Transcript EVIDENCE BASED PRACTICE: where is the evidence?

KANGAROO MOTHER CARE
Dr. M. Karanja
Kenyatta National Hospital
Principles of KMC
 Skin to skin contact between infant and
parent or other helpers
 Exclusive Brest milk feeds
 Early discharge with continued KMC
KMC COMPONENTS
 Kangaroo Position (skin to skin contact)
 Kangaroo Nutrition
 Kangaroo Support
 Kangaroo discharge
What is Kangaroo Position?
 Infant in upright position against mothers bare chest
between breasts
 Infants Kept naked except for nappy, socks and woollen
cap
 Infants Exhibits specific not-stress behaviour patterns
such as crawling towards the nipple and self
attachment.
 Both Mother and infant are usually covered by a
blanket or shirt.
What is Kangaroo Nutrition?
 Exclusive breastfeed on demand
 With KMC, Most infant breastfeed or feed on
expressed breast milk
 Infants have easy assess to mothers breasts.
 KMC increases the volume of breast milk that a
mother produces.
 Immature infants as 30 weeks can begin breastfeeding
partially or completely as it has been noted.
What is Kangaroo Mother Care?
 Is skin to skin care. The mother uses her own body
temperature to keep her infant warm
 It is useful for nursing low birth infant below 2500gm
 Provides basic needs for survival i.e. Warmth,
stimulation, breast milk, love and protection.
 NB Mothers Kangaroo care for her infant in a special
pouch day and night. In the pouch, the infant is war,
protected and able to suckle anytime it wants.
Where Did Kangaroo Care Start?
 Skin to skin against mother bare breast is not a new
idea. The idea was made popular in modern health
times by healthcare worker in Bogota (Capital of
Colombia in South America)
 From here, it was introduced to many developed and
developing countries.
NB. Doctors Rey and Mertines first started KMC in
Bogota in 1979 in response to a crisis with the
 Large numbers of low birth weight infants
 Shortage of staff and facilities
 Overcrowded nurseries
 High mortality due to hospital infection.
What is Kangaroo Support?
This is physical and emotional support
 Nursing and Medical staff to assist and encourage mothers
to provide KMC
 Whole family should be informed about KMC so that they also
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support the mother. Rest and sleep are essential for mother.
Father or partner is important in support.
Mothers own mother has a very important role to play in
helping her give KMC.
Community need to be told about KMC. A community
support helps mother succeed.
In hospital, clinics staff also require support.
Education support on KMC so that it I meaningful and can
continue in hospital and after discharge.
What is Kangaroo Discharge?
 Mother leaves the hospital with her infant in the
Kangaroo position and continues to provide at home.
 Predischarge plan is important each mother to
practise KMC in the hospital and make arrangement
for discharge home.
 The family be told that the infant will be receiving
KMC at home.
Advantages of KMC
Mother
 Has more confidence and bonding to the infant. Mother feels less
stressed.
 Empowered to play active role in the Infant care
 Breast feeding is promoted
 Less neglect and abandonment
 Able to choose breast feeding above formula feeding
Fathers
 Able to play a greater role in the care of infant
 Improves bonding between father and infant and important in
countries with high rate of violence towards children
Advantages Continued
Infants
Can be kept warm, stable with KMC
Serious infection is less
Less apnoea
Less stressed as mother and infant are together
Reduces mortality
Health care provider
 Fewer staff and less staff needed.
 Conventional incubators are expensive, often used
incorrectly are broken and cannot be repaired. They are
not cleaned properly and regularly, power supply often
unreliable.
 Infants can be discharged home early
 It is cheaper
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Advantages Continued
NB: KMC should be started as soon as possible.
Infants of normal weight are gestational age can
also benefit from KMC especially in cold
conditions.
Infants receiving KMC exhibit a vagal response
which promote growth and development and
speeds up the adjustment from an intre-uterine
an extra-uterin existence.
Is KMC Safe?
Yes
 The infant is kept war, heart rate and respiratory rates
are normal, less apnoea and bradycoardia and fewer
episodes of cyanosis. KMC should be demonstrated
and supervised by trained staff.
 Mother should be taught what danger signs to look
for (e.g. breathing difficult or cyanosis.
How does KMC keep infant warm?
 Temperature over the mothers breast warms the infants
naked skin.
 This keeps infant warm or warms a cold infant.
 If the infant is cold, the mothers skin become warmer of if
war, the mother’s skin cools down.
 A woollen cap keeps baby warm during KM. In cold
weather the infant can wear a cotton jacket with an open
in front.
NB: The temperature of an infant receiving KMC is slightly
higher that that of incubator in KMC, the mother’s skin
temperature may rise as much as 2oC to keep the baby warm.
