birth i-KMC, reduces neonatal mortality
due to sepsis by another 36%
• Zero separation of mother and newborn is effective way of reducing
both neonatal morbidity and mortality
