|
|
|
|
|
|
|||
|
|
There are more than 200 publications on KMC or skin to skin contact, which prove the beneficial effect of KMC. The various outcome variables studied include:
References
EVIDENCE FOR KMC - EXPERERIENCE FROM INDIA 1. Kangaroo Mother Care in very low birth weight infants. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. Source Indian J Pediatr. 2001 Nov;68(11):1019-23 ABSTRACT OBJECTIVE: This study was conducted (i) to study through a randomized control trial the effect of Kangaroo Mother Care (KMC) on breast feeding rates, weight gain and length of hospitalization of very low birth neonates and (ii) to assess the acceptability of Kangaroo Mother Care by nurses and mothers. METHODS: Babies whose birth weight was less than 1500 Grams were included in the study once they were stable. The effect of Kangaroo Mother Care on breast feeding rates, weight gain and length of hospitalization of very low birth weight neonates was studied through a randomized control trial in 28 neonates. The Kangaroo group (n = 14) was subjected to Kangaroo Mother Care of at least 4 hours per day in not more than 3 sittings. The babies received Kangaroo Care after shifting out from NICU and at home. The control group (n = 14) received only standard care (incubator or open care system). Attitude of mothers and nurses towards KMC was assessed on Day 3 +/- 1 and on day 7 +/- 1 after starting Kangaroo Care in a questionnaire using Likert's scale. RESULTS: The results of the clinical trial reveal that the neonates in the KMC group demonstrated better weight gain after the first week of life (15.9 +/- 4.5 gm/day vs. 10.6 +/- 4.5 gm/day in the KMC group and control group respectively p < 0.05) and earlier hospital discharge (27.2 +/- 7 vs. 34.6 +/- 7 days in KMC and control group respectively, p < 0.05). The number of mothers exclusively breastfeeding their babies at 6 week follow-up was double in the KMC group than in the control group (12/14 vs. 6/14) (p < 0.05). CONCLUSION: KMC managed babies had better weight gain, earlier hospital discharge and, more impressively, higher exclusive breast-feeding rates. KMC is an excellent adjunct to the routine preterm care in a nursery. Top of Form 2. KMC facilitates mother baby attachment in low birth weight infants. Gathwala G, Singh B, Balhara B. Division of Neonatal Services, Department of Pediatrics, Pt. B.D. Sharma PGIMS, Rohtak, India. Source Indian J Pediatr. 2008 Jan;75(1):43-7. ABSTRACT OBJECTIVE:To determine whether Kangaroo mother care (KMC) facilitates mother baby attachment in low birth weight infants. METHODS: Over 16 month period 110 neonates were randomized into kangaroo mother care group and control group using a random number table. The kangaroo group was subjected to Kangaroo mother care for at least 6 hours per day. The babies also received kangaroo care after shifting out from NICU and at home. The control group received standard care (incubator or open care system). After 3 months followup, structured maternal interview was conducted to assess attachment between mothers and their babies. RESULTS: Mean birth weight was 1.69 +/- 0.11 Kg in KMC group compared to 1.690 +/- 0.12 Kg in control group (p>0.05). Mean gestational age was 35.48 +/- 1.20 week in KMC group and 35.04+/-1.09 week in the control group (p>0.05). KMC was initiated at a mean age of 1.72+/-0.45 days. The duration of KMC in first month was 10.21+/-1.50 hour, in the 2nd month was 10.03+/-1.57 hour and in the 3rd month was 8.97+/-1.37 hours. The duration of hospital stay was significantly shorter in the KMC group (3.56+/-0.57 days) compared to control group (6.80+/-1.30 days). The total attachment score (24.46+/-1.64) in the KMC group was significantly higher than that obtained in control group (18.22+/-1.79, p< 0.001). In KMC group, mother was more often the main caretaker of the baby. Mothers were significantly more involved in care taking activities like bathing, diapering, sleeping with their babies and spent more time beyond usual care taking. They went out without their babies less often and only for unavoidable reasons. They derived greater pleasure from their baby. 3. Feasibility of kangaroo mother care in Mumbai. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A.Lokmanya Municipal Medical College and General Hospital, Sion, Mumbai, India. Source Indian J Pediatr. 