How does KMC reduce risk of apnoea
and braclycardia ?
 Probably the constant temperature, together with the
mothers movement, breathing heart sounds that
simulate the infant and reduce apnoea, braclycardia.
 Incubators makes a constant sound and does not
move. Incubator babies cry more and sleep deep
from exhaustion.
 KMC babies require less oxygen and have better
oxygen saturation in their blood. They also sleep
longer.
How is Breast feeding Promoted by
KMC?
 Breast milk production is better and baby breast feed
longer. KMC promotes well-being of the mother as
she can see and touch her infant all the time. This
stimulates milk production and helps with let down
reflex.
 The secretion of both prolactin and oxytocin is
inhibited when a mother is anxious, unhappy, worried
and separated from an infant.
 Breast feed even formula fed babies benefit from
KMC.
Why does KMC improve Mother’s
Confidence ?
 They feel satisfied, relaxed and fulfilled
by the experience.
 It restores a mother’s self esteem,
which is often low after delivering a
low birth weight infant.
Why do infants receiving KMC have
fewer infections?
 Infants being given KMC become coloised
by mothers own skin bacteria.
 The cells and antibodies in the mother
breast milk are specially protective against
those bacteria which colonise her baby.
 They have less of sever infections as
necrotising enterocolities
How can KMC save Money?
 Breast feeding save cost of formula
 Fewer nurses are needed as mothers provides most of
the care to her infant
 Less hospital equipment
 Less infection, less infants are admitted in intensive or
special care units.
 Small infants are discharged home sooner.
When can infants receiving KMC
discharge home.
When;
 They are healthy and gaining weight
 They are breast feeding or cup feeding well
 Mother is confident and able to manage her infant
 Good follow-up care is provided.
KMC Can be
Intermittent
For infants who are vey small but still needs incubator
care.
Continuous
When baby no longer requires incubator and almost
ready for discharge
What is a KMC Ward?
 Special ward where mothers and their infants are kept
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together so that KMC is given all the time
Though supervised by nursing staff, mothers take
responsibility for all their infants care.
In a KMC ward mothers support and learn from each other.
A KMC ward provides wonderful opportunity to also teach
mothers about primary healthcare (immunization, family
planning, good nutrition.
NB: Intensive care infants can receive KMC if they are more
stable and no longer ill, but have to be monitored.
HIV positive mothers can also give KMC
Using KMC Care
How can health workers be persuaded to accept KMC
 Often not easy, any new idea is difficult to introduce at
first
 Clear description of KMC, advantages safety must be
presented to all staff including senior management.
 Visit to established KMC facilities
 Staffs must buy this new method
Kangaroo Implementation
 Staff acceptance of KMC
 Adopting KMC policy
 Writing KMC guidelines
 Training staff on KMC
 Establishing KMC facilities
 Managing ambulatory KMC
 Educating the community to accept KMC
All staff must e encouraged and trained to help mothers
provide KMC to their small infants.
KMC policy written statement to give benefits of KMC
and commits the service to implement and promote
KMC
Implementation continued
 NB: Bogota declaration on KMC at the 2nd
international workshop on KMC in Colombia in 1998,
declares that KMC is a basic right of the newborn and
should be integral part of the management of low
birth weight and full term new born in all setting and
at all levels of care and in all countries.
Who Promotes KMC?
 KMC should be promoted as safe, affordable method
of caring for newborn.
 The nurses, doctors, administrators, as community
members should do this. General public should also
know it.
 Infants grandmothers should also be trained to
support KMC in hospitals and home.
How are mothers informed about KMC?
 Benefits, safety and method must be explained to the
mother.
 Mothers should be talked to once a low birth infant is
born. She needs to know that she may nave to stay in
hospital longer, give KMC when discharged home and
attend follow-up clinic
How can you inform public about KMC?
 Teaching KMC in Schools
 Showing KMC in Media, specially TV and local news
papers
 Discussing the benefits of KMC in the media especially
Radio and Magazines
 Using KMC posters or video presentation in primary
health care clinic
NB: All pregnant women should know about KMC in the
antenatal clinic
Method of KMC
 Baby should be in frog position
 Keep infant upright to prevent vomiting
 Make sure airway is not obstructed.
 Head turned to one side, neck not flexed over
extended
 If mother lying she and her infant should be at an
angle of 45o C
Special Group
 Teenage mothers may be rebellious by nature-may
require special support.
 Other mothers may need to go home briefly for social
reasons.
Ambulatory KMC done when mothers and infant are
well, mother can walk about with baby in KMC as she
does her duties.
KMC for Transport
NB: Severely ill infants who are going to die can also be
given KMC (Compassionate KMC) Many parents want to
hug or hold their dying infants.