Sunday, April 8, 2007

Kangaroo Care: Why Does It Work?

Kangaroo Care: Why Does It Work?
By the early 1980s, the mortality rate for premature infants in Bogota, Colombia was 70 percent. The babies were dying of infections and respiratory problems as well as lack of attention paid to them by a bonded parent. "Kangaroo care" for these infants evolved out of necessity. Mothers of premature infants were given their babies to hold twenty-four hours a day-they slept with them and tucked them under their clothing as if in a kangaroo's pouch. If a baby needed oxygen, it was administered under an oxygen hood placed on the mother's chest.
Doctors who conducted a concurrent study of the kangaroo care noticed a precipitous drop in neonatal mortality. Babies were not only surviving, they were thriving. Currently in Bogota, babies who are born as early as ten weeks before their due date are going home within twenty-four hours! The criteria for these babies is that they be alive, able to breathe on their own, are pink and able to suck. However, their weight is followed closely, and they can be gavage-fed if necessary.
Dr. Susan Ludington is one of the people who have been most instrumental in bringing kangaroo care to the United States. She has been intimately involved in many research projects, and her work is having a powerful, positive impact on premature babies and their families. In the United States, the few hospitals that regularly use kangaroo care protocols have mothers or fathers "wear" their babies for two to three hours per day, skin-to-skin. The baby is naked except for a diaper, and something must cover his or her back—either the parent's clothing or a receiving blanket folded in fourths. The baby is in a mostly upright position against the parent's chest.
The benefits of kangaroo care are numerous: The baby has a stable heart rate (no bradycardia), more regular breathing (a 75 percent decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of "purposeless" activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge. Benefits to the parents include "closure" over having a baby in NICU; feeling close to their babies (earlier bonding); having confidence that they can care for their baby, even better than hospital staff; gaining confidence that their baby is well cared for; and feeling in control—not to mention significantly decreased cost!
Why does kangaroo care work? Why are Dr. Ludington and others seeing such phenomenal results with babies in kangaroo care? What is happening to the baby and the mother during this time?
One of the first things to happen is that maintenance of the baby's body temperature begins to depend on the mother, requiring the baby to use fewer calories to stay warm. Mothers naturally modulate the warmth of their breasts to keep their infants at the optimal temperature where babies sleep best, have the best oxygen saturation levels, the least caloric expenditure, and so forth. Maternal breast temperature can rise rapidly, then fall off as baby is warmed. As the baby starts to cool, the breasts heat up again—as much as 2 degrees C in two minutes!
Being next to morn also helps the baby regulate his or her respiratory and heart rates. Babies experience significantly less bradycardia and often, none at all. The respiratory rate of kangarooed infants becomes more stable. The depth of each breath becomes more even, and apnea decreases four-fold and often disappears altogether. If apneic episodes do occur, the length of each episode decreases. In my own experience with a baby in NICU for bradycardia and apnea, I found that both problems disappeared completely when I was home kangarooing my baby.
During kangaroo care, a premature baby's overall growth rate increases. This is in part due to the baby's ability to sleep, thus conserving energy and putting caloric expenditure toward growth. According to Dr. Ludington, during the last six weeks of pregnancy, babies sleep twenty to twenty-two hours per day. In a typical NICU, however, they spend less than two hours total in deep, quiet sleep. Most of that comes in ten or twenty second snatches. With kangaroo care, the infant typically snuggles into the breast and is deeply asleep within just a few minutes. These babies gain weight faster than their non-kangarooed counterparts, and it is interesting to note that they usually do not lose any of their birthweight.
Researchers have gained significant insight into what happens to an infant's brain during kangaroo care. Any baby's heart rate and respiratory rates can be plotted as a sort of artistic drawing. Because premature infants lack the ability to coordinate their breathing and heart rates, the rates "plot out" as chaotic. This means with increased demand on the cardiovascular system, as with crying or fussing, the system does not respond with a related increase in cardiac output. In other words, the baby's respiratory rate may increase while crying, but the heart rate does not. As premies mature, these rates become synchronized, or "coupled," resulting in an orderly drawing when the rates are plotted together. The drawing no longer looks random.
In infants in kangaroo care, researchers found that coupling takes place after only ten minutes. This hardly seemed possible because it equaled four weeks of brain development in the "normal" premie. As researchers studied brain wave patterns of infants in kangaroo care, they found two significant things. First, there was a doubling of alpha waves—the brain wave pattern associated with contentment and bliss. Second, they found that "delta brushes" were occurring. Delta brushes happen only when new synapses are being formed. So holding the infant skin-to-skin allows his or her brain to continue its work of developing neural synapses.
Imagine the implications if all infants "at risk" were kangarooed. Dr. Ludington sums up kangaroo care very aptly by saying "Separation is not biologically normal."
