The kangaroo method is safe for premature infants under 30 weeks of gestation during ventilatory support

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Abstract

A case control study into the safety of the kangaroo method in a group of ventilated prematurely born children less than 30 weeks of pregnancy was conducted. Four parameters, heart rate, oxygen saturation, respiratory rate and arterial blood pressure, were compared with one another 1 h before, 1 h after the start and 1 h after finishing kangaroo care. This nursing intervention is safe for this group of premature born infants. They are protected against the risk of decline in physiological stability during and after kangaroo care when the temperature of the infant is controlled and when necessary, extra warmth is provided.

Introduction

The kangaroo method, used in neonatal nurseries, is named after the manner in which a kangaroo carries her sibling in her pouch. After birth, the small and newborn sibling remains for many months in the pouch, where it is kept warm and feeds on the mother's milk until it is strong enough to survive outside its mother's pouch. This can be compared to how kangaroo care is provided in the nursery. During kangarooing the child wears a nappy and is placed, covered, on the bare chest of one of the parents. The kangaroo method is an intervention to encourage the bond between parents and child through skin to skin contact (Whitelaw and Sleath, 1985). The intervention was first used in 1978 in Columbia, Bogotá, because of a lack of incubators which resulted in a high death rate amongst premature infants. Other alternatives were researched and kangarooing seemed a good method, increasing the survival chances and a shorter hospitalisation. From 1985 onwards the kangaroo method has also been used in Western countries to encourage the bond between parents and child.

A separation between parents and their newborn infant can have a negative effect on social interaction and lead to problems in bonding (Christensson et al., 1992, Mangelsdorf et al., 1996). This can result in a change in sleeping pattern; increase in oral activity; limited growth; angriness; increase in motor activity; disturbed hormonal reactions; and an increase in heart rate (Hofer, 1994). In a study with rats these reactions were positively influenced by the introduction of stimuli such as warmth, smell and tactical stimuli (Rosenblatt, 1994).

It is indeed these stimulants which are offered in a large amount during kangaroo care. For a long period of time the kangaroo method has been used in stable premature infants to encourage bonding between parents and children. Until now it has been proven to be a safe intervention in premature newborns who are not on a ventilator or supported by continuous positive airway pressure (CPAP). Kangaroo care in these cases does not affect oxygen consumption and body temperature (Bauer et al., 1996). There is no deterioration of the physical condition and a few infants even have a reduction in oxygen use (de Leeuw et al., 1991).

Some children showed a clear improvement in cardio-respiratory stability and others a decrease in physiological stability, but then changes were never serious enough that the kangaroo method had to be terminated (Fischer et al., 1998). Clifford and Barnsteiner (2001) evaluated the oxygen usage, temperature, heart rate and respiratory rate in 7 children of 24–30 weeks of gestation of which the majority was supported on a mechanical ventilator, and found the kangaroo method to be safe.

The benefits of the kangaroo method have been proven for both children and the parents. In our NICU it was not standard to give kangaroo care to children under 30 weeks of gestation who are supported by a ventilator. To study its safety, we studied a group of premature infants under 30 weeks of gestation and compared four parameters, before, during and after the kangaroo session.

Section snippets

Methods

The study population consisted of 34 premature infants with a gestational age less then 30 weeks who were admitted to our NICU. They were divided into two age sub-groups: 18 infants born at a gestational age less than 28 weeks constituted group 1 and 16 infants born at 28–30 weeks of gestation constituted group 2 (Table 1).

Inclusion criteria were: a post-conceptional age of 25–30 weeks and the need for ventilatory support by Conventional Mechanical Ventilation (CMV), Nasal CPAP (nCPAP) or Infant

Results

No bradycardias or tachycardias were seen during or after kangaroo care. Heart rate decreased during kangaroo care and remained lower after kangaroo care (Fig. 1). Group 1 showed a decrease of 2.1% during (P = 0.002) up to 3.9% after kangaroo care session (P < 0.0001), when compared with the values before kangaroo care. Group 2 showed a decrease of 2.7% during (P = 0.0002) up to 4.2% after kangaroo care (P = 0.0001), when compared with the values before kangaroo care. Heart rate and skin temperature

Discussion

Based on the results of this study, premature infants under 30 weeks of gestation on a ventilator can safely receive kangaroo care to stimulate bonding between parents and child. The established parameters remained within the safety norms at all times. Heart rate, respiratory rate and oxygen saturation even improved during and after kangaroo care. The results of previous studies on more mature infants are in agreement with the results we found in this population of infants with a gestational age

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