International Journal of Information Research and Review

Vol. 03, Issue, 10, pp. 2902-2907, October, 2016

Research Article
KMC FOR PREMATURE BABIES
1,*Mrs. Rajalakshmi, S. and 2Dr. Kalavathi, S.
1Reader in Nursing, SMVNC, Puducherry
2Principal, Rani Meyyammai college of Nursing, Annamalai University

ARTICLE INFO ABSTRACT

Article History: Kangaroo Care is likely the most widely used term for skin-to-skin contact. Gene Cranston Anderson may
have been the first to coin the term Kangaroo Care in the USA. The defining feature of this is however for
Received 24th July 2016 skin-to-skin contact, commonly abbreviated as SSC, also STS. This is used synonymously with "skin-to-
Received in revised form skin care". Dr.Nils Bergman of the founders of the Kangaroo Mother Care Movement argues that since
15th August 2016 skin-to-skin contact is a place of care, not a kind of care in itself, skin-to-skin contact should be the preferred
Accepted 16th September 2016 term. Kangaroo Mother Care is a broader package of care defined by the WHO. Kangaroo Mother Care
Published online 31st October 2016 originally referred only to care of low birth weight and preterm infants, and is defined as a care strategy
including three main components: kangaroo position, kangaroo nutrition and kangaroo discharge. Kangaroo
Keywords: position means direct skin-to-skin contact between mother and baby, but can include father, other family
Kangaroo Nutrition, member or surrogate. The infant should be upright on the chest, and the airway secured with safe technique.
Kangaroo Position. (The term Kangaroo Mother Care is commonly used to mean skin-to-skin contact, despite its definition from
the WHO as including a broader strategy). Kangaroo nutrition implies exclusive breastfeeding, with
additional support as required but with the aim of achieving ultimately exclusive breastfeeding. Kangaroo
discharge requires that the infant is sent home early, meaning as soon as the mother is breastfeeding and able
to provide all basic care herself. An essential part of this is that there is close follow-up, and access to daily
visits. One recent survey found that 82 percent of neonatal intensive care units use kangaroo care in the
United States today.

Copyright © 2016, Rajalakshmi and Kalavathi. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION connectedness, bonding and attachment. KMC helps the

Kangaroo Mother Care (KMC) has often been used as a physical, emotional, and social development to be the best it
treatment for premature or preterm babies. In a rural third possibly can be. The Kanga Carrier was originally designed to
world situation where no incubators are available this method enable mothers of premature babies to be permanent incubators
of caring for preterm or low birth weight babies can be life- for their babies. Medical research has shown that maternal
saving. This works because the baby on the mother’s chest infant skin-to-skin contact is better than incubators for keeping
does not get cold, so the lungs function better. The baby in babies warm, provides better breathing and heart rate, better
skin-to-skin contact also feels safe with mom’s familiar heart breastfeeding and better growth. The problem is a mother has a
beat and voice so they do not become stressed and the heart preconceived idea of an incubator as something stuck in a
rate, blood pressure and breathing stabilize faster. On the hospital ward and not allowed to be moved or to be touched.
mothers chest the baby also stimulates the production of breast The mother has been an incubator for nine months, and with
milk. This milk is vital for providing the preterm baby with the the Kanga Carrier she can now carry on being an incubator.
exact food needed to grow her brain. About 4 million babies Many premature and low birth weight babies will have special
die each year in the first week of life; KMC could help 25% needs and require medical care, all these can be provided
survive. In a first world hospital setting KMC is also being together with continuous skin-to-skin contact. Steps of
used for premature babies. The same biology applies and Kangaroo Mother Care
means that the baby is more stable with all of the above
benefits. For both contexts it is not just SURVIVAL of the KMC –step 1, 2
preterm baby, but it is also the QUALITY of that survival in
terms of brain growth, healthy brain wiring, emotional Kangaroo Mother Care (KMC) is a special way of caring of
low birth weight and preterm babies. It fosters their health and
*Corresponding author: Mrs. Rajalakshmi, S., well being by promoting effective thermal control,
Reader in Nursing, SMVNC, Puducherry. breastfeeding, infection prevention and bonding.
2903 Rajalakshmi and Kalavathi. KMC for premature babies

In KMC, the baby is continuously kept in skin-to-skin contact  ii. Post-discharge follow up KMC is continued at home
by the mother and breastfed exclusively to the utmost extent, after early discharge from the hospital. A regular follow
KMC is initiated in the hospital and continued at home. up and access to health

KMC- step 5,6,7: Benefits of KMC

Thermal control: Prolonged skin-to-skin contact between the

mother and her preterm/ LBW infant provides effective thermal
control with a reduced risk of hypothermia. For stable babies,
KMC is at least equivalent to conventional care with incubators
in terms of safety and thermal
Protection.

