Transcript Evaluation of Kangaroo Care on Newborn Thermoregulation

Emily Forward, RN, Margaret Gerulski, RN, Mary
Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN
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Evaluate the benefit of Kangaroo Care to the
neonate
Providing evidence-based research to provide
mothers and newborns a more natural birth
experience
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Minimize separation of the maternal-infant
couplet to enhance birth experience
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Provide cost effective care
“What does the literature say
about kangaroo care (KC), also
known as skin-to-skin care, in
the regulation of the
thermoregulatory system of the
neonate?
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In term newborns born vaginally, will the
axillary temperature remain within the normal
range in infants placed skin-to-skin
immediately after birth compared with infants
placed within minutes of birth under a radiant
warmer during the first hours of life?”
Literature Eliminated
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Critical evaluation of ten selected articles
Articles were examined for appropriateness
to the purpose statement, reliability, and
validity (Nieswiadomy, 2008, p. 63)
Qualifications of the researchers and the
ethical content was also analyzed
(Nieswiadomy, p. 29)
Articles not meeting criteria were eliminated
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A comparison of skin-to-skin contact and radiant heaters in
promoting neonatal thermoregulation (Fardig, J., 1980).
This was an outdated source
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Keeping infants warm: Challenges of hypothermia (Mance,
2008).
Involved preterm infants which did not meet the criteria set in
the purpose statement
Temperature variation in newborn babies: Importance of
physical contact with the mother (Fransson, Karlsson, &
Nilsson, 2005).
Article did not discuss skin-to-skin content and the research
did not start until four to eight hours after birth
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The effect of skin-to-skin contact (kangaroo care) shortly
after birth on the neurobehavioral responses of the term
newborn: A randomized, controlled trial (Ferber & Makhoul,
2004).
Focused on infants neurological behavior with minimal
discussion regarding temperature
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Kangaroo mother care: 25 years after (Charpak et al., 2005).
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Early skin-to-skin contact for mothers and their healthy
infants (Anderson, Moore, Hepworth, & Bergman, 2003).
Difficult to follow, and mainly pertained to the unhealthy
newborn in underdeveloped countries with a minimal
discussion regarding temperature
Article only consisted of one page and required advance
knowledge of statistics in order to understand
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Gretchen A. Dabrowski RN, BSN
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Qualitative evidence-based discussion
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Utilizes historical studies
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The article’s findings provided evidence that
“newborns placed skin-to-skin with mothers
remained considerably warmer during the
first three hours of life” (Dabrowski, p. 66)
Kangaroo Care at Birth for
Full Term Infants: A Pilot
Study
Mary W. Walters, MS, RN.
Kim M. Boggs, MSN, RN, BC.
Susan Ludington-Hoe, PHD, CNM, FAAN.
Kimberly M. Price, RN, IBBCLC.
Barbara Morrison, PHD, FNP, CNM.
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Level I qualitative research study
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Approval obtained from hospital review board
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All of the researchers practiced in women's health
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Clear purpose statement
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Outlined clearly in a systematic process discussing
the descriptive design
Judith S. Mercer CNM, DNSc
Debra A. Erickson-Owens CNM, Ms
Barbara Graves CNM, MN, MPH
Mary Muford Haley CNM, MS
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Article listed additional findings to benefit neonate.
Clear summarization of articles reviewed
Findings significant for the benefit of this
intervention (p<or =0.02-0.03)
Large population used for study and randomized
controlled trials
Benefits of KC care shown for long and short-term.
Article supports the benefit of maintaining and
increasing temperature when infant placed skinto-skin
Recommendation made of KC care
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Rintaro Mori, MD, PHD, MSc, FRCPCH
Rajesh Khanna
Debbie Pledge
Takeo Nakayama
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Peer reviewed journal
Recent publication 2010
Significantly related to the research question
Directly evaluated physiological parameters
affecting infants before-and-after the KC
intervention to evaluate safety
Consisted of both systematic reviews and
random-controlled trials
Methods categorized
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Meta-analysis included 23 studies, consisting of
13 before-after studies, five randomized control
trials, a cross-over trial, and four cohort studies
Limitations of studies were acknowledged
Confounding variables were eliminated to
increase validity
p value was < 0.05 making this study significant
in findings
Findings of this article showed an increase in
body temperature during skin-to skin contact
Barrier
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The desire by the
mother to allow
visitors to hold the
baby was reported
(Anderson et al, 2003)
Bridge
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Provide education and
encouragement to
mothers regarding
what KC is and the
benefits KC has been
shown to provide
Barrier
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The attitude of health
care providers is noted
to be a barrier to KC.
This may be due to a
lack of knowledge
regarding the benefits
of KC or fear of a
change in practice
Bridge
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The provision of
adequate education to
both healthcare
providers and patients,
including their
families, is a potential
way to solve these
barriers (Dabrowski, p.
