kangaroo mother care

KANGAROO   MOTHER CARE

WHAT IS KMC?  

•      Caring skin-to-skin low birth weight (LBW) babies

•      It promotes

§    Effective thermal control
§    Breast feeding
§    Prevention of  infection
                                            §    Parental bonding

COMPONENTS OF KMC

1. Skin-to-skin contact:Early, continuous and      prolonged skin-to-   skin contact
2. Exclusive breast feeding:Promotes lactation and facilitates feeding

   3.Support the mother and infant dyad:Promotes bonding between the mother and the infant

PRE-REQUISITES OF KMC

1. Support to the mother

▪        In hospital &

▪        At home

2. Post-discharge follow-up

BENEFITS OF KMC TO THE BABY

¡  Breast feeding

      ▪      Increased breast  feeding rates
       ▪      Increased duration of    breast feeding

¡  Thermal control

      ▪      Effective thermal control
      ▪      Equivalent to conventional incubator care in stable babies

¡  Early discharge

      ▪      Better weight gain leads to early discharge

¡  Lesser  morbidity

       ▪      Regular breathing
      ▪      Less apnea
      ▪      Protection from nosocomial infections

• Leads to stable oxygen rate, breathing.

•      Stabilizes  faster on skin-to-skin care than in the incubators.

• Promotes physical growth and extra uterine adaptation.

•      Reduced risk of infection

•      Improved immunity

•      Increased weight gain

•      Chances of hypoglycemia is less as they are taking regular and adequate amount of milk

•      Reduced crying

•      Decreases developmental delay during first year of year

•      Reduces infant mortality and morbidity

•      Promotion of early tactile, audiovisual and emotional contact for both mother and baby and baby is given opportunity to further familiarity with his mother’s voice, smell and heart beat.

BENEFITS OF KMC TO THE MOTHER 

•      Stronger bonding with the baby

•      Deep satisfaction

•      More confident parents

•      Successful lactation because of increased hormonal and sensory stimulation of the mother’s milk production.

•      Greater maternal self esteem

•      Helps  to increase the duration of breast feeding.

•      Mothers are more quickly adapted to the appearance of their babies

•      Mother can involve in the care of her small newborn

•      Mothers are more likely to become their baby’s advocate.

•      Strengthen mother’s confidence in gaining control over her emotions, her competency in mothering skills and her perception of herself as a good mother.

• Hospitalization is reduced

ELIGIBILITY CRITERIA: BABY

•      Birth weight >1800 gm:

        Start at birth

•      Birth weight 1200-1799 gm:

        Hemodynamically stable – takes a few days          

•      Birth weight <1200 gm:

        Need specialized care due to sickness – may take weeks to initiate

        Hemodynamic stability is a MUST 

ELIGIBILITY CRITERIA: MOTHER

•      Willingness

•      Lack of significant illness

•      Hygiene

•      Supportive family

•      Supportive community

• General health and nutrition

REQUIREMENTS FOR KMC IMPLEMENTATION

•      Skills

        Nurses, physicians and other staff

•      Educational material

        Information sheets, posters and video films on KMC

•      Furniture (optional)

▪      Semi-reclining easy chairs

▪      Beds with adjustable back rest

PREPARING FOR KMC

•      Counseling

§     Demonstrate procedure

§     Ensure family support

§     KMC support group

•      Mother’s clothing

§     Front-open, light dress as per the local culture

•      Baby’s clothing

§     Cap, socks, nappy and front-open sleeveless shirt      or ‘jhabala’

WHAT SHOULD THE BABY WEAR?

Cap, Socks, Nappy and Front-open sleeveless shirt or 'jhabala'

WHAT SHOULD THE MOTHER WEAR?

Any front open, light dress as per local culture. Blouse and sari, shawl  and gown

KMC PROCEDURE:
KANGAROO POSITIONING

• Place baby between the mother’s breasts in an upright position
• Head turned to one side and slightly extended
• Hips flexed and abducted in a “frog” position; arms flexed
• Baby’s abdomen at mother’s epigastrium
• Support baby’s bottom 

Maintain privacy for the mother

Monitoring during KMC

Check if

• Neck position is neutral
• Airway is clear
• Breathing is regular
• Color is pink
• Temperature is being maintained

INITIATION OF KMC

•      Baby should be stable

•      Short KMC sessions alright even if the baby is receiving

§            IV fluids

§           Oxygen therapy

§           Orogastric tube feeding

DURATION OF KMC

•      Start KMC sessions in the nursery

•      Practice at least one hour sessions initially

•      Transit from conventional care to longer KMC

•      Transfer baby to post-natal ward and continue KMC

•      Increase duration up to 24 hours a day

KMC DURING SLEEP AND RESTING

Resting

•      Reclining or semi-recumbent position

•      Adjustable bed

•      Several pillows on an ordinary bed

•      Easy reclining chair

Sleep

•      Supporting garment resting for baby

               Any family member can do it.

      Father, Grandmother etc 

Father & other family members can also provide skin-to-skin care

DISCHARGE CRITERIA  

•      Baby is well with no evidence of infection

•      Feeding well (predominant breast milk)

•      Gaining weight (15-20 gm/kg/day)

•      Maintaining body temperature

•      Mother confident of taking care of the baby

•      Follow-up visits ensured

DISCONTINUATION OF KMC

•      Term gestation

•      Weight ~ 2500 gm

•      Baby uncomfortable

§         Wriggling out

§         Pulls limbs out

§         Cries and fusses

Mother can continue KMC after giving the baby a bath and during cold nights

POST-DISCHARGE FOLLOW UP

•      Once or twice a week till 37-40 wks / 2.5-3 kg

•      Thereafter, once in 2-4 wks till 3 months chronological age

•      Subsequently, every 1-2 months during first year

•      More frequent visits if baby is not growing well (< 15-20 gm/kg/day up to 40 weeks post-conceptional age and then < 10 gm/kg/day)

KEY MESSAGES

•      KMC is a safe and effective method for caring stable LBW babies

•      In addition to providing thermal control, it

–     Promotes exclusive breastfeeding

–     Decreases  risk of infections

–     Promotes bonding between mother and baby