Early discharge: Studies have shown that KMC cared LBW

infants could be discharged from the hospital earlier than the
conventionally managed babies. The babies gained more
weight on KMC than on conventional care.

Less morbidity: Babies receiving KMC have more regular

breathing and less predisposition to apnea. KMC protects
KMC-step 3 against nosocomial infections. Even after discharge from the
hospital, the morbidity amongst babies managed by KMC is
Components of Kangaroo Mother Care-The two components of less. KMC is associated with reduced incidence of severe
KMC are: illness including pneumonia during infancy.

Skin-to-skin contact

Early, continuous and prolonged skin-to-skin contact between

the Mother and her baby is the basic component of KMC. The
infant is placed on her mother's chest between the breasts.

Exclusive breastfeeding

The baby on KMC is breastfed exclusively. Skin-to-skin

contact promotes lactation and facilitates the feeding
interaction.

KMC- step 4

Pre-requisites of KMC- The two pre-requisites of KMC are

 Support to the mother in hospital and at home a mother

cannot successfully provide KMC all alone. She would
require counseling along with supervision from care- Other effects: KMC helps both infants and parents. Mothers
providers, and assistance and cooperation from her are less stressed during kangaroo care as compared with a baby
family members. Skin to skin contact of theinfant on the kept in incubator. Mothers prefer skin-to-skin contact to
mother’s chest conventional care.
2904 International Journal of Information Research and Review Vol. 03, Issue, 10, pp. 2902-2907, October, 2016

They report a stronger bonding with the baby, increased Birth weight 1200-1799 g: Many babies of this group have
confidence, and a deep satisfaction that they were able to do significant problems in neonatal period. It might take a few
something special for their babies. Fathers felt more relaxed, days before KMC can be initiated. If such a baby is born in a
comfortable and better bonded while providing place where neonatal care services are inadequate, he should be
Kangaroo care. transferred to a proper facility. Immediately after birth, along
with the mother/ family member. He should be transferred to a
KMC- step: 8 refferal hospital after initial stabilization and appropriate
Requirements for KMC implementation management, One of the best ways of transporting small babies
is by keeping them in continuous skin-to-skin contact with the
 Training of nurses, physicians and other staff mother / family member during transport.
involved in the care of the mother and the baby.
 Educational material such as information sheets, Birth weight <1200 g: Frequently, these babies develop
posters, video films on KMC in local language should serious prematurity-related morbidity often starting soon after
be available to the mothers, families and community. birth. They benefit the most from in-utero transfer to the
 If possible, reclining chairs in the nursery and institutions with neonatal intensive care facilities. It may take
postnatal wards, and beds with adjustable back rest days to weeks before baby's condition allows initiation of
should be arranged. Mother can provide KMC sitting KMC.
on an ordinary chair or in a semi-reclining posture on
a bed with the help of pillows. MOTHER
KMC-step 9, 10
All mothers can provide KMC, irrespective of age, parity,
Eligibility criteria education, culture and religion.

Baby Willingness: The mother must be willing to provide KMC.

Healthcare providers should counsel and motivate her. Once
All stable preterm and LBW babies are eligible for KMC. the mother realizes the benefits of KMC for her baby, she will
However, very sick babies needing special care should be cared learn and undertake KMC.
under radiant warmer initially. KMC should be started after the
baby is hemo -dynamically stable. General health and nutrition: The mother should be free
from serious illness to be able to provide KMC. She should
receive adequate diet and supplements recommended by her
physician.

Hygiene: The mother should maintain good hygiene: daily

bath/sponge, change of clothes, hand washing, short and clean
finger nails.

Supportive family: Apart from supporting the mother, family

members should also be encouraged to provide KMC when
mother wishes to take rest. Mother would need family's
cooperation to deal with her conventional responsibilities of
household chores till the baby requires KMC.

Guidelines for practicing KMC include Supportive community: Community awareness about the
benefits should be created. This is particularly important when
Birth weight >1800 g: These babies are generally stable at there are social, economic or family constraints.
birth. Therefore, in most of them KMC can be initiated soon
after birth. KMC- step 11

Preparing for KMC

When baby is ready for KMC, arrange a time that is convenient

to the mother and her baby. The first few sessions are
important and require extended interaction. Demonstrate to her
the KMC procedure in a caring, gentle manner and with
patience. Answer her queries and allay her anxieties.
Encourage her to bring her mother/mother in law, husband or
any other member of the family. It helps in building positive
attitude of the family and ensuring family support to the mother
which is particularly crucial for post-discharge home-based
KMC. It is helpful that the mother starting KMC interacts with
someone already practicing KMC for her baby.
2905 Rajalakshmi and Kalavathi. KMC for premature babies

