Kangaroo Care Objectives • Give the learner a history of Kangaroo Care • Give the learner a good understanding of KC • Give the learner enough knowledge of KC to promote the correct use of it in our NICU • Give the learner enough knowledge of KC to teach parents and families to continue it at home Definition Kangaroo Care is a special way to hold an infant where the infant is held skin to skin and chest to chest so that the entire ventral surface from umbilicus to sternum of the infant is up against the mother’s ventral surface. There are very sensitive cells in this area that can create a vagal-induced hormonal cascade that does not occur anywhere else in the body. History of Kangaroo Care • In the 1970’s, Dr. Edgar Rey and Dr. Hector Martinez from the Institito Maternal-Infantil in Bogota, Columbia visited a mountain village. • They witnessed a grandmother carrying a small baby skin to skin between her breasts under clothing and wraps that made a pouch. • They said it reminded them of how a kangaroo carries a baby in its pouch. History of Kangaroo Care • They decided to try this in their unit where: • average temperature was 50 degrees • no formula was available • mother often not available • mortality rate was nearly 80% History of Kangaroo Care • Mortality rate was primarily due to infections: • nutrition- not mom’s own milk • bed sharing- 2-3 infants per incubator • inadequate cleansing capabilities • lack of sterile supplies (rinse and reuse IV bags and tubing) • nurse to baby ratio was 1:65 History of Kangaroo Care • Instituted Kangaroo Care in 1979. • In first year, decreased their mortality rate by 70% • Presented their findings to the world at the First Conference for Fetal and Neonatal Medicine in Bogota in 1983 • Attributed the success to a triad of milk, warmth, and bonding which is the conceptual model of Kangaroo Care History of Kangaroo Care Practice still in place in Bogota: • After delivery, mother and baby taken out in the hall and do Kangaroo Care • After 2 hours, if mother not bleeding, and baby is alive, pink, and tries to suck, both go home. History of Kangaroo Care • 1986- International Congress of Infant Studies convened in LA. • 1996- WHO recommends every infant 28 weeks gestation or more has a right to KC. • 1998- WHO’s International Network on KC: 1. All infants 28 weeks or greater should be given KC as soon as possible. 2. Ideally, it should be started immediately after birth. 3. It should be done as much as possible. 4. It should be done for as long as possible. History of Kangaroo Care • 2007- Save the Children Organization promotes KC as one of the 5 essential elements of NB care(resuscitation, BF, KC, small infant care, and thermoregulation). • 2010- KC is practiced around the world in all levels of neonatal and home care. Glossary of Terms • Birth KC- begins within 5 minutes of birth • Early KC- begins 5minutes to 24 hours of age • End of Life KC- given when demise is anticipated • Immediate KC- begins immediately after birth (less that 5 minutes) • Kangaroo Care- Skin to skin placement of infant’s chest against the chest of another human being Glossary of Terms • Kangaroo Mother Care- KC 24/7 • Late KC- begins after discharge from hospital • Palliative KC- another name for End of Life KC • Paternal KC- given by father • Shared KC- more that one infant held simultaneously • Surrogate KC- held by someone other than biological mother or father Glossary of Terms • Ventilated KC- given to intubated infant • INC- International Network on KMC- organization that began in Trieste, Italy in 1996 • Skin to Skin- any skin to skin contact, not necessarily KC- has to be chest to chest • Kan Guru- someone certified in KC issued by the US division of WHO INK Why Chest to Chest The keratinocytes in the 7 epidermal layers of the skin in this ventral area are especially sensitive: 1. Seat of the vagus nerve 2. Nerve fibers very powerful in this area and release corticotropin releasing hormone 3. Make their own cortisol 4. Can initiate a vagal induced hormone cascade that does not occur anywhere else Why Chest to Chest Where do you think most of these cells are located? Acronym for KC Skin to Skin: • S is for Survival • K is for Kinder • I is for Immunity • N is for Nutrition • T is for Thermoregulation and Transfer • O is for Other Options for KC Pneumonic for KC • S is for State • K is for “K”ardiorespiratory • I is for Involvement of Parents • N is for Neurobehavioral Developement S is for Survival • Hundreds of world-wide studies have repeatedly shown that KC decreases morbidity and mortality rates of both preterm and full term infants. • Dramatically increases the survival rate of premature infants • Reduces severity of illnesses • Decreases length of stay/costs • Fewer complications at 1 year follow-ups K is for Kinder and Gentler Environment • Responses