KANGAROO CARE - NURSING ASSIGNMENT

INTRODUCTION

        Caring low birth weight baby is a great challenge for the neonatal care unit and the family. Number of low birth weighs baby is still for beyond the expected target in our country. The cost of the quality management of these babies is increasing day by day. Kangaroo care is low cost approach for the care of low birth weight baby. This method of care was introduced and popularized by Dr.Edger Ray, Dr.Martinez and Dr.Charpak in late 1970s.

DEFINITION

        Kangaroo Mother Care (KMC) is a special way of caring low birth weight infants by skin to skin contact if promotes their health and welling by effective thermal control, breast feeding and bonding. KMC is initiated in hospital and continued at home.

COMPONENTS OF KMC

        In KMC, the infant is continuously kept in skin contact by the mother and breastfed exclusively to the utmost extent.

        The two components of KMC are;

1.   Skin to skin contact is provided between the mother and her baby to promote thermal control.

2.   Exclusive Breast Feeding: Skin to skin contact promotes lactation and feeding interaction with exclusive breast feeding for adequate nutrition and to improve desired weights gain.

PRE-REQUISITES OF KMC

1.   Support to the mother: Mother needs support in hospital and home from care gives and family members

2.   Post discharge follow up: KMC should be continued at home after discharge from hospital. For safe and successful KMC at home, a regular follow up should be arranged to solve problem and to evaluate health status of the infant.

BENEFITS OF KMC

·        KMC helps in thermal control and metabolism. Prolonged continuous and direct skin-to-skin contact between mother and neonate provides effective thermal control and reduces risk of hypothermia.

·        KMC results in increased duration and rate of breast feeding.

·        KMC satisfied all five senses of the infants. Baby feelds warmth of the mother through skin-to-skin contact (touch), listen to mother voice and heart beat (hearing), sucks the breast to feed (taste) smells the mothers odor (olfaction) and makes eye contact with mothers (vision)

·        During KMC, the baby has more regular breathing and less predisposition soaphea

·        KMC protects against nosocomial infection and reduces incidence of severe illness including pneumonia during infancy

·        Daily weight gain is slightly better with KMC, thus duration of hospital stay may be reduced. LBW baby receiving KMC should be discharged from the hospital earlier than conventional care.

·        KMC facilities better mother-infant bondage due to significantly less stress during Kangarooing than the incubator care of the baby.

·        KMC is one of the best methods of transporting small babies by keeping them in continuous skin-to-skin contact with mother or family members.

·        Mother feels increased confidence, self steam, sense of fulfillment and deep satisfaction with KMC. Father feels more relaxed, comfortable and better bonded.

·        KMC does not require additional staff compared to incubator care.

REQUIREMENTS FOR KMC IMPLEMENTATION

·        Training of nurses, doctors and other staff on KMC, specially who are involved in care of mother and baby.

·        Educational materials like information booklets, pamphlets, poster, video film etc on KMC in local language.

·        KMC does not require extra staff once KMC is implemented, care gives appreciate its because of health benefits to the babies and the satisfaction expressed by the mother.

ELIGIBILITY CRITERIA FOR KMC

For baby;

·        All stable IBW babies are eligible for KMC. It is particularly useful for caring LBW infants weighing below 2000gm

·        In a stable baby, KMC can be initiated soon after birth

·        KMC should be started after the baby is hemadynamically stable

·        Silk LBW infants may take a few days to initiate KMC. So the silk baby needs transfer to a proper facility immediately

·        Infants of birth weight less than 1200 gms with serious prematurity related morbidity may take days to weeks to allow initiation of KMC

·        KMC can be initiated who is otherwise stable but may still be on IV fluid therapy, tube feeding and or O² therapy

For mothers;

·        All mothers can provide  KMC irrespective of age, parity, education, culture and religion

·        Mother should be free of serious illness and able to take adequate diet and supplements recommended by her doctors

·        She must be willing to provide KMC to her baby

·        She should maintain good hygiene, daily both/sponge, change of cloths, hand hygiene, short and clean finger nails etc

·        She should have supportive family and community to be encouraged to continue KMC to her baby

PREPARATION FOR KMC

Counseling:

·        Explain the benefits of KMC to the mother and the family members

·        Demonstrate the procedure to the mother gently with patience

·        Answer the questions as asked by the mother and the family members to remove anxiety.

·        Allow the mother to interact with someone who have already practicing KMC for her baby.

·        Discuss about the procedure to the mother-in-law, husband or any other members of the family

Mothers Clothing

·        Mothers should wear front open, light does as per local confuse

Baby’s Clothing

·        Baby should be dressed with front open sleeveless shirt, cap, socks, happy and hand gloves.