Helping our clients understand their options, including risks, benefits and alternatives, is a very important part of being "with woman." Knowing enough about kangaroo care to help them make informed decisions is another important tool for the caregiver's birth bag. All infants benefit from skin-to-skin contact, breastfeeding, shared sleep and so forth, but some babies very seriously need kangaroo care. They include premature infants, infants with low muscle tone or disabilities, high-needs infants, those with intrauterine growth retardation or those who have a hard time gaining weight. Midwives would do well to learn the basics of kangaroo care, and where to turn for further information. Adding Dr. Ludington's book Kangaroo Care to one's library is a good first step. Being supportive of parents and giving encouragement and positive reinforcement is also very helpful. Remember that in some instances, kangaroo care has meant the difference between life and death.
Close Contact
How Kangaroo Care Can Help Your Preemie
By Lyn Mettler
Most new parents get to bond with their babies immediately after birth, but according to experts, 7 percent of all babies are born premature, and those parents may have to wait weeks before ever holding their baby. Thanks to a technique called "Kangaroo Care," however, parents of premature babies are getting to hold their newborns much sooner – and help their little ones at the same time.
Krisanne and Gene Larimer of Colorado Springs, Colo., only had to wait five days before holding their baby girl who weighed just over a pound at birth. Krisanne nervously tried touching her baby, only to be discouraged by alarms alerting nurses to a problem with the baby’s heart. When she tried Kangaroo Care, with the baby skin-to-skin on her chest, it was a different story. "Every time I’d touched her before that, her alarms would just sound," says Larimer. "With Kangaroo Care, there were no alarms. I felt like a mom for the first time then."
Kangaroo Care allows moms and dads to hold their babies, wearing only diapers, on their bare chest up to several times a day. This skin-to-skin contact has numerous benefits, both emotional and physical, for both the baby and parents. "We mammals have been doing this for eons," says Theresa Kledzik, an infant development nurse specialist at Memorial Hospital in Colorado Springs, Colo. "It seems like a natural instinct thing to do."
Healthy Benefits for BabyDoctors in Bogotá, Colombia developed the technique in 1983 in response to the number of premature babies dying at their hospital. Because the facility had unreliable equipment and power, the doctors decided to see if the babies would do better with their moms. The women carried their babies around all the time on their bare chests – under their shirts, in their bras or in specially-designed pouches (thus the term "kangaroo"). Through Kangaroo Care, the doctors were able to decrease the mortality rate from 70 percent to 30 percent.
After these findings, the world began to take note and do further research on Kangaroo Care. The idea first spread through Europe, and then in 1988, Susan Ludington, currently a professor at the University of Maryland School of Nursing, began doing studies in the U.S. Now hospitals across the country and the world are offering Kangaroo Care, and countless research studies have documented the benefits.
Placing babies on bare skin helps keep them warm, a task that is difficult for premature babies who have not yet developed the layer of fat that full-term babies have. Moms also seem to have an innate way of adjusting their body temperature to meet the baby’s needs. For example, if Baby gets too hot, Mom will cool down and vice versa. Ludington, also the author of Kangaroo Care: The Best Thing You Can Do to Help Your Preterm Infant, says Kangaroo Care helps the baby develop a regular heart rate and breathing pattern. It also reduces periods of apnea, when babies stop breathing, and increases oxygen in the blood.
Babies in Kangaroo Care also grow and gain weight more quickly. Studies have found that they go to sleep twice as often, get more restful sleep and are more alert, relaxed and calm when they are awake. Kangaroo Care often enables babies to go home from the hospital earlier, saving much wear and tear on parents who may have already spent days or weeks with their babies in the stressful neonatal intensive care unit (NICU).
Skin-to-skin Stress Relief for Mom and DadKangaroo Care also can help reduce some of the stress of the NICU for both parents and babies, as well as the fear and nervousness parents may feel about handling their baby. "It is a very stressful environment for parents," says Dr. Scott Johnson, the medical director of neonatal services at Piedmont Hospital in Atlanta, Ga. "They feel helpless and are worried about the baby’s medical condition. It’s intimidating. Some are even scared to death to touch them. I’ve seen [Kangaroo Care] greatly decrease the level of anxiety they feel in visiting their baby. It allows them to gradually get more comfortable and feel better caring for the baby, easing the transition from hospital to home."
Larimer says she was afraid to hold her own baby, but overcame the fear quickly. "I was scared to death to hold her. I couldn’t breathe for the first few minutes," says Larimer, who advises parents to give it a try despite their reservations. "Even though you’re scared to death to try it, it’s the best feeling you’ll ever have." Larimer has developed a free booklet for parents of premature babies who may be scared or unsure about Kangaroo Care that is available through her Web site at
Researchers have found that babies receive the same benefits by "kangarooing" with their dad as they do with their mom. According to Ludington, though, the baby is naturally immune to Mom’s germs – but not to Dad’s, so fathers need to "scrub up" before holding the baby.