65)
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Patient preference is an important aspect of
implementing any evidence-based nursing
practice (Nieswiadomy, 2008, p. 8)
Nurses should provide education and support
for kangaroo care, but allow patients to
express their preference about the utilization
of kangaroo care
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The evidence highly supports a change in practice,
encouraging skin-to-skin contact at birth
The evidence correlates well with the expectations
of evidenced-based medicine research
Each of the articles selected clearly defines the
purpose of the study
All of the selected articles are rated as level I or
Level II, with the exception of one article, according
to hierarchy of evidence
The articles chosen contain recent findings, with
the oldest article being from 2007
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“Birthing units that separate mothers and babies with the
intention of preventing cold stress unwittingly increase
the risk of cold stress, and at the same time deprive the
pair of intimacy and bonding while delaying
breastfeeding initiation” (Mercer et al., 2007, p. 267)
“The evidence suggests that skin-to-skin contact should
be the mainstay of newborn thermoregulation” (Mercer et
al., 2007, p. 267)
The benefit of increasing fetal well-being is the primary
focus in these studies
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Initiation of skin-to-skin contact immediately after
birth is an evidence-based nursing practice
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More effective than the use of radiant warmers
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Has many other benefits
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Cost effective and more natural extension of the
birth process
The search of the literature and evaluation of current
research support the recommendation to change the
hospital’s current practice
Implement Kangaroo Care
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Anderson, G., Shiu, S., Dombrowski, M., Swinth,
J., Albert, J., & Wada, N. (2003). Mothernewborn contact in a randomized trial of
kangaroo (skin-to-skin) care. JOGNN: Journal
of Obstetric, Gynecologic & Neonatal Nursing,
32(5), 604-611.
doi: 10.1177/0884217503256616
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Anderson, G. C., Moore, E., Hepworth, J., and
Bergman, N. (2003). Early skin-to-skin contact
for mothers and their healthy newborn infants.
Birth, 30(3), p. 206–207. doi: 10.1046/j.1523536X.2003.00247.x
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Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A.,
Figueroa, Z., Tessier, R., Cristo, M., Anderson, G.,
Ludington, S., Mendoza, S., Mokhachane, M., and
Worku, B. (2005), Kangaroo mother care: 25 years after.
Acta Pædiatrica, 94(5), p. 514–522.
doi: 10.1111/j.1651-2227.2005.tb01930.x
Dabrowski, G. (2007). Skin-to-skin contact: Giving birth
back to mothers and babies. Nursing for Women's
Health, 11(1), p. 64–71. doi: 10.1111/j.1751486X.2007.00119.x
Fardig, J. A. (1980). A comparison of skin-to-skin
contact and radiant heaters in promoting neonatal
thermoregulation, Journal of Nurse-Midwifery, 25(1), p.
19-28. doi: 10.1016/0091-218(80)90005-1
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Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-toskin contact (kangaroo care) shortly after birth on the
neurobehavioral responses of the term newborn: A
randomized, controlled
trial. Pediatrics, 113, 4. p.858(8). Retrieved from:
http://www.pediatrics.org/cgi/content/full/113/4/858
Ford, L. C. (2010). Evidence based nursing practice project:
NURS 350 Research in nursing. Retrieved from Ferris State
University School of Nursing, Ferris Connect website:
http://myfsu.ferris.edu/webct/urw/lc1399024356061.tp14
06116086031/displayContentPage.dowebct?pageID=14639
32005011&resetBreadcrumb=false&displayBCInsideFrame=
true
Fransson, A., Karlsson, H., Nilsson, K. (2005). Temperature
variation in newborn babies: Importance of physical contact
with the mother. Archives of Disease in Child: Fetal
Neonatal Edition, 90(6), p. F500-504. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721966/
doi:10.1136/adc.2004.066589
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Galligan, M. (2006). Proposed guidelines for skin-toskin treatment of neonatal hypothermia. MCN: The
American Journal of Maternal Child Nursing, 31(5),
298-306. Retrieved from:
http://www.nursingcenter.com/_PDF_.aspx?an=0000
5721-200609000-00007 .
Mance, M. (2008) Keeping infants warm: Challenges
of hypothermia. Advances in Neonatal Care, 8(1), 612. doi:10.1097/01.ANC.0000311011.33461.a5
Mercer, J. S., Erickson-Owens, D. A., Graves, B.,
Mumford Haley, M. (2007). Evidence based practices
for the fetal to newborn transition. Journal of
Midwifery & Women’s Health, 52(3), p.262-272.
doi:10.1016/j.jmwh.2007.01.005
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Mori, R., Khanna, R., Pledge, D. and Nakayama, T.
(2010). Meta-analysis of physiological effects of
skin-to-skin contact for newborns and mothers.
Pediatrics International, 52(2), p. 161–170.
doi: 10.1111/j.1442-200X.2009.02909.x
Nieswiadomy, R. (2006). Foundations of nursing
research. (5th ed.). Upper Saddle, New Jersey:
Pearson Prentice Hall.
Walters, M. W., Boggs, K. M., Ludington-Hoe, S., Price,
K. M., Morrison, B. (2007). Kangaroo care at birth for
full term infants: A pilot study. The American Journal of
Maternal/Child Nursing, 32(6), p. 375-381.
doi:10.1097/01.NMC.0000298134.39785.6c