By: Dr Olapeju Daniyan
Introduction
Kangaroo mother care (KMC) is a method of providing skin- to- skin contact between a mother and her newborn. It has been proven to be a wonderful intervention for the care of preterm and low birth weight babies especially in resource-poor countries where there is limited availability of incubators needed to provide warmth for the baby1. It can be used in both developed and developing countries. KMC is one of the ways the global theme of the world prematurity day 2021 which is ‘zero separation act now! Keep parents and babies born too soon together’ can be achieved.
Components of KMC
Components of KMC includes kangaroo position, kangaroo nutrition, kangaroo support and kangaroo discharge.2 The baby is usually placed on the mother’s chest and a KMC binder/ wrap is used to secure the baby there. KMC can also be done by the father or any other relative. With KMC, exclusive breastfeeding is achieved and on discharge, the mother can continue KMC. Support is given to the mother by health care staff while in the hospital and at home by relatives.
Benefits of KMC
It promotes early initiation of breastfeeding and encourages exclusive breastfeeding,3 reduces severe morbidity and mortality in preterm infants,4 improves body temperature, increases peripheral oxygen saturation,5 promotes maternal and infant bonding and reduces cost of capital investments and recurrent costs in hospitals of low-income countries.1 KMC has been shown to have a good impact on all parameters of the extremely low birth weight and premature babies
and longer duration on KMC resulted in better outcomes, enabling early discharge at low weights for continuation of home-based KMC.6
Resources for KMC
The most important resources for KMC are the mother, healthcare worker trained in KMC and a supportive environment.
Healthcare workers role in KMC
Neonatal units should have a KMC section where mothers can stay and practice KMC. Doctors and nurses offering care in the unit should be trained on how to administer the KMC binder/ wrap. The healthcare workers are involved in teaching mothers how to apply the KMC wrap. Subsequently, mothers will be observed to administer the binder/wrap by themselves under supervision of the healthcare worker with the aim of ensuring the mother is able to sustain the KMC at home upon discharge. Keeping of KMC chart and recording of vital signs during KMC is also done by the healthcare personnel.
Using the KMC Binder/wrap
Prior to starting the preterm on KMC, the mother is informed about KMC and its benefits. KMC is commenced as soon as the baby is clinically stable. The mother is instructed at each step on what to do with the assistance of a healthcare worker.
There are various methods of making the KMC binder/wrap, one of which is described below;
Three (3) yards of fabric (locally available and affordable) can be used to make the KMC wrap. It is cut in a way that four straps are present on the wrap with a central portion which is rectangular in shape that forms a center part of the pouch.
The mother takes the wrap and applies it on her body, the lower two straps are crossed at the back firmly and then in front below the breast to make a tight knot, this keeps the baby from falling out .The upper straps are then held by the mother. She takes the one of the straps, crosses it at her back and passes it over the opposite shoulder to the front and same for the second strap. The two straps are pulled over the shoulder to allow a firm fitting at the back. A pouch is thus created. With the help of an assistance, the baby is carried in the pouch and placed between the mother’s breasts in an upright position with the baby’s head turned to one side and slightly extended. Also baby’s hips are flexed and extended in a frog-like position and the arms flexed.1 The lower and upper wraps on each side are then tied firmly.
The mother is assisted and taught this process many times until she fully masters it before the baby is discharged home. By self- administering the KMC wrap, it gives the mother the confidence to continue this care at home, therefore ensuring sustainability of the KMC.
Conclusion
KMC has proven to be useful in the care of preterm and low birth weight infants. It should be encouraged especially in resource-poor countries to reduce morbidity and mortality among these infants.
References
- World Health Organization. Kangaroo mother care: a practical approach. 2003. https://www.who.int/publications/i/9241590351.
- Amelia T, Pratomo H, Adisasmita AC, Martha E, Rustina Y, Murty AI et al. Feasibility of kangaroo mother care (KMC) implementation in Depok city, Indonesia. Global Pediatr Health 2021; 8:2333794×211012390.doi:10.1177/2333794×211012390
- Mekonnen AG Yehualashet SS, Bayleyegn AD. The effect of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. