Purpose and Goal: CNEP # 2032

  • Understand the benefits of Kangaroo Care in the neonate.
  • Learn about the effects of Kangaroo Care in preterm infants.

None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored.

Requirements for successful completion:

  • Successfully complete the post-test
  • Complete the evaluation form

Date

  • February 2016 – February 2018

Learning Objectives

  • Describe the benefits of Kangaroo Care in the neonate.
  • Describe the benefits of using Kangaroo Care in the NICU.
  • Identify 2 outcomes of using Kangaroo Care in the preterm infant.

Introduction

  • Preterm birth is defined as < 37 weeks gestation
    • It affects up to 12% of the population
  • Prematurity is the leading determinant of neonatal outcomes
  • 40% of premature infants have neurodevelopmental disabilities
  • Kangaroo Care has been shown to improve neurodevelopment
    • It promotes physiological stability
    • It promotes psychological stability
    • It’s effects are both short term and long term

Kangaroo Care and Skin-to-Skin Holding

  • Kangaroo Care (KC) originated in Bogotá, Colombia
    • In the early 1970s
    • As a response to:
      • Overcrowded nurseries
      • A lack of sophisticated equipment
      • As an alternative to incubator care
  • Kangaroo Care is a method of holding an infant
    • On a parent’s chest
    • In a vertical position
    • Diapered and upright
    • With skin to skin contact
  • KC is also known as:
    • Skin-to-Skin Care
    • Skin-to-Skin Holding
    • Kangaroo Mother Care
  • The benefits of KC have been found:
    • During hospitalization
    • At 6 months of age
    • At 12 months of age

The Benefits of Kangaroo Care

  • The benefits of KC have been well established
    • They far outweigh the risks
    • They are supported by multiple studies
  • The major benefits of KC include:
    • Thermoregulation
    • Physiologic stability
    • Improved weight gain
    • Improved behavioral state
    • Enhanced breastfeeding support
    • Enhanced parent-Infant bonding
    • Improved pain management
  • These benefits apply to both term and preterm infants
  • The immediate effects of KC on any neonate are:
    • Improved infant sleep
    • Improved infant feeding
    • Decreased infant stress
    • Parental-infant attachment
    • Decreased parental anxiety

The Short-Term Effects of Kangaroo Care in the NICU

  • The short-term effects of KC include:
    • Improved stability
      • Physiologic
      • Behavioral
      • Developmental
      • Psychosocial
  • Physiologic effects
    • Cardiorespiratory stability
      • Heart rate (HR)
        • May see no changes
        • Typically ↑ 5-10 bpm
          • Due to change in head position
          • Due to increased temperature
        • Increases with heelsticks
          • ↑ 8-10 bpm during KC
          • ↑ 36-38 bpm in incubator
        • Bradycardia events are rare
      • Respiratory rate (RR)
        • Similar to HR
        • May see no changes
        • May ↑ 10 bpm initially
        • Typically ↓ 3 bpm
        • Lower RR in KC
        • Higher RR in incubator
      • Oxygen saturation
        • Typically ↑ by 2-3%
        • No changes during heelsticks
      • Desaturation events
        • Fewer events during KC
        • ↑ events during swaddled holding
        • Slight ↑ after 2+ hours
          • Airway obstruction
        • No events during breastfeeding
      • Apnea events
        • May see no changes
        • Typically ↓ during first 3 hours
        • Tend to occur with interrupted sleep
        • Tend to occur during arousal
        • KC leads to ↑ sleep and ↓ arousals
      • Body temperature
        • Typically increases
        • Can exceed 37.5 degrees
        • Can be ↓ by exposing an extremity
      • Weight gain
        • This effect is controversial
        • May see no increases
        • May see ↑ 20 gram/day with KC
        • May see 10 gram/day in incubator
      • Cortisol levels
        • ↑ cortisol is a sign of stress
        • ↑ cortisol impairs immune function
        • May see ↓ by 60% after 20 minutes
        • Typical cortisol levels
          • Normal levels are 50 nmol/L
          • 193-212 nmol/L in incubator
          • A 60% reduction is significant
      • Nosocomial infections
        • Strong evidence for ↓ infection
        • Consistent evidence for ↓ infection
        • In 24/7 Kangaroo Mother Care units
          • Proven ↓ infection rates
  • Behavioral effects
    • Sleep
      • Increases duration of sleep
      • Increases quiet or deep sleep
      • Increase quality of sleep
    • Crying
      • Crying is rarely seen
      • Decreased crying with heelsticks
      • KC → less overall crying
    • Breastfeeding (BF)
      • KC promotes BF
      • KC enhances BF success
        • 98% BF at 40 weeks
        • 76% BF without KC
  • Neurobehavioral development
    • Minimizes stress
    • Minimizes impact of NICU
    • Increases periods of alertness
    • Increases attention to environment
    • Increases sleep organization
      • Improved brain development
  • Psychosocial effects
    • Preterm birth is stressful
    • KC minimizes parental guilt
    • KC minimizes parental anxiety
    • Improves adaptation to preterm birth
    • Improves positive interactions with infant
    • Facilitates parent-infant attachment