With twin boys born at 28 weeks, Matthew and Suzanne Howard of Smyrna, Ga., were nervous about Kangaroo Care, but they worked it out so each held a baby. Though Matthew was unsure about holding the babies at first because they were so tiny, once he laid them on his chest, he was hooked. "When we got to hold them, it was incredible," he says. "They would snuggle right up on my chest. It was really sweet."
Practicing Kangaroo CareIn a typical Kangaroo Care session, the mother or father relaxes in a chair while the nurses slowly transfer the baby, still attached to any tubes or cords, from the bed onto the parent’s bare chest. Screens are usually provided for privacy. Once the baby is settled, the nurse will either place a blanket over the baby’s back or help the parent button their shirt around the baby. Sessions usually last from 30 minutes to two hours and are typically done twice a day.
Not all hospitals use Kangaroo Care, so parents interested in the technique should check with their local hospitals to find out if it is an option. For parents whose hospitals don’t offer Kangaroo Care, Kledzik suggests trying to find a nurse or other staff person who is sympathetic to the idea. "A lot of nurses have heard about it, and if they have a mother that’s begging for it to happen, they may attempt to accommodate her on their shift," she says.
When Larimer was pregnant with her second child, it was critical to her that the hospital where she would deliver allow Kangaroo Care. She and her husband passed up a major job promotion for him because they would have had to move to a city where no hospitals offered it. Larimer hopes that one day all hospitals will see the benefits of Kangaroo Care and implement a program in their NICUs.
"There’s no downside to doing this or at least trying it," says Dr. Johnson. "There are many small stories of how amazed parents are. Just the look of amazement and excitement on their face when they do it and the happiness it provides parents is what I remember most."
Kangarooing Tips In her book, Kangaroo Care: The Best Thing You Can Do To Help Your Preterm Infant, Susan Ludington offers several tips for a successful kangarooing session. Here are just a few:
Select a time after a feeding. If breastfeeding, moms may feed their baby during the session.
Make sure the room temperature is between 70 to 72 degrees Fahrenheit and stay away from drafts.
Use a wide, reclining chair (if available) with good padding or bring a pillow along.
Wear clothing that is easily adjustable when positioning the baby.
Moms who are six weeks or less postpartum should stand up every hour to hour and a half for several minutes.
Try to "kangaroo" for at least an hour.
During Kangaroo Care, also known as skin-to-skin care, the baby is placed on the parent's chest, clad only in a diaper and cap. The baby's head is turned to the side so that it's ear is against the parent's heart. Vent tubing and wires are taped to the parent's gown. Usually, two nurses assist in the transfer from warming bed or isolet to the parent's chest. This process can take just 10 minutes, even with a vented baby. Kangaroo Care can also benefit older preemies and full-term babies.
The name Kangaroo Care is used because the method is similar to how a baby kangaroo is carried by its mother. Kangaroo Care originated in Bogota, Columbia in 1983 by Neos Edgar Rey and Hector Martinez when they developed the "Kangaroo Mother Care" program to decrease the high mortality rate among preemies. Moms carried their preemies in slings all day, every day and the mortality rate fell from 70% to 30%. According to Katie Brietbach, R.N.C., N.C., of the Pediatric Nursing Division at the University of Iowa Hospitals & Clinics, Kangaroo Care began in South America, where premature babies were sent home snuggled between their mothers’ breasts, being fed only breastmilk. The method spread to countries in Europe and then to the United States, where an estimated 200 neonatal intensive-care units practice kangaroo care, up from about 70 in the early 1990s. Kangaroo care is often used with premature babies because the close contact with the parent can stabilize the baby’s heartbeat, temperature and breathing. Premature babies have a hard time coordinating their breathing and heart rates (often called coupling). As the baby’s heart rate increases, there could be an increase of apnea, which is a temporary loss of breathing. Studies have shown and many medical professionals agree that kangaroo care can help the baby better coordinate its breathing and heart rate. However, some doctors believe premature babies are too fragile to be held, and that close contact with parents can increase the risk of infection. Studies to date have shown only positive results of Kangaroo Care. Unfortunately some hospitals still don't allow any form of Kangaroo Care or holding. Some allow Kangaroo Care only when the baby is 'stable' or off all breathing machines. But, there are a few that realize that Kangaroo Care is the best thing a parent can do for their baby! Mothers who use kangaroo care can have more success with breastfeeding and improve their milk supply. Premature babies (particularly those less than 34 weeks gestational age) often suck better at the breast than the bottle, because premature babies are usually not able to control the flow of milk from a bottle. At the breast, preemies can coordinate the suck, swallow, breath sequence better. Susan Ludington, a professor of maternal and child health nursing at the University of Maryland at Baltimore and author of "Kangaroo Care: The Best You Can Do for Your Premature Infant," has conducted several studies on kangaroo care. Her research has found that Kangaroo Care conserves a baby’s energy and increases milk production in mothers. Kangaroo Care can also boost a premature baby’s brain development, according to Ludington. She has found that for a 30-week-old preemie, a 10-minute session of close contact with a parent can increase the fusion of the preemie’s brain cells. Researchers from Case Western Reserve University in Cleveland conducted a case study in which a mother with ECLAMPSIA practiced Kangaroo Care with her premature baby in order to breastfeed. Because of the mother's condition, the Kangaroo Care sessions were closely monitored by medical professionals. The study showed that kangaroo care allowed the mother to successfully nurse.
