KANGAROO MOTHER CARE
Kangaroo mother care (KMC) refers to a novel, low-cost intervention in care of the preterm or low birth weight infants, by nursing them in close skin-to-skin contact with mother or other caregiver, to promote temperature control, breastfeeding and emotional bonding, as well as to prevent hypothermia and infections.
First described by Dr Edgar Ray, Columbia, in 1978, the term derives its name from the similarities of marsupial baby care in Kangaroo species. KMC can be started at hospital and continued at home after discharge.
Benefits: Important benefits of KMC include: (a) reduced risk of hypothermia, (b) higher rates of exclusive breastfeeding, (c) better weight gain with early hospital discharge, (d) lesser morbidity in hospital and also post-discharge, (e) better emotional bonding between mother and baby, and (f) involvement of mother and family in neonatal care, reducing the stress associated with facility-care.
Prerequisites for successful KMC include birth weight lt;2500 gm and (a) baby should be hemodynamically stable*, (b) mother should be willing, with good health and hygiene, (c) support at the hospital as well as at home, (d) regular monitoring as well as post-discharge follow-up.
*KMC can be initiated in otherwise stable babies on IV fluids, tube feeding or oxygen. Most babies gt;1800 gm#8725;gt;34 weeks can be directly managed with KMC; while lighter ones may need technology-based care in early days, till stable enough for KMC.
Procedure of KMC involves following steps:
Step I. Pre-KMC preparations including: (a) counseling the mother, spouse and other caregivers, (b) demonstration of actual procedure and answering their queries/apprehensions, (c) provision for appropriate, warm, front-open clothes for mother and baby; and (d) provision for suitable sitting arrangement, (e.g. reclining chairs) and adequate privacy.
Step II. Positioning of the mother-baby pair involves:
• Mother should be sitting or lying comfortably, preferably in semi-reclined posture;
• Baby's head should be placed between the mother's breasts in an upright position.
• Baby's head should be turned to one side in slightly extended position to ensure open airways and adequate eye to eye contact with mother.
• Baby's hips should be flexed and abducted in a quot;frogquot; position; the arms should also be flexed.
• Baby's abdomen should be at the level of the mother's epigastrium as maternal breathing stimulates the baby, reducing the risk of apnea.
• Baby's bottom should be supported with a sling/ binder.
• Both mother and the baby should be properly covered as one unit (Fig. 12.12).
Each skin-to-skin contact session should not last less than one hour to avoid frequent handling. Duration may be gradually increased up to 24 hours a day, interrupted only for changing diapers. Mother can eat and sleep in
Fig. 12.12: Kangaroo mother care (KMC).
KMC position, with proper support, preferably in semireclining position. KMC can be initiated in preterms within 24 hours of life (Early KMC) or even in babies on ventilators.
Monitoring: Babies during KMC should be closely monitored, specially in initial sittings, to ensure that: (a) neck is not too flexed/extended, (b) breathing is normal, and (c) feet and hands are warm. Mother should also be educated to watch for these parameters at home.
Feeding: KMC stimulates lactation and mother must be trained to feed the baby in KMC position. She must also be trained to express her milk and feed the baby by spoon, if required. Gavage feeding may continue during KMC, depending on the condition of baby.
When to stop KMC: Mother and baby may be discharged depending on their clinical status with adequate training and motivation to continue KMC at home, till it is comfortable and baby is not wriggling-out to show she/ he is uncomfortable. Post-discharge, babies on KMC should be followed up till 37 weeks or 2500 gm weight, when KMC usually becomes unnecessary.
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