2005 Jan;72(1):35-8 OBJECTIVE:The purpose of this study was to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India. METHODS: A randomized controlled trial was performed over one year period in which 89 neonates were randomized into two groups kangaroo mother care (KMC) and conventional method of care (CMC). RESULTS: Forty-four babies were randomized into KMC group and 45 to CMC. There was significant reduction in KMC vs CMC group of hypothermia (10/44 vs 21/45, p-value < 0.01), higher oxygen saturations (95.7 vs 94.8%, p-value < 0.01) and decrease in respiratory rates (36.2 vs 40.7, p-value < 0.01). There were no statistically significant ifferences in the incidence of hyperthermia, sepsis, apnea, onset of breastfeeding and hospital stay in two groups. 79% of mothers felt comfortable during the KMC and 73% felt they would be able to give KMC at home. KMC is feasible, as mothers are already admitted in hospitals and are involved in the care of newborn. CONCLUSION:KMC is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of KMC demonstrated in the study. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all place 4. Kangaroo mother care for low birth weight infants: a randomized controlled trial. Suman Rao P N, Rekha Udani and Ruchi Nanavati From the Department of Neonatology, Seth GS Medical College and KEM Hospital, Mumbai, India. Correspondence to: Dr. Suman Rao PN, B 27, Kudremukh Colony, Koramangala II Block,
Bangalore 34, India. Source: Indian Pediatr. 2008 Jan;45(1):17-23. ABSTRACT OBJECTIVE:To compare the effect of Kangaroo mother care (KMC) and conventional methods of care (CMC) on growth in LBW babies (<2000 g). Study Design: Randomized controlled trial. Setting: Level III NICU of a teaching institution in western India. Subjects: 206 neonates with birth weight <2000 g. Intervention: The subjects were randomized into two groups: the intervention group (KMC-103) received Kangaroo mother care. The control group (CMC: 103) received conventional care. OUTCOME MEASURES:Growth, as measured by average daily weight gain and by other anthropometrical parameters at 40 weeks postmenstrual age in preterm babies and at 2500 g in term SGA infants was assessed. Results: The KMC babies had better average weight gain per day (KMC: 23.99 g vs CMC: 15.58 g, P<0.0001). The weekly increments in head circumference (KMC: 0.75 cm vs CMC: 0.49 cm, P = 0.02) and length (KMC: 0.99 cm vs CMC: 0.7 cm, P = 0.008) were higher in the KMC group. A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and sepsis. There was no effect on time to discharge. More KMC babies were exclusively breastfed at the end of the study (98% vs 76%). KMC was acceptable to most mothers and families at home. CONCLUSION:Kangaroo mother care improves growth and reduces morbidities in low birth weight infants. It is simple,acceptable to mothers and can be continued at home. 5. Effect of Kangaroo Mother Care Expressed Breast Milk Administration on Pain Associated with Removal of Adhesive Tapes in Very Low Birth Weight Neonates: A Randomized Controlled Trial Nanavati RN, Balan R, Kabra NS Department of Neonatology, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400 012, India. Correspondence to : Dr Nandkishor S Kabra, Department of Neonatology, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, Maharashtra,India. Source.: Indian Pediatr. 2013 May 5. doi:pii: S097475591200346. [Epub ahead of print ABSTRACT OBJECTIVE:To compare the pain relief effect of Kangaroo Mother Care (KMC) and Expressed Breast Milk (EBM) on the pain associated with adhesive tape removal in very low birth weight (VLBW)neonates. DESIGN:Randomized Controlled Trial. SETTING:Neonatal intensive care unit of tertiary care teaching hospital. PARTICIPANTS:15 VLBW neonates who needed adhesive tape removal for the first part and 50 VLBW neonates needing adhesive tape removal for the second part. METHODS:In first stage of the study, we demonstrated that the procedure of adhesive tape removal in VLBW neonates is painful. In the second stage, eligible VLBW neonates were randomised to compare the efficacy of KMC and EBM in reducing the pain during the procedure of adhesive tape removal. RESULTS:There was significant increase in pain associated with the removal of adhesive tape (Mean pre-procedure PIPP score 3.47±0.74; post-procedure mean PIPP score 12.13±2.59; P<0.0001. The post intervention mean PIPP pain score was not significantly different between the KMC and EBM groups (P= 0.62). CONCLUSIONS:Removal of adhesive tape is a painful procedure for VLBW neonates. There was no difference between KMC and EBM in relieving pain associated with adhesive tape removal. 6. Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial. Chidambaram AG, Manjula S, Adhisivam B, Vishnu Bhat B. Neonatal Division, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India. Source : J Matern Fetal Neonatal Med. 2013 Jul 18. [Epub ahead of print] ABSTRACT ABSTRACT BACKGROUND:Preterm neonates undergo several painful procedures in NICU including heel prick for blood sugar monitoring. Nonpharmacological interventions have been tried to decrease this procedural pain. There are only few studies on Kangaroo mother care(KMC) in reducing pain among preterm neonates. METHOD:This crossover trial was conducted at a tertiary care teaching hospital in southIndia. Premature Infant Pain Profile (PIPP) related to heel prick was assessed in 50 preterm neonates undergoing KMC and compared with 50 preterm babies without KMC. RESULTS:PIPP scores at 15 minutes and 30 minutes after heel prick were significantly less in KMC group compared to control group. Mean PIPP difference between baseline and 30 minutes after heel prick was also significantly low in KMC group CONCLUSION:KMC is effective in reducing pain due to heel prick among preterm babies. 7. KNOWLEDGE AND AWARENESS ABOUT BENEFITS OF KANGAROO MOTHER CARE. Muddu GK, Boju SL, Chodavarapu R. Department of Pediatrics, MGMH/Kakatiya Medical College, Warangal, Andhra Pradesh, India, Source Indian J Pediatr. 2013 Jun 8. [Epub ahead of print] ABSTRACT OBJECTIVE:To determine mothers' prior knowledge of Kangaroo Mother Care (KMC) and awareness about benefits of KMC for preterm babies. METHODS:Mothers of a consecutive sample of 46 preterm babies, eligible for KMC admitted to a teaching hospital, from June through August 2009, were studied to determine the attitude and knowledge about KMC. A structured questionnaire was prepared. Mothers were asked questions to determine their baseline knowledge about KMC. Then each mother was explained about KMC and instructed to do KMC. After one hour of KMC, mothers were asked questions again to know their feelings and difficulties regarding KMC and feasibility of breast feeding during KMC. RESULTS:Most of the mothers could understand what was explained to them (97.8 %; 95 % CI 88.5-99.9 %) in a single session. Positive feelings like closeness to baby (93.5 %) and sense of goodness (97.8 %) were noted amongst mothers. Though statistically not significant, the proportion of mothers who felt it impracticable to give breast feeding while doing KMC was considerable (39.1 %; 95 % CI 25.1-54.6 %) compared to those who felt no difficulty in breast feeding (60.9 %; 95 % CI 45.4-74.9 %). Practicable duration of KMC is 1, 2 and 12 h as felt by 52 %, 19.6 % and 6.5 % of mothers respectively. All the mothers expressed their willingness to continue KMC at home. CONCLUSION:Mothers can understand and implement KMC with simple and clear oral instructions in local language. Positive feelings arise in mothers even with 1 h of KMC. KMC of 24 h is not practicable to almost all of the mothers. There is a need for special emphasis on breast feeding the child while doing the KMC. 8. Kangaroo Mother Care in Kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants. Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S. Department of Neonatology, Fernandez Hospital, Hyderabad, India. Source: Acta Paediatr. 2012 Dec;101(12):e545-9. ABSTRACT AIM:To study the effect of Kangaroo mother care in the Kangaroo ward in comparison with conventional care at neonatal unit on growth and breastfeeding in very low birth weight infants at 40 weeks' corrected gestational age. METHODS:One hundred and forty neonates with birth weight <1500 g were randomized. The primary outcome was the average weight gain (g/kg/day) from the time of randomization to term gestational age. RESULTS:Mean birth weight, age in days and weight at randomization were similar in both the groups. At term gestational age, average weight gain (g/kg/day) post randomization (23.3 ± 8.7 g vs. 22.64 ± 9.1 g, p = 0.67) and breastfeeding rate (85.9% vs. 87.0%) were comparable. There was no difference in weight gain (g/kg/day) from randomization to hospital discharge between the Kangaroo care group and conventional care group (18.01 g vs. 15.64 g, p = 0.12). Mortality, morbidities like sepsis, hypothermia, apnoea, hypoglycaemia and duration of hospitalization were equally distributed. On average, 11.5 days of intermediate care were saved in the kangaroo group. CONCLUSION:Kangaroo mother care in the Kangaroo ward is as effective as conventional care in the neonatal unit without any increase in morbidity or mortality in stable VLBW infants. 