Mother's clothing Short KMC sessions can be initiated during recovery with
ongoing medical treatment (IV fluids, oxygen therapy). KMC
KMC can be provided using any front-open, light dress as per can be provided while the baby is being fed via or gastric tube
the local culture. KMC works well with blouse and sari, gown or on oxygen therapy.
or shawl. A suitable apparel that can retain the baby for
extended period of time can be adapted locally. KMC-steps 17
Baby's clothing Duration of KMC
Baby is dressed with cap, socks, nappy, and front-open
sleeveless shirt or 'jhabala'. • Skin-to-skin contact should start gradually in the
nursery, with a smooth transition from conventional
KMC- step 12, 13, and 14 care to continuous KMC.
• Sessions that last less than one hour should be avoided
The KMC procedure- Kangaroo positioning because frequent handling may be stressful for the baby.
• The length of skin-to-skin contacts should be gradually
 The baby should be placed between the mother's breasts increased up to 24 hours a day, interrupted only for
in an upright position. changing diapers.
 The head should be turned to one side and in a slightly • When the baby does not require intensive care, she
extended position. This slightly extended head position should be transferred to the post-natal ward where KMC
keeps the airway open and allows eye to eye contact should be continued..
between the mother and her baby.
 The hips should be flexed and abducted in a "frog" KMC- steps 18, 19, 20, 21
position; the arms should also be flexed.
 Baby's abdomen should be at the level of the mother's Can the mother continue KMC during sleep and resting?
epigastria.
 Mother's breathing stimulates the baby, thus reducing A comfortable chair with adjustable back may be useful to
the occurrence of apnea. provide KMC during sleep and rest. In the KMC ward or at
 Support the baby’s bottom with a sling/binder. home, the mother can sleep with the baby in kangaroo position
in a reclined or semi-recumbent position, about 15 -30o
KMC- step 15 degrees from above the ground. This can be achieved with an
adjustable bed, if available, or with several pillows on an
Monitoring ordinary bed. It has been observed that this position may
decrease the risk of apnea in a baby. A supporting garment to
Babies receiving KMC should be monitored carefully carry the baby in kangaroo position will allow the mother or
especially during the initial stages. Nursing staff should make the father or the relatives to sleep even with the baby in the
sure that baby’s neck position is neither too flexed nor too kangaroo position. When the mother and the baby are well
extended, airway is clear, breathing is regular, color is pink and adapted to KMC they can be discharged from the hospital.
baby is maintaining temperature. Mother should be involved in
observing the baby during KMC so that she herself can KMC- step 20
continue monitoring at home.
From hospital to home
Feeding
Criteria to transfer the baby from nursery to the ward Standard
The mother should be explained how to breastfeed while the criteria of the unit for transferring baby from the nursery to the
baby is in KMC position. Holding the baby near the breast post-natal ward should be as follows:
stimulates milk production. She may express milk while the
baby is still in KMC position. The baby could be fed with • Stable baby
paladai, spoon or tube, depending on the condition of the baby. • Gaining weight
Privacy • Mother confident to look after the baby

KMC unavoidably requires some exposure on the part of the KMC-21

mother. This can make her nervous and could be de-
motivating. The staff must respect mother's sensitivities in this Discharge criteria
regard and ensure culturally-acceptable privacy standards in
the nursery and the wards where KMC is practiced. The standard policy of the unit for discharge from the hospital
should be followed. Generally the following criteria is accepted
KMC- step 16 at most centres:
Time of initiation
 Baby's general health is good and no evidence of
infection
KMC can be started as soon as the baby is stable. Babies with
 Feeding well, and receiving exclusively or
severe illnesses or requiring special treatment should be
predominantly breast milk.
managed according tothe unit protocol.
 2906 International Journal of Information Research and Review Vol. 03, Issue, 10, pp. 2902-2907, October, 2016

 Gaining weight (at least 15-20 gm/kg/day for at least Skin-To-Skin Contact Benefits For Parents
three consecutive days)
 Maintaining body temperature satisfactorily for at least  Parents become central to the caring team
three consecutive days in room temperature.  Better bonding and interact with their child better
 The mother and family members are confident to take  Emotional healing.
care of the baby in KMC and should be asked to come  Less guilt
for follow-up visits regularly..  Parents are calmer
 Mum and dad are empowered and more confident
KMC-22  Parents are able to learn their baby’s unique cues for
hunger
When should KMC be discontinued?  Parents and baby get more sleep
 Parents, (especially mothers)are less depressed
When the mother and baby are comfortable, KMC is continued  Cope better in NICU
for as long as possible, at the institution & then at home. Often
 See baby as less “abnormal”
this is desirable until the baby's gestation reaches term or the
weight is around 2500 g. She starts wriggling to show that she
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