KMC PROCEDURE

Kangaroo Positioning

·        The baby should be placed between the mothers breast in an upright position

·        Baby’s head should be turned to one side and in a slightly extended position which helps to keep the airway open and allow eye to eye contact between mother and baby

·        Baby’s hip should be flexed and abducted in a frog like position. The arms should also be flexed and placed on mothers chest

·        Baby’s abdomen should be placed at the level of mothers epigastrium

    This position helps to reduce the occurrence of aphea, as mother’s breathing and heart beat stimulate the baby.

Monitoring during KMC

·        During initial stage of KMC the baby should be monitored for airway, breathing, colour and temperature. Hands and feet should be examined to assess the warmth. Airway must be kept clear with regular breathing, normal skin colour and temperature

·        Baby’s neck position should be neither too flexed nor too extended

Feeding

·        Mother need help to breast feed her baby during KMC. Holding the baby near the breast stimulates milk production and the Kangaroo position make the breast feeding easier

·        Baby could fed with paladai, spoon tube depending upon the baby’s condition

Psychological Support to Mother

·        Mother need motivation to continue KMC

·        She should be encouraged to ask questions to remove anxieties

Privacy

·         Privacy should be maintained to avoid unnecessary exposure on the part of the mother which makes her nervous and de-motivating

Time of Initiation of KMC

·        KMC should be initiated gradually with a smooth transition  from conventional care to continuous KMC

·        KMC can be started as soon as the baby is stable in the neonatal care unit

·        Short KMC sessions can be initiated during recovery with on going medical treatment, i.e. IV fluid, O₂ therapy  etc

·        KMC can be provided while the baby is with gavage feeding

Duration of KMC

·        Duration of KMC should not be less than one hour to avoid frequent handling which may be stressful to the baby

·        Gradually the length of KMC sessions should be increased upto 24 hours a day. Interruption only can be done for changing of diapers

·        KMC should be continued in postnatal ward and home

·        It may not be possible for mother to provide KMC prolonged period in the beginning. Encourage her to increase the duration each time to provide KMC as long as possible

·        When mother is not available then other family members such as father, grand father, aunty can provide KMC

·        Mother can sleep with baby in KMC position in a reclined or semi-recumbent position about 15-30 from above the ground

·        A comfortable chair with adjustable back may be useful to provide KMC during sleep and rest at ward or home

·        Adjustable bed or several pillows or an ordinary bed can be used to maintain the position which usually decreased the risk of apnea of the baby

·        Supporting garment can be used to carry the baby in kangaroo position during sleep and rest

DISCHARGING CRITERIA

        The baby should be discharged from hospital when the baby is having the following conditions;

·        General health is good and there is no evidence of infection and apnea

·        Feeding well exclusively with breast milk

·        Gaining weight 15-20 gm/kg/day for at least three consecutive days

·        Maintaining normal body temperature satisfactorily for at least three consecutive days in room temperature

·        Mother and family members are confident to take care of the baby at home and would able to come regularly for follow up visits

·        Home environment should be suitable and cogenial for continuation of KMC

DISCONTINUATION OF KMC

·        KMC can be continued until the baby gains weigh around 2500 gm or reaches 40 weeks of post conception age

·        KMC can be discontinued or pulls limbs out, cries and fusses every time, when mother tries to put the baby back into skin contact

·        When mother and baby are comfortable KMC can be continued as long as possible of health facility or at home.

·        Mother can provide skin-to-skin contact occasionally after the baby bath and during cold nights

NURSES ROLE IN KMC

        Help mother to obtain a proper position for Kangaroo mother care it in a recline or semi recumbent position.

·        Provide a comfortable chair with adjustable back to provide KMC during sleep

·        Provide adjustable bed or several pillows for comfort during KMC

·        Advice the mother about the importance of KMC, positioning

·        Remove all anxieties from mother mind by maintaining good IPR

·        Help the mother and baby to was the clothing

·        Give information about KMC in educational material like in booklet or pamphlets

·        Advice the mother to maintain her personal hygience, and other hygiene’s also

CONCLUSION

        Caring low birth weight baby is great challenge for the neonatal care unit and the family. Number of low birth weight baby is still for beyond the expected target in one country. The cost of quality management of these babies is increasing day by day. Kangaroo mother care is low cost approach for the low birth weight baby.

BIBLIOGRAPHY

·        A Text Book of Child Healthy Nursing

Second Edition, Page No. 109-112

l'>·        A Text Book Obstetrics of D C Dutta

6^th Edition, Page No. 218-220

·        Myles Text Book of midwives

14^th Edition, Edited by Diane M Fraser and Margaret A Cooper

Page No. 216-217