to KC have been so positive that is has been called an integral part of the foundation of contemporary developmental care. • It provides an appropriate balance between under stimulated tactile and proprioceptive systems and the overwhelmed later developing systems such as vision and auditory. (provides low intensity stimulation to the developing senses) K is for Kinder and Gentler Environment • Meets NANN’s criteria as a developmental intervention: 1. Modifies the environment 2. Individualizes care 3. Promotes relief from inappropriate elements of the environment 4. Promotes attachment and confidence in the parents K is for Kinder and Gentler Environment Some developmental outcomes of KC include the following: 1. Increased duration and frequency of quiet sleep/ Less crying 2. Improved organizational state 3. Encourages self regulatory behaviors 4. Provides rest period from often noxious environment K is for Kinder and Gentler Environment 5. Better arousal modulation at 3 months when presented with increasingly complex stimulation 6. Higher scales at 6 months on Bayley Scales of Infant Development - mental and psychomotor index I Stands For Immunity The evidence linking KC to immunity is just beginning to appear in literature, but the majority of studies show that infants who receive KC have no increased risk for infection and have fewer infections that require hospitalizations up to 1 year of age than infants who did not receive KC. I Stands For Immunity There is decreased trans-epidermal water loss from the skin for the following reasons: 1. Infant is contained in a warm and often flexed environment. 2. Humidity with KC is >50%. 3. Infant spends more time asleep than awake. Trans-epidermal water loss is greater in awake states. I Stands For Immunity 4. Less trans-epidermal water loss means more water is retained in the stratum corneum. This enables it to maintain better integrity against injury and organisms and enables it to stay smooth and flexible. 5. Less trans-epidermal water loss also means energy conservation and growth. 6. Improved skin hydration causes improved barrier function of the skin. I Stands For Immunity • KC is a form of pleasing touch. Pleasing touch sensations go straight to the limbic area of the brain, which is the seat of emotion. This in turn, decreases the release of the stress hormone cortisol. High circulating levels of cortisol impair the body’s immune function. • Pleasing touch also causes the release of neuropeptides, especially opioids. This calms, reduces cortisol release, and thus reduces stress. I Stands for Immunity • KC is also a form of warm touch. This stimulates cytokine expression in the stratum corneum, which further enhances the barrier function. (Warm environments improve cytokine expression more than cold environments.) I Stands for Immunity • When the hair follicles of the mother and infant touch each other, both secrete cutaneous corticotrophin releasing hormone. This hormone causes vasodilation of the skin blood vessels, making mother and infant skin warmer. Warm skin enhances cytokine expression. • When the infant moves against the mother’s skin, the movement and touch improve the immune function of the keratinocytes in the infant’s skin. I Stands for Immunity The entero-mammary pathway theory: • Infant comes in contact with pathogens, and they enter the skin through the skin, mucous membranes, and air. Once there, they are antigens. • The antigens are transferred to the mother by mucus with breastfeeding and through the skin during KC. I Stands for Immunity • The mother’s mature immune system produces antibodies against the antigens. • The antibodies enter the infant’s system in breastmilk and by passing through the mother’s skin then through the infant’s skin with KC. • The theory is that the more skin to skin contact that occurs, more antibodies will be inherited, and the better the infant’s immunity will be. I Stands for Immunity • This provides species specific antimicrobial action. • The entero-mammary pathway is supposed to be especially efficient in protecting preterm babies from nosocomial infections. N is for Nutrition KC has long been known to promote and enhance BF in both pre-term and full-term infants. • BF in KC position achieves better latch, nutritional and weight gain outcomes than a swaddled infant. • KC allows self-regulatory and on-demand feeding. (more hunger cues, more feeding organization, more weight gain, shorter hospitalization) N is for Nutrition • Infants held in KC are more likely to initiate BF, continue BF, BF more frequently, BF longer, and exclusively BF. • Milk production increases with KC. KC mothers reported being warmer, sleepier, and thirstier than mothers without KC. • Lack of early contact with infants is a cause of BF failure. • Infant’s physiology is more stable while breastfeeding in KC.