The Long-Term Effects of Kangaroo Care in the NICU

  • The long term effects of KC include:
    • Improved brain development
      • Accelerated maturation
      • Possible ↑ myelination
      • Possible ↑ synaptic formation
    • Improved cognitive development
    • Improved neuromotor development
  • Improved standardized test scores
    • At 6 months and 12 months
    • Bayley Scales of Infant Development
    • Wechsler Primary Scale of Intelligence
    • NEPSY (Neuropsychological Assessment)
  • Adolescents who experienced KC show:
    • Improved motor skills
    • Faster conduction test times
  • Mothers who experienced KC show:
    • ↓ depression scores
    • ↑ attachment scores

Infant Readiness for Kangaroo Care

  • Not all NICU infants initially qualify for KC
    • IVH prevention within first 72-96 hours
    • Unstable infants on respiratory support
  • Most infants become more stable during KC
    • But not all infants are ready
    • Readiness should be assessed daily
  • Several factors should evaluated for KC readiness:
    • Unstable vital signs
      • No tachycardia
      • No hyperthermia
    • Unstable blood pressure
      • No vasopressor medications
    • Unstable apneic events
      • That last > 20 seconds
      • That require stimulation
    • Unstable oxygen saturations
      • No desaturations < 85%
      • Especially with O2 support
    • Inability to tolerate handling
    • Lack of unstable IV lines
      • Any positional line
      • Any fresh umbilical line
      • Any peripheral arterial line
      • Any unstable line of any kind
    • Lack of chest tubes of any kind
    • Unstable respiratory support
      • No rapid weaning of support
      • No increased respiratory support
      • Not in first 24 hours of ventilator support
      • No high frequency oscillating ventilation
    • Unstable blood gases
    • Unstable signs of sepsis
      • Emerging signs
      • Evaluation in process
      • Active signs of sepsis
    • Unstable bilirubin levels
      • No bilirubin close to exchange level
    • Lack of parental readiness
      • No signs of illness
      • No parental anxiety
      • No recent smoking
      • No parental lack of time

Summary

  • Kangaroo Care has been shown to be safe
    • It helps the infant
    • It helps the parents
  • KC can decrease the length of NICU stay
  • KC can decrease infant morbidity and mortality
  • It gives parents the chance to parent in the NICU
  • The short and long term outcomes of KC are significant

References

  1. Ludington-Hoe, S.M. 2011. Thirty Years of Kangaroo Care Science and Practice. Neonatal Network, 30 (5), p. 357-362.
  2. Hardy, W. 2011. Integration of Kangaroo Care in Routine Caregiving in the NICU: What Is Stopping You? Advances in Neonatal Care, 11 (2), p. 119-121.
  3. Neu, M. 2004. Kangaroo Care: Is It For Everyone? Neonatal Network, 23 (5), p. 47-54.
  4. Ludington-Hoe, S.M., Morgan, K. and Abouelfettah, A. 2008. A Clinical Guideline for Implementation of Kangaroo Care with Premature Infants of 30 or More Weeks’ Postmenstrual Age. Advances in Neonatal Care, 8 (3S), p. S3-S23).
  5. Head, L.M. 2014. The Effect of Kangaroo Care on Neurodevelopmental Outcomes in Preterm Infants. The Journal of Perinatal and Neonatal Nursing, 28 (4), p. 290-299.

Evaluation

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