Kangaroo Care : Close cuddling helps premature babies develop produced by Gregg Bakerreported by Lucky Seversonstory by Shawn O’Learyvideo edited by Katie Elfsten
Every year in the United States, over 400,000 babies are born prematurely or at a low birth weight. Typically a premature baby is whisked away at birth from its mother and hooked up to hi-tech intensive care machines that control breathing and other vital functions. But the most powerful therapy may be old-fashioned, low-tech snuggling that neo-natal experts call kangaroo care.
FREE RIDEA baby kangaroo doesn’t start hopping around in the open world until it has spent some five months in its mother’s pouch where it breastfeeds, sleeps, and otherwise gets a free ride. During these 180 days, the senses and size of the joey, as it’s called, grow so that is better able to survive on the outside.
BACK TO THE WOMBIn the 1980’s doctors found that this style of nurturing can significantly help premature human babies grow. Kangaroo care requires a parent to hold the baby chest to chest and skin to skin a few hours a day for several weeks until the infant is out of danger and well on the path of normal development.
Neonatologist Dr. David Golembeski, MD of Palomar Medical Center in Escondido, CA points out that in study after study, this simple bonding tends to significantly improve a “preemie’s” fragile health. “Part of the philosophy is to try and put them back into the uterus, to let them feel the mother’s breathing and heartbeat, to control their temperature,” says Golembeski. “Babies have fewer days on the ventilators, fewer days on oxygen, go home sooner, and have less complicated courses in the hospital if we simply let parents be involved, bond with their babies, and let them do this kind of holding.”
IMMUNE SYSTEM STRENGTHENINGBabies treated with kangaroo care also tend to overcome their breast feeding problems which allows them immunity enhancement from their mother’s milk and mother-child bonding. “I see breast feeding as another example of it where you get a closeness not only to food, but to your mother, to skin, to warmth,” says Dr. Golembeski.
Little Michael Zimmerman is catching up after six weeks in the neo-natal intensive care unit. He was born almost eight weeks early, weighing just three pounds. His mother Laura was asked to hold him more and more as the weeks went by, as he became stronger. “I’d go in in my gown and I’d just uncover it and they’d just put him against my chest,” she recounts. “He’d hardly move or cry; he’d just fall asleep. I remember it being very difficult because he was connected to IV lines and feeding tubes. I was just crying.”
Dr. Nancy Wight, MD neonatologist at Sharp Community Health Group in San Diego is convinced that a combination of hi-tech and kangaroo care works wonders on intensive care preemies like Michael: “They’re doing everything,” says Wight. “They are catching up a lot quicker than they would otherwise. The mother’s body temperature self-regulates and adjust to the baby’s temperature. If the baby cools down, the mother heats up, and vice versa.”
HOME AT LASTAfter several weeks Michael and Laura were spending up to half a day together. “Everyone needs to be held and touched. He had no significant medical problems. And it was a matter of him growing big enough in the hospital to be released.”
Now that Michael is home, he is gaining weight rapidly, enthusiastically breastfeeding, and breathing with healthy newborn lungs, thanks to his mother’s touch. Laura feels the entire experience has been emotional but has made them closer: “My husband tells me, ‘You’re going to spoil him,’” says Laura. “Yes I spoil him. I carry him with me constantly. We have the little front carrier. He’s tiny, he’s tinier than a regular term baby would be, and I just feel like he needs me.”
BENEFITS FOR ALLNot a problem, says Dr. Wight. Kangaroo-style bonding helps healthy babies too, promoting breastfeeding, alleviating stress, and stimulating development. “You have children who are more independent, more self-sufficient, less fearful if you establish a trust right at the beginning,” she says. “Hold your child. Be with your child as much as possible.
Dr. Wight admits doctors don’t always have all the answers: “It’s hard to get neonatologists, pediatricians, obstetricians, and other really intensive docs to back off a little bit and see what Mother Nature has to offer.”

1 comment:

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