9. KANGAROO MOTHER CARE IN REDUCING PAIN IN PRETERM NEONATES ON HEEL PRICK. Nimbalkar SM, Chaudhary NS, Gadhavi KV, Phatak A. Neonatal Unit, Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat 388325, India. Source: Indian J Pediatr. 2013 Jan;80(1):6-10. ABSTRACT OBJECTIVES:Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score. RESULTS:The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO(2)). The difference(4.85) in PIPP score was clinically and statistically significant (p��.0001). CONCLUSIONS:The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure. 10. EFFECT OF KANGAROO MOTHER CARE ON PHYSICAL GROWTH, BREASTFEEDING AND ITS ACCEPTABILITY. Gathwala G, Singh B, Singh J Department of Pediatrics, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak-124001, Haryana, India. Source: Trop Doct. 2010 Oct;40(4):199-202. ABSTRACTThe aim of this study was to determine whether the implementation of Kangaroo Mother Care (KMC) to low birth weight infants would improve physical growth, breastfeeding and its acceptability. A randomized controlled trial was performed over 16 months in which 110 neonates were randomized into a KMC group and a control group using a random number table. The KMC group was subjected to KMC for at least 6 h per day. The babies also received KMC after moving from the neonatal intensive care unit and at home. The control group received standard care(incubator or open care system). Weight, length and occipitofrontal circumference (OFC) were measured weekly for three months. The acceptability of KMC by mothers and nursing staff was assessed on day 7 after the start of KMC using a questionnaire incorporating the Likert scale. Breastfeeding rates were calculated based on history at end of three months. The mean gestational age was 35.48 ± 1.20 weeks in the KMC group and 35.04 ± 1.09 weeks in the control group (P > 0.05). KMC was initiated at a mean age of 1.72 ± 0.45 days and the duration of KMC was 9.74 ± 1.48 h/day. The mean birth weight was 1.69 ± 0.11 kg in the KMC group compared to 1.69 ± 0.12 kg in the control group (P > 0.05). The mean weight gain in gm/day in the KMC group was 21.92 ± 1.44 compared to 18.61 ± 1.28 in the control group (P < 0.05). The mean length gain in cm/week was 1.03 ± 0.5 in the KMC group compared to 0.74 ± 0.05 in the control group (P < 0.05). The mean OFC gain in cm/week was 0.59 ± 0.04 in the KMC group compared to 0.47 ± 0.03 in the control group (P < 0.05). The exclusive breast-feeding rate at end of three months was 88% in the KMC group compared to 72% in the control group (P < 0.05). KMC improved physical growth, breastfeeding rates and was well accepted by both mothers and nursing staff. 11. KANGAROO MOTHER CARE--AN ALTERNATIVE TO CONVENTIONAL CARE. Thukral A, Chawla D, Agarwal R, Deorari AK, Paul VK. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India Source: Indian J Pediatr. 2008 May;75(5):497-503 ABSTRACTThe term kangaroo mother care (KMC) is derived from practical similarities to marsupial care-giving, i.e., the premature infant is kept warm in the maternal pouch and close to the breasts for unlimited feeding. It is a gentle and effective method that avoids agitation routinely experienced in a busy ward with preterm infants. An important main stay of kangaroo mother care is breastfeeding encouragement. Observational studies have shown reduction in mortality after institution of KMC. Preterm babies exposed to skin to skin contact showed a better mental development and better results in motor tests. It also improves thermal care. All stable LBW babies are candidate for KMC. Often this is desirable, until the baby's gestation reaches term or the weight is around 2500 g. The mother and family members are encouraged to take care of the baby in KMC and should be counseled to come for follow-up visits regularly. 12. EXPERIENCE WITH KANGAROO MOTHER CARE IN A NEONATAL INTENSIVE CARE UNIT (NICU) IN CHANDIGARH, INDIA. Parmar VR, Kumar A, Kaur R, Parmar S, Kaur D, Basu S, Jain S, Narula S. Department of Pediatrics, Government Medical College Hospital, Chandigarh, India. Source: Indian J Pediatr. 2009 Jan;76(1):25-8 ABSTRACT OBJECTIVES:To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies. METHOD:A observation in the NICU. RESULTS:A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day, were included. The mean birth weight and gestation were 1460 gm and 30 week respectively. 47% babies started KMC within first week of age. Mean duration of KMC was 7 days (3-48) days. The O(2) saturation improved by 2-3%, temperature ( degrees C) rose from 36.75 +/- 0.19 to 37.23 +/- 0.25, respiration stabilized (p<0.05 for all) and heart rate dropped by 3-5 beats. No episodes of hypothermia or apnea were observed during KMC. KMC was accepted by 96 % mothers, 82% fathers and 84% other family members. 94% HCW considered it to be safe and conservative method of care of LBWI. Benefits of KMC on the babies' behavior and on maternal confidence and lactation were reported by 57%, 94% and 80% respectively. A decline in use of heating devices in the NICU was reported by 85% and 79% said it did not increase their work load. CONCLUSION:KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU settings. Positive attitudes were observed in mothers, families and HCW. 13. KANGAROO MOTHER CARE (KMC) IN LBW INFANTS--A WESTERN RAJASTHAN EXPERIENCE. Gupta M, Jora R, Bhatia R. Department of Pediatrics, Regional Institute of Maternal & Child Health, Umaid Hospital for Women and Children, Dr. S.N. Medical College, Jodhpur, India. Source: Indian J Pediatr. 2007 Aug;74(8):747-9. ABSTRACT OBJECTIVE:This study was taken to study the various beneficial effects of KMC in LBW babies. METHODS:50 LBW babies (birth weight> 2 kg) two who delivered at Umaid Hospital, RIMCH Jodhpur included in this study and they have given KMC 4-6 hours/day in 3-4 settings. Maternal & Neonatal characteristics and complications prospectively recorded. RESULTS:Of 50 LBW babies enrolled, M:F ratio was 1.5:1 and mean birth weight was 1.487 +/- 0.175 kg. The mean age at which KMC started was 4+/-1.738 days. The mean weight gain was 29 +/- 3.52 g, mean age of discharge 23.6 +/- 3.52 days and mean duration of hospital stay was 15.5 +/- 11.3 days. CONCLUSION:KMC is effective and safe in stable preterm infants and as effective on traditional care with incubators. KMC because of its simplicity may have a place in home care of LBW babies. 14. FEASIBILITY OF KANGAROO MOTHER CARE IN MUMBAI. Kadam S, Binoy S, Kanbur W, Mondkar JA, Fernandez A. Lokmanya Municipal Medical College and General Hospital, Sion, Mumbai, India. Source: Indian J Pediatr. 2005 Jan;72(1):35-8. ABSTRACT OBJECTIVE:The purpose of this study was to determine the feasibility and acceptability of kangaroo care in a tertiary care hospital in India METHODS:A randomized controlled trial was performed over one year period in which 89 neonates were randomized into two groups kangaroo mother care (KMC) and conventional method of care (CMC). RESULTS:Forty-four babies were randomized into KMC group and 45 to CMC. There was significant reduction in KMC vs CMC group of hypothermia (10/44 vs 21/45, p-value < 0.01), higher oxygen saturations (95.7 vs 94.8%, p-value < 0.01) and decrease in respiratory rates (36.2 vs 40.7, p-value < 0.01). There were no statistically significant differences in the incidence of hyperthermia, sepsis, apnea, onset of breastfeeding and hospital stay in two groups. 79% of mothers felt comfortable during the KMC and 73% felt they would be able to give KMC at home. KMC is feasible, as mothers are already admitted in hospitals and are involved in the care of newborn. CONCLUSION:KMC is a simple and feasible intervention; acceptable to most mothers admitted in hospitals. There may be benefits in terms of reducing the incidence of hypothermia with no adverse effects of KMC demonstrated in the study. The present study has important implications in the care of LBW infants in the developing countries, where expensive facilities for conventional care may not be available at all place. |
|
|
|
|
Copyright \A9 2004 Kangaroo Mother Care Initiative, India. All Rights Reserved. Disclaimer |
|
