Complication of pre-maturity and low birth weight are now leading cause of neonatal death. In November 2015, kangaroo mother care (KMC) was included as one the recommendations issued by the World Health Organization (WHO) for the care of preterm infants

What is Kangaroo Care or Kangaroo Mother Care?

Kangaroo mother care (KMC) or kangaroo care, occasionally referred to as skin-to-skin contact, is a method of newborn care whereby parent, commonly mothers keep their baby skin-to-skin or chest-to chest.It involves an intimate skin-to-skin contact with the mother as it is the custom of the female kangaroo animal.

It is most commonly used for low birth-weight preterm babies (birth weight less than 2500g), who are more likely to suffer a fall in body temperature to below 35oC. Kangaroo care is a safe and effective alternative to the generally accepted method of neonatal care for low birth weight (LBW) infants, mainly in countries with limited resource.

History of kangaroo mother care (KMC)

In the 1970s, non-availability and unreliability of incubators in some countries led to the development of the kangaroo care to care for preterm infants in such countries. It was named as kangaroo mother care because of its similitude to how certain marsupials (kangaroo)carry their newborns.

The use of the term “skin-to-skin contact” was first reported in 1979 by Thomson and in its rationale made reference to the work of de Chateau. This comes before the origin of Kangaroo Mother Care (KMC) in Bogota, Colombia and this make the practice more generally known.

When should KMC be commenced?

As soon as a baby is stabilized KMC can be commenced. It may be at birth or commenced hours, days, or weeks after birth. 

How KMC is Done or Performed by Mothers

The baby should be placed between the mother’s breasts in an upright position.

The head should be in a delicately upturned position and turned to one side. This position is to maintain the mother and child eye-to-eye contact and to aid breathing.

The baby’s abdomen should be placed on the upper abdomen of the mother with the legs and arms folded.

Provide a support for the baby’s bottom with a sling/binder.

Feeding the new born on KMC?

Breast milk production is stimulated when the baby is held near the breast. Therefore, while in kangaroo mother care position the mother can express her breast milk and depending on the condition of the new born, the new born could be fed with spoon and cup or tube.

When should KMC be discontinued?

KMC can be discontinued ones the baby starts to show signs of discomfort for example the newborn starts to wriggle, pulls limbs out, cries and fusses every time the mother tries to restore the newborn back to skin to skin.

What are the requirements to be eligible to carry out KMC?

To be fit to carry out KMC:

The mother must be willing and should be confirmed free from major illnesses.

She should be properly nourished and should have received the various recommended supplements.

The mother should practice good hygiene: correct hand washing,change of clothes, daily birth,clean and short finger nails.

Required support for successful KMC practice

For a successful KMC practice the mother requires training, supervision and counseling from a trained health care provider after which she can practice the KMC herself at home after discharge from the hospital.

KMC should be initiated first at the hospital then at home until there is a considerable weight gain. continues for as long as possible, first at the hospital then at home until the weight is 2500g.

To ensure successful and safe KMC practice at home a regular follow up is crucial.

Cooperation and assistance from family member is required to enable mother give proper attention to her low birth weight newborn.

The Role of Family Member

Mother would need the family support to help with some of her conventional responsibilities for example the household chores while she practices KMC.

Apart from encouragement and supportive role played by family member; when the mother take rest, other family member can also offer to provide KMC.

Also, in case of multiple birth and not limited to that, but under proper guidance and supervision other older member of the family can be enrolled to carry out kangaroo care.

What Are the Benefits of Kangaroo Mother Care?

Babies who are in kangaroo care tend to be less prone to apnea and bradycardia and have stabilization of oxygen needs. During painful procedures the skin-to-skin contact effectively reduce the accompanying pain.Kangaroo care is of great psychological importance to parents as it promotes attachment and bonding, improves parental confidence, and helps to promote and increased milk production and breastfeeding success. Overall, kangaroo mother care provides numerous merits for both parents and their infants:

It improves infant sleep patterns and may be a useful intervention for colic.

It boosts parenting skill confidence. Parents who practiced KMC showed greater confidence in their ability to care for their child.

Mothers who practice KMC produce larger amounts of milk for prolonged period as KMC has been shown to positively affect breastfeeding.

It lowers parental anxiety.

It reduces infant risk of hospital acquired infection and mortality

It boosts infant breastfeeding rate and weight gain

KMC help in the reduction of mortality and morbidity in preterm/LBW infants.

Reduction in hospital stay, expensive technological health care and increase in teaching opportunities and parental involvement and a better use of health care funds are some of the importance KMC offer to health care institutions

Controversy

Among the proponents of Kangaroo Mother Care, the main controversy relates to eligibility to initiate kangaroo position: in Rey & Martinez model and the WHO guidelines, the infant should be stable to “tolerate skin-to-skin contact” but the biological and neuroscience perspective, argue that it is the mother-child separation that causes the instability.

There is little controversy regarding kangaroo nutrition as well, with accumulating evidence for the benefits of breastfeeding as such, and evidence that even preterm infants can be exclusively breastfed.

Fundación Canguro, in Bogota, Colombia defended the controversy as regards the ‘early discharged the evidence reported from Cochrane review.

Common challenges and suggested solutions

The mother can be nervous or demotivated because of the requirement to expose some of her body parts. Mothers practicing KMC should therefore be provided with some privacy.

It may be impossible for mothers to carry out KMC for a long period of time. Mothers practicing KMC should ensure that each session of KMC last for a minimum duration of an hour. The focus should be to provide KMC for as long as possible (preferably for the whole day hour: 24 hours).

To ensure the continuity of KMC during rest or sleep; several pillows on a bed or comfortable chair should be made available.

Conclusion

In kangaroo mother care the parent’s stable body temperature helps to regulate the new-born’s temperature more appropriately than an incubator, and allows for readily accessible breastfeeding. By placing the infant in direct skin-to-skin contact with one of the family members, kangaroo care restores the closeness of the newborn with family members. This has physiological and psychological impact by creating warmth and bonding. Kangaroo care provide relevant benefits for pre-term and low-birth-weight infants, they experience more normalized heart rate, temperature, and respiratory rate, improved weight gain and reduced risk of hospital-acquired infections. Additionally, preterm infants who experience kangaroo care have decreased stress levels, improved cognitive development,normalized growth, reduced pain responses, and positive effects on motor development. Reduce hospital stay i.e. earlier hospital discharge is also a possible outcome.

Reviewed on 16/10/2020