review literature

REVIEW LITERATURE

Review of literature is a vital aspect of scientific research. It involves systematic identification, location, scrutiny and summary of written material that contains information on research problem. Reviewing literature is important in broadening the understanding and gaining an insight necessary for development of a broad conceptual context into which a problem fits. In order for a researcher to build on existing work, it is essential to understand what is already known about topic.

                    The purpose of reviewing literature was to develop a deeper understanding of the problem areas, development of the conceptual framework, research design, development of tools and plan computer assisted teaching programme  in case of kangaroo mother care.

STUDIES RELATED TO BREAST FEEDING IN KMC

          (2007). Better births feature continuous care for moms, “Kangaroo” care for kids. Medical News,2007. Available from http:/www.newswise.com/articles/view/531475/?sc=mwhr. Released July 12, 2007..Author may be “news wise” or “health behavior news service”. 30 studies with 1925 mother-infant pairs were reviewed in this up dated meta-analysis of KC immediately after birth and within 30 minutes of birth. Pairs who had early skin-to-skin contact were more likely to breastfeed and to breastfeed for longer than those who did not. The review also showed that babies who had KC immediately after birth “interacted more with their mothers, stayed warmer, and cried less.” See following citation which is very similar. Review of new Cochrane (Moore et al., 2007) results, Birth KC, VEKC, Breastfeeding, crying, interaction, full

NAME: Charpak, N., Ruiz-Pelaez,J.G., Figueroa Z, & Kangaroo Research Team. YEAR:(2005). STUDY: Influence of feeding patterns and other factors on early somatic growth of healthy, preterm infants in home-based kangaroo mother care: a cohort study. Prospective descriptive study of 129 healthy preterm infants sent home on ambulatory KC and exclusive BF. In hospital, formula given to infants who did not gain 15 g/day for 3 consecutive days. At term age (at home by then?) 60/126 infants gained wgt adequately with exclusive BF, In 14 who need supplements, adequate wgt gain achieved before term age and supplements were stopped. More immature infants need supplementation more frequently, infants with lower weight for GA at birth were less likely to achieve adequate weight by term age. Growth indices at term age in KMC group were between 10-25th percentile, similar to non KMC preterms. PT, weight, home KC, exclusive BF. Journal Pediatric Gastroenterology and Nutrition, 41(4) Oct., 430-437.

NAME: Anderson, GC, Chiu, SH, Morrison, B, Burkhammer M & Ludington-Hoe, SM. YEAR: 2004.  STUDY:  Skin-to-skin Care for Breastfeeding Difficulties Postbirth. 50 Mother/infant dyads who said they were having difficulty BF within 11 hours of birth were given three consecutive supervised BF in the KC position on postpartum day 1 and another on Day 2. Amount of KC varied but occurred between 11-24 hours postbirth. Several measures were recorded with each BF and at discharge, 7 days postbirth, and one month postbirth. 2 dyads withdrew before discharge, so 48 finished KC sessions: 39 (81.3%) were exclusively BF & 9/48(18.7%) were partially BF. At 1 week postdischarge, 35/48 (72.9%) were exclusively BF; 5 (10.4%) were partially, 6 (12.5%) were not BF, and 2 (4.2%) were lost to FU. At one month postdischarge, 25 dyads (52.1%) were exclusively BF, 9 (18.8%) were BF partially,, 13 (27.1%) were not BF, and 1 (2.1%) lost to FU. These data compare favorably with the 71.9% of Ross Mother’s Survey and the 75% designated as Objectives 16-19 of Healthy People 2010. Descriptive, Fullterm, BF at discharge, 1 week, 1 month, exclusive BF,KCBF, Early KC In Field, T. (Ed.). Touch and Massage in Early Child Development, Skillman, N.J.:Johnson & Johnson Pediatric Institute. 115-136.

STUDIES RELATED TO WEIGHT GAIN WITH KMC

NAME: Rao, SPN, Udani R, & Nanavati R. YEAR: 2008.STUDY:  Kangaroo mother care for low birth weight infants: a randomized controlled trial. 206 neonates with birth weight <2000 grams in western India received either KMC (n=103) or conventional incubator care (n=103)KC given as much as possible but at least one hour at a time. Mean duration of KMC was 13.5 hr/day. Average daily weight gain and anthropometric measures (head circumference, chest circumference, mid-arm circumference, foot length) at 40 weeks postmenstrual age and at 2500 grams in term SGA infants. All babies were exclusively breastfed + calcium + phosphorus + multivitamins. Babies who had problem or bilirubinemia were temporarily withdrawn from KC. KMC babies had better average daily weight gain (kmc=23.99 g, controls= 15.58 gm, p<0.0001). Weekly increments in head circumference (KMC =0.75 cm, controls =0.49 cm, p<0.02) and length (KMC =0.99 cm vs control = 0.7 cm, p,0.008) were higher in KMC infants. Significantly more control infants suffered from hypothermia, hypoglycemia, and sepsis but no difference in length of stay. KMC significantly reduced the incidence of apnea in VLBW infants. More KMC were exclusively breastfeeding at end of study (KMC = 98% vs 76% in controls). KMC was acceptable to most mothers and families at home without any adverse events (pg. 21).. One of KMC and 5 control infants died during study. Had mothers complete diary of home KC. KMC improves growth and reduces morbidities in LBW infants. KMC can be continued at home. Preterm, RCT, 3rd world, wgt, head circumference, hypothermia, hypoglycemia, infection, apnea, length of stay, exclusive breastfeeding, home KC, diary, maternal feeling, 1hr sessions of KMC.

NAME: Gupta M, Jora R, & Bhatia R. YEAR: 2007. STUDY: Kangaroo Mother Care (KMC) in LBW infants—a western Rajasthan experience. Indian Journal of Pediatrics, 74(8), 747-749. Descriptive study of 50 LBW (Birth weight >2 kilograms, M=1.487+/-0.175 kg; M ga= 28.2. range 28-32 weeks) were given KMC (under father’s shirt with head cap) 4-6 hours/day in 3-4 sessions once thermally stable, no o2 support, and tolerating enteral feeds (mean age when KC started = 4+/-1.78 days, and until discharge at >1.8kg, >34 weeks pma, and mother ready to go home. 8 weeks postdischarge they followed up infants to see if KC was being done at home & if baby was gaining weight..No mother refused to participate. Weighing done once per day on electronic scale Mean birthweight was 1.487 gm and age when KC started was 4.0 (+/- 1.738 days). Mean weight gain during KMC was 29+/-3.52 grams, mean discharge age = 23.6 +/-3.52 days, mean duration of hospital stay was 15.5+/-11.3 days. AT 8 weeks postdischarge, 20/50 moms had continued KC in their homes, average weight gain was 1.135+/-0.121 kg, the number of infants exclusively breastfeeding was 16/50. Moms reported that KC helped increase milk production (pg. 48). No discomfort in moms about doing KC. At home, fathers, grandmothers, and sister-in-law did KC with good weight gain and thermal results. Also, no evidence of infection once on KC. Main problems prior to KC were respiratory distress and icterus (pg. 48) Greater weight gain, shorter stay with KC. KMC is effective & safe in stable preterms . Because of its simplicity, KMC may have place in home care. Preterm, implementation descriptive study, weight gain, length of stay, 3rd world, infection, community-based, breastfeeding, milk production, paternal KC, surrogate KC, home KC.

NAME: Suman Rao P N, Rekha Udani And Ruchi Nanavati From the Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India. Correspondence to: Dr. Suman Rao PN, B 27, Kudremukh Colony, Koramangala II Block, Bangalore 34, India. E mail id: raosumanv@rediffmail.com. YEAR: Manuscript received: June 14, 2006; Initial review completed: August 18, 2006; Revision accepted: October 4, 2007. STUDY : Kangaroo Mother Care for Low Birth Weight Infants: A Randomized Controlled Trial Objective: To compare the effect of Kangaroo mother care (KMC) and conventional methods of care(CMC) on growth in LBW babies (<2000 g). Study Design: Randomized controlled trial. Setting: Level IIINICU of a teaching institution in western India. Subjects: 206 neonates with birth weight <2000 g. Intervention: The subjects were randomized into two groups: the intervention group (KM 103) received Kangaroo mother care. The control group (CMC: 103) received conventional care. Outcome Measures: Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed. Results: The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P<0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home. Conclusions: Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple, acceptable to mothers and can be continued at home

STUDIES RELATED TO THERMOREGULATION WITH KMC

     NAME: Bergstrom A, Okong P, Ransjo-Arvidson AB. YEAR: 2007. STUDY: Immediate maternal thermal response to skin-to-skin care13of newborn. Acta Paediatrica 96(5), 655-658. 39 Ugandan moms who had normal spontaneous vaginal delivery and non-asphyxiated newborns were studied. Maternal skin and axillary temps were taken immediately before KC, then every two minutes for 20 minutes and 10 minutes after neonate was removed. Infant axillary and forehead temps were measured immediately before KC, twice after initiating KC, and 10 minutes after newborn had been removed from KC. Maternal breast skim immediately displayed a rapid thermal response after KC was initiated (rose by 0.5 C p<0.0001 within first 2 minutes of KC and then dropped by 0.5C by 10 minutes after end of KC. Maternal axillary temp similarly rose by 0.5C). Descriptive, Fullterm, birth KC, maternal breast temperature, maternal axillary, infant axillary and forehead temps. 3rd world

NAME: Darmstadt GL, Kumar V, Yadav R, Singh V, Singh P, Mohanty S, Baqui AH, Bharti N, Gupta S, Misra RP, Awasthi S, Singh JV, Santosham M, Saksham Study Group. YEAR: 2006. STUDY: Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India.. Descriptive study portion of a cluster randomized controlled trial with 3 interventions: control group (government providers and Nutrition advisors), Essential care group (got nutrition advisor and taught KMC), and essential care (with kmc) + THERMOSPOT for temperature measurements. Gave KMC for variable lengths of time. Community-based workers taught expectant mothers newborn care, including KC and were interviewed and had focus groups to assess KC acceptance. Maternal (axillary when not in KMC), newborn (axillary) and ambient temperatures on day one of life (mean = 17 hours postbirth) in the home in where community based KMC was introduced in India..Globally 2/3 of women deliver at home. 733 LBW, 971 fullterm were studied. 77% of moms gave KMC usually or almost always, 855 of moms with LBW gave KMC. Hypothermia (<36.5) was high in LBW (49.2% 361/733) and normal birthweight (43% or 418/971). If ambient temp was <20 mean infant body tem was lower than when in ambient temps>20C. Among hypothermic newborns, 42% (331/78) of their moms had lower temperatures (R=-34-37) and were 6.7 to 0.1C different from oral temperature). Acceptance of KMC was nearly universal at one month postpartum, No adverse events during KMC, KMC prevented hypothermia and protected baby from evil spirits and made babies more content. Descriptive, 3rd world, Community KMC, fullterm, LBW birth KC, Early KC, temperatures, acceptance of KMC, home KC, hypothermia, content, evil spirits, duration, implementation . Journal of Perinatology, August 17, vol 26(10), 597-604

      NAME: Mukhopadhyay, K., Narang A, Kumar P, Pradeep GCM, Arora U, Mahajan R, & Dutta S. YEAR: 2004. STUDY: Premature infants need dads too! Presentation at “Workshops on KMC at Neocon 2004. XXIV NNF Annual Convention at Chandigarh, 28October, 2004” Available from file://E:\KangarooMother CareInitiative(KMCI) ..htm  . Descriptive study of paternal KC (during the daytime) with preterms weighing at least 2000 grams and being medically stable (no oxygen support). Duration of KMC was measured, as was infant and father temperature before and after KC. Social worker interviewed parent to learn their perception and response to KC. 81 infants eligible from Feb-July (mean GA = 30.5 wks, mean birthweight = 1364.2 gms, mean enrollment weight= 1363.4 grms. Father gave KC in 24 (29.6%) of infants, father + other family member (sister, mother-in-law, grandmother) in 28 (34.5%). Mean duration of KC by father = 2.8hr/day. Mean father temp during KC= 36.8 (SD=0.27)°C. Mean temp of baby during KC was 36.9 (SD=0.26)°C. No hypothermia, no hyperthermia during KC. Fathers were more supportive of mothers during hospital stay and after discharge in families where both mother and father gave KC, and these babies had increased duration of KC after discharge. Descriptive, preterm, 3rd world., paternal KC, grandmother KC, mother-in-law KC, sister KC, surrogate KC, duration of Pat. KC, home KC, maternal support . Not on charts yet

NAME:   Ramanathan K, Acolet D, Sleath K, & Whitelaw A. YEAR: 1989. STUDY:  Oxygenation, heart rate, and temperature in very low birth weight infants during skin-to-skin contact with their mothers. KC for 10 minutes in 14 very low birth weight infants 6-134 days old and between 1000-1200 grams (five infants had BPD; two on nasal cannula, and 9 had no lung disease). When asleep, infants placed prone in incubator or prone 60º incline on mom’s chest. 5 minutes of stabilization and then VS every 30 seconds for 10 minutes. Then positions were changed (KC went to incubator; incubator went to KC) for another 10 minutes. During KC HR rose significantly within normal limits, BPDers had significant rise in transcutaneous pO2, no infant had apnea, bradycardia during KC, and all maintained their temperature. Concluded KC was safe for BPD babies. No change in RR. States they do not do KC with infants having serious apnea/bradycardia. .Descriptive Cross Over Study, Preterm, VLBW (Micro preemie), BPD, Nasal cannula, HR, RR, SaO2, Axillary Temp, Bradycardia, apnea, Safety Acta Paediatrica Scandinavica, 78, 189-193.

STUDIES RELATED TO BONDING WITH KMC 

NAME: Gathwala G, Singh B, Balhara B. YEAR: 2008. STUDY: KMC facilitates mother baby attachment in low birth weight infants.. Randomized trial of 103 infants KMC=50 (gestational age of35 weeks in both groups) who got at least 6 hours/day starting at 1.72 days of age until discharge (wearing head cap and diaper only) and at home or infants who got incubator care or open cot care (n=50). All KMC was for at least one hour at a time. First month KMC duration was 10.21 hrs, in second month 10.03 hours, and in 3rd month 8.97 hours. Length of stay sig shorter for KMCers (3.56 vs.6.80 days) At 3 month follow up, mother were interviewed and attachment score (authors own 5 questions) was significantly higher in KMCers (24.46 vs. 18.22. In KMC group mother was more often primary caregiver, were more involved in care of baby, spent more time beyond usual caretaking with baby, went out without baby less often, and derived greater pleasure from baby than controls. Did not report how measured home KC, may have been by recall at interview. KMC facilitates mother baby attachment. PT, RCT, home kc, length of stay, attachment, maternal feelings, 1hour sessions of KMC. Indian J. Pediatrics, 75(1), 43-48

NAME: Vaidya K, Sharma A, & Dhungel S. YEAR:2005. STUDY: Effect of early mother-baby close contact over the duration of exclusive breastfeeding. 92 lactating mother-infant pairs were followed for six months to determine effect of perinatal factors on duration of exclusive breastfeeding. Early postpartum KC had powerful influence (p<.001) over duration of exclusive BF up to 4-6 month and was more significant than early initiation of BF (p<0.05). Mode of delivery had no effect on duration of exclusive BF. Recommends that a “few minutes of early postpartum KC and early initiation of BF to promote BF”. Fullterm, descriptive, exclusive BF, BF duration, birth KC? (Says early postpartum but until we get the article we don’t know if early postpartum = birth KC or later), third world, 6 month follow-up. . Nepal Medical College Journal. 7(2), 138-140

NAME: Bauer, K., Uhrig C, Versmold H. YEAR: 1999. STUDY: How do mothers experience skin contact with their very immature (gestational age 27-30 weeks), only days old premature infants?. English Abstract. 17 mothers recorded their experiences with ad lib KC over 14 days beginning 3 days post birth with 27-30 (median was 27.5wk;median wgt of 1130g). They increased KC from 60-120 minutes, 21% wanted longer KC periods, 82% had positive feelings and 78% said KC increased attachment to baby. Descriptive Qualitative Study, duration of  KC, mat feelings, attachment Z Geburtshilfe Neonate, 203(6): 250-254

STUDIES ON TRANSPORT WITH KMC

NAME: Sontheimer, D., Fischer, C.G., Buch, K.E.YEAR: 2004. STUDY: Kangaroo transport instead of incubator transport. 31 stable preterm and term infants were given “in transports” (n=13) and “back transports’ (n=18). 27 were maternal KC transports, 1 paternal transport, 2 by RNs and one by MD. No differences between surrogate and maternal/paternal KC outcomes. HR, RR, SaO2(taken every 5 minutes throughout transport)and rectal temp (B4 and After transport- after transport was 36.5-37.4) were stable in all KC transports. One baby had HR increase from 130-165 after 1 hr of transport due to warming (so blanket was removed). No crying or agitated behavior observed. Parents felts comfortable and safe and appreciated this type of transport. Transports were by ambulance and helicopter and weights were 1220-3720 grams and took 2-400 km and 10-300 minutes. KC reduces jarring but may not be appropriate for critically ill infants who neeed repeated handling and therapeutic interventions during transport. Baby is tied to mother using a sling and two blankets. KC transport is safe, effective, and inexpensive method of transport. Article includes many pictures. Descriptive, PT, FT, HR, RR, SaO2, Rectal Temp, crying, agitation, maternal feelings, Pat KC, surrogate KC. Pediatrics 113 (4), 920-923.

COMPARATIVE STUDIES

          NAME: De Macedo EC, Cruvinel F,. Lukasova K, & D’Antino ME. YEAR: 2007. STUDY: The mood variation in mothers of preterm infants in kangaroo mother care and conventional incubator care. 90 mothers were divided into 3 groups: 30 moms of term newborns, 30 moms of preterms with KC, and 30 moms of preterms in incubators. The visual analogue MOOD SCALE by Guimares, 1999 was used. Preterm moms were evaluated before and after either KC and incubator visit; fullterm moms were evaluated once. NO depressed moms or malformed babies. Ancova (with hospitalization time, birthweight, and birth age as covariates) determined differences in maternal mood between groups. Term moms differed from preterm moms (p<0.05) but no differences between preterm moms who visited incubator and preterm moms who did KC. Pretest-posttest paired t-tests showed significant improvement in 13/16 items of mood variation in KC moms (in calm vs excited; strong v. feeble, muzzy v. clear-headed, well coordinated v. clumsy, lethargic v. energetic, contented v discontented, troubled v tranquil, quick-witted v. mentally slow, tense v relaxed, attentive v dreamy, incompetent v. proficient, happy v sad, antagonistic v amicable) (but no difference in alert v drowsy, interested v bored, and withdrawn v. gregarious); incubator moms showed improvement in only one item (being well coordinated versus clumsy). Before visit mothers did not differ in mood state, so mood state was not determined by type of care. After visit, incubator mothers reported feeling more awkward than before. A benefit of KC to mothers is increased feelings of well being, intense connectedness with the infant, and high self-confidence in ability to care for infant. Differences in KC mom’s moods were attributed to prolonged contact with baby, pleasant feelings from skin to skin contact, help of professional during baby’s placement and removal, and knowledge of on-going benefits to the baby. These elements need to be provided to moms when they visit the infant in an incubator. PT, descriptive,3rd world, Maternal feelings. J. Tropical Pediatrics, 53(5), 344-346.

NAME : Fegran L, Helseth S, & Fagermoen MS.YEAR:  2008. STUDY: A comparison of mother’s and fathers’ experiences of the attachment process in a neonatal intensive care unit.. Descriptive qualitative study of 6 mothers and 6 fathers had interviews upon discharge from Norwegian NICU. Hermeneutic analysis revealed two main categories of experience: 1. “taken by surprise”- moms felt powerless and period was surreal and strange. Fathers experienced the birth as a shock, but were immediately ready to be involved. 2. Building a relationship. Moms needed to regain the temporarily lost relationship with their child and fathers experienced the beginning of a new relationship. Fathers were encouraged to have KC with the child from the very beginning (pg.813 and commented that the KC experience initiated an exchange of power which made both father and child relax (pg. 814) and one dad who could not sleep went to NICU to KC in the middle of the night and it made him feel more confident, have better self esteem and better coping abilities. Doing KC made fathers feel like important contributors to baby’s care. Paternal relationship changed from an impersonal one to one characterized by “belonging” and “protecting the child.”(p.814). Mothers wanted to do KC but were afraid to touch the preterm infant at first. Despite the need to be close, 3 mothers expressed ambivalent feelings and cried the whole time they KCed, or expressed a need to do KC but did not dare to do KC, confronting mothers with the realization that they could not take on the burden of taking care of their child. Being involved in KC also confronted the mother with the burden of not being able to take care of her child. Parents of preterm infants have different starting points and these should be noted as professionals encourage parents to have early KC. PT, descriptive, attachment process, paternal KC J Clinical Nursing, 17(6), 810-816

NAME: Erlandsson K, Dsilna A, Fagerberg I, & Christensson K. YEAR; 2007. STUDY: Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior. Randomized Controlled trial of paternal KC during first 2 hours after elective c/s (due to breech, small pelvis, previous c/s) 37-41 week gestation c/s birth with spinal analgesia in 30 moms (KC=15 immediate KC after c/s; 14 placed immediately in cot). One cot infant was transferred to NICU at 82 mins postbirth for tachycardia, one KC infant transferred at 60 mins postbirth for hypoxia  – resultant med diagnoses was “prolonged pulmonary adaptation” and were reunited with moms in postpartum 1 and 4 days later (pg. 107).Measured tape-recorded separation distress crying (when there is absence of maternal body contact [Christensson, Cabrera et al., 1995]), prefeeding behaviors (rooting, mouth movements, sucking (from NBAS), and behavioral state (from NBAS, recording predominant behaviors in first minute of every 15 minute observations but two sleep states were collapsed into one so they measured sleep, drowsy, away, and crying). Immediately after delivery, cord was cut, infant wrapped in two towels, shown to mom, taken to open incubator, wiped off, suctioned prn, then returned to mom in surgery room and put on her chest still wrapped in towels, stayed on moms chest for 5-10 mins, then went to nursery with father. Father sat on chair and gave KC with 2 blankets covering infant, father interacted with awake child, consoled crying child (pg. 108). Control infants in cot in nursery, wrapped in 2 blankets and father present in same room but not able to pick up child. First recording was at 30 minutes postbirth and continued until 120th min post-birth recording was complete, using mean values for every five minutes for crying and feed behaviors and every 15 minutes for state. There were 221 5-min periods for KCers and 162 5-min periods for controls. KCers cried less (p<0.001; KC Mean=13.4 second SD=3.60; control Mean=33.4 SD=6.61 seconds). Mean crying time for 35-40 mins postbirth =30.4 sec KC & 57.8 cot; for 55-60 mins postbirth =17.6 secs KC & 53.3 cot; for 85-90 mins postbirth = 10.8 secs KC & 22.5 cot). Crying of KCers decreased rapidly (in first 15 mins) and cot group took longer. KCers had lower level of wakefulness than cots (p<0.01), and dropped from crying to drowsy state by 60 mins postbirth (cot babies dropped to drowsy at 110 mins post birth). Rooting patterns not different between groups. KCers showed less rooting than cots (p<0.01), lowest level of rooting was at 75 mins postbirth, cot infants showed steady medium level of sucking 105 mins postbirth while KCers declined in sucking at 60 mins postbirth (p<0.001), which was when drowsiness began. Because sleep is important for infant’s recovery from being born, earlier drowsiness and sleep is a positive outcome. Within 15 minutes of onset of paternal KC, crying stopped. KC facilitated coordination of prefeeding behavior. All pat KC infants rooted, put fingers/hands on father’s skin, and sucked on fathers nipple (pg. 113). KC after c/s is often limited and it cites Baby Friendly sources (Rowe-Murray, H, & Fisher, J. 2003 on KC bib). Fullterm, RCT, cesarean, paternal KC, HR, crying, drowsy, behave state, sleep, Early KC. Put on Charts.

NAME: Conde-Agudelo A., Diaz-Rossello JL, Belizan JM. YEAR: 2003. STUDY: Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. This is the Feb. 11, 2003 update. They reviewed 5 new studies out through Dec. 2002 (Tessier et al., 1998 was one). ALL STUDIES HAVE TO BE 24/7 KMC, not intermittent KC).. No RCT met criteria for review (weaknesses were blinding procedures for those who collected outcomes, handling of drop outs, completeness of follow-up) so recommendations are not changed. Results of new studies (but not meta-analysis) for Mortality (no difference), Infection (decreased in KC), BF (More exclusive BF in KC), Readmissions (no differences), Weight gain (significantly more in KC), psychomotor development (no differences at 12 months), maternal competence (sig. better in KC), hypo & hyperthermia (sig. less in KC), cost (50% less for KC), and length of stay (KC= 4.5 days, control – 5.6 days)are reported on pages 8-10 and based on three studies of 1362 infants, all tested in developing countries. Available through www.nichd.nih.gov/cochrane/condeagudelo/ conde-agudelo.htm Meta-analysis – no new results, but reviews several individual studies WGT, Infection, Temp, LOS, Cost, 12 month Psychomotor Dev, Maternal competence.

NAME: Charpak, N., Ruiz-Pelaez, J.G., Figueroa de Calume, Z. & Charpak, Y. YEAR: 1997. STUDY: Kangaroo mother versus traditional care for newborn infants <2000 grams: A randomized, controlled trial. 382KMC and 364 traditional care newborns were followed in this RCT. 24 hour/day 7 days a week KMC given in upright position at different hospital than traditional infants and moms taught KMC and ambulatory KMC +early discharge. Early discharge criteria early discharge. Early discharge criteria are have overcome major adaptation to extrauterine life, have received treatment for infection or other problems, suck and swallow properly, achieve 20 g/day weight gain (p. 683). Traditional care stayed in hospital until usual discharge criteria met (wgt of 1700 grams or more, regulates temp, gains weight). Term age results reported here. No differences in: # and proportion of deaths; # & proportion of infections (14% in each) (infection was one that required antibiotic), weight, height, head circumference, # of infants total or partially (some formula) breastfeeding, no diff in readmission rate.. Differences were: KMC had earlier discharge (1.1 days sooner), lower # of severe infections (nosocomial infections requiring rehospitalization – KMC 3.8%, controls 7.8%), proportion of subjects getting only formula was lower in KMC. KMC is not associated with increased risk of dying, there’s no reduction in early physical growth in KMC, early discharge did not increase admissions, and 50% shorter stay can mean less crowding. KMC is safe. She differentiates intermittent skin-to-skin contact from KMC and says skin-to-skin contact is only one component of KMC. RCT. Mortality, Wgt, height, head circumference, infections, Fortified breastmilk, length of stay, skin-to-skin contact is not KMC, readmissions, 3rd world Pediatrics, 100 #4, Oct. 1997, 682- 688.

NAME: Bier J-A.B., Ferguson A.E., Morales, Y., Liebling, J.A., Archer, D., Oh, W., & Vohr, B. YEAR: 1996. STUDY:  Comparison of skin-to-skin contact with standard contact in low birth weight infants who are breast-fed. Gave KC once medically stable and no oxygen support to 50 PT <3.3lbs BW for 10 minutes only each day x 10 days and measured every minute HR, RR, SaO2, Axillary Temp, # Desats. First 10 minutes of 176 KC sessions and 137 standard contact sessions were scored. RR, HR, temperature were same between groups. SSC temps rose in first 5 minutes and then matched control group thereafter. A warming effect of KC was seen. SaO2 was higher during KC and fewer desats (<90%) during KC (11% of 1716 SaO2 recordings during KC) and 24% of 1334 recordings during standard care (swaddled by moms). No diff in mean daily maternal milk expression, more stable milk production in KC. 90% of KC moms vs 61% non-KC moms were breastfeeding thru out hospitalization and 50% vs 11% were still BF at l month after discharge. At 6 months, 20% of KC & 10% control still BF. All mothers of multiples who Kced breastfed at discharge, and only 50% of multiples in standard care were BF at discharge, but no mother of multiples was still BF at 3 and 6 months. Moms and babies calm in KC. RCT, KCBF, BF, milk production, milk expression, duration of BF, SaO2,oxygenation, HR, RR, Axillary Temp, #Desats, stability, twin KC Archives Pediatric and Adolescent Medicine, 150, 1265-1269.

NAME: Charpak, N., Ruiz-Pelaez, J.G., & Charpak, Y. YEAR: 1994. Rey-Martinez Kangaroo mother program: STUDY: An alternative way of caring for low birth weight infants? One year mortality in a two cohort study.. Infants < 2000 grm birthweight observed in two hospitals, one that gave KMC and the other did not. Enrolled when ready for minimal care. KMC infants (n=162) were 24/7 KMC until not tolerated any more (about 37 weeks postmenstrual age), and discharged early. Controls (n=170) were in incubators and had later discharge. Both followed up to one year. KMC infants had higher relative risk of death, grew less in first 3 months, and had higher proportion of developmental delay at 1 year, survival was similar between groups, but weight gain and neurodevelopment questions remain. .PT, descriptive of two groups, Mortality, 12 month follow-up, development, weight gain, length of stay, 3rd world. Not on charts yet. Comment in Pediatrics, Dec. 1994, 94(6 PT1), 931-932. Pediatrics, 94(6 Pt1), 804-810

REPORTS, GUIDELINES FOR KMC:-

UNICEF, 2007. Breast crawl.. This is a very big document that accompanies the video that everyone/anyone can see called BREAST CRAWL on the website http://www. Breastcrawl .org . The film only shows a fullterm infant being placed between the breasts (not on the mother’s belly, so no crawl from belly to breast is possible), and moving his head over to a nipple and latching on. The infant’s head remains wet, and there is no covering over the infant’s back, so this film is not an optimal film to use. However, the Breast Crawl document does address KC: FT, BF, crawl                                                                                                                                 

World Health Organization, Dept. of Reproductive Health and Research. 2003. Kangaroo Mother Care. A Practical Guide. Geneva: World Health Organization, Dept of Reproductive Health and Research. This is a practical book for KC’s use with low birthweight and premature infants and is an outcome of the 1996 Trieste WHO Consensus Conference on Kangaroo Care. Contents cover the nature of KC, evidence supporting KC’s use with this population, requirements for safe KC (Setting, policy, staffing, mother’s willingness, equipment and supplied, and how to feed babies in KC), and practice guide (when to start, how to start, the KC position, length and duration of KC, KC at home). ISBN: 92 4 159035 1 Available from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; Fax: +41 22 791 4857). 

Preterm, Positions, Policy, and Breastfeeding, BF in KMC position

Academy of Breastfeeding Medicine (2002). Peripartum breastfeeding management for the healthy mother and infant at term. Academy of Breastfeeding Medicine Protocols, protocol #5, 1-2. All protocols are on their website. “The healthy newborn can be given directly to the mother for skin-to-skin contact until the first feeding is accomplished. The infant may be dried and assigned APGAR scores and the initial physical assessment performed as the infant is placed with the mother. Such contact provides the infant optimal physiologic stability, warmth, and opportunities for the first feeding. Delaying procedures such as weighing, measuring, and administering vitamin K and eye prophylaxis (up to an hour) enhances early parent-infant interaction”. Available from website: www.bfmed.org/ace-files/protocol/ then type in peripartum.pdf (2002) or cosleeping.pdf (2003) or mhpolicy_ABM.pdf (2004a) or near_term.pdf (2004b) or NICU GradProtocol.pdf (2004c)for the ones relevant to KC. Fullterm, BF, Birth KC, guideline

UNICEF. 1998. Reassessment of Baby-Friendly Hospitals and Maternity Services: A Guide to Developing a National Process. Part VII. Pp. 3-5. New York: UNICEF Programme Division. Problems and barriers in implementing Step 4 of Baby Friendly criteria (placement of infant skin-to-skin within 30 minutes of birth) have been documented since the early years (1992) of implementation. Among the commons barriers are lack of staff time in general, need to finish newborn procedures, the mother may drop the baby, need for episiotomy repair, the mother must be cleaned-up first, need to move the mother from the delivery room, or the delivery room is too cold. Guidelines, Implementation, barriers, Birth KC, VEKC, BF, episiotomy

World Health Organization/UNICEF. 1992. Global criteria for the Baby Friendly Hospital Initiative. Geneva & New York: WHO/UNICEF. Spells out all baby friendly criteria, specifically #4 is about KC: “…80% of mothers in the maternity ward who have had normal vaginal delivery should confirm that within half-hour of birth they were given their babies to hold with skin contact for at least 30 minutes, and offered help by staff to initiate breastfeeding. At least 50% of mothers who have had caesarean deliveries should confirm that within a half hour of being able to respond, they were given their babies to hold with skin contact.” See also the UNICEF 1998 and Lazarov 1994 references for barriers encountered to implement these guidelines. Guidelines, BirthKC, VEKC, BF, C/S.

                 World Heath Organization/UNICEF, 1992 Baby Friendly Hospital Initiative Part II: Hospital level implementation. Geneva, Switzerland, WHO 1992. Very similar to the document immediately preceding this citation. Guidelines, BirthKC, VEKC, BF, C/S.

World Health Organization/UNICEF. 1989. Protecting, promoting, and supporting breastfeeding: the special role of maternity services. A joint World Health Organization/UNICEF statement. Geneva, Switzerland: World Health Organization. This is the original Baby Friendly Hospital Initiative, the way it was written for the world (the United States amended the statements [deleting skin-to-skin care] to make it easier to achieve in the U.S... In 1999 the International Lactation Consultants Association [ILCA] adopted the revised steps that did not include skin-to-skin contact- see ILCA 1999 reference). The original document states “…80% of mothers in the maternity ward who have had normal vaginal delivery should confirm that within half-hour of birth they were given their babies to hold with skin contact for at least 30 minutes, and offered help by staff to initiate breastfeeding. At least 50% of mothers who have had caesarean deliveries should confirm that within a half hour of being able to respond, they were given their babies to hold with skin contact.” After producing this document in 1989, Baby Friendly started to be globally initiated in 1992. Ten items were in the BFHI, and item #4 pertains to KC: Relates recommendation the mothers have skin-to-skin contact and start to breastfeed them less than 30 minutes after birth. Review, birth KC, VEKC, BF, C/S, Guidelines

World Health Organization (1985). Preliminary report of joint consultation. Bogota. World Health Organization/Pan American Health Organization. Interregional Conference on Appropriate Technology Following Birth. Trieste, Italy, 1985.                             

UNICEF (1984). Kangaroo treatment saves underweight babies. News Feature, May 1984. Clinical report and guidelines for use of KMC to prevent mortality due to cold stress. Preterm, Temperature, guidelines.