Original ArticleDoes Kangaroo care affect the weight of preterm/low birth-weight infants in the neonatal setting of a hospital environment?
Introduction
Kangaroo Care (KC) or Skin to Skin Care (SSC) is the method of placing an infant between or on the mother's breasts dressed only in a hat and nappy so that the frontal contact of mother and baby is skin to skin (Bigelow et al., 2012). KC was first identified and introduced in Bogota, Columbia in 1978, when incubator shortages necessitated keeping preterm infants warm through the “natural incubator” of skin to skin contact with a mother or carer (Leonard and Mayers, 2008). Physical growth and development is an integral part of neonatal recovery (Samra et al., 2013, Sharma et al., 2016). Weight gain in the neonatal setting is considered an indication of health and thriving and dictates the discharge home of these preterm and/or low birth weight infants (Dodd, 2005). This systematic review was undertaken to ascertain if kangaroo care contributes to the weight gain of preterm/low birth weight infants in the neonatal setting of a hospital environment. Weight gain of preterm/low birth weight infants through the provision of kangaroo care in a hospital setting only is unclear in previously undertaken systematic reviews.
A Conde-Agudelo and Diaz-Rossello (2016) SR aimed to determine whether KC with LBW infants reduces morbidity and mortality. It was concluded that kangaroo care does promote weight gain in LBW infants but the review followed infants that were not all in a hospital environment or a neonatal setting. They compared LBW infants including data from the hospital and at home. Additionally, they only included RCT's and disregarded the information from other quantitative studies. Boundy et al. (2016) conducted a systematic review to estimate the association between KMC and neonatal outcomes. Infants of any birth weight or gestational age were included and the literature was not limited to a hospital environment. Moore et al. (2012) SR assessed the effects of early SSC on breastfeeding, physiological adaptation and behaviour in healthy newborns weighing greater than 2500 g. Johnston et al. (2014) SR reviewed the effect of SSC on pain in neonates undergoing painful procedures. It did not detail any other effects on the infants. Chan et al. (2015) SR examined barriers and enablers of KC with regard to qualitative articles. Therefore, although the area of KC/SSC is well researched in recent years, a gap still remains with regards to how KC effects weight gain of preterm and/or LBW infants in the neonatal setting of a hospital environment only. It is therefore timely that a SR on KC with regard to weight gain in these infants is undertaken.
Section snippets
Methods
The PICO (population, intervention, comparison, and outcome) acronym gives structure to the framework of a SR (Higgins and Green, 2011). Population in this SR is preterm and/or LBW infants, intervention is KC, comparison is no KC and outcome is weight gain.
Results
The search results (See Fig. 1) identified 839 records which were then screened by two independent reviewers through reading titles and abstracts. This resulted in the exclusion of 824 records. 17 eligible quantitative records were included in the SR.
Discussion
It is apparent from this SR that KC is a positive factor in the increase of weight of preterm/LBW infants in a neonatal hospital environment. However, the reason weight gain occurs through KC can be considered physiologically subjective, but is yet supported through recent literature. Chiu and Anderson (2009) describe how quiet sleep states promote better physiological outcomes in infants, including weight gain. This state could be applied to the KMC method. Tourneux et al. (2009) report how
Conclusion
The authors recommend further research of the effects of KC on the weight gain of ill preterm/LBW neonatal infants. It is also apparent that further research is warranted in how many hours per day of KC are advisable in order to promote weight gain in these infants. Finally, the study of traditional and cultural practices in differing NICU's and how this affects preterm/LBW KC practices is an evident gap in the literature where a SR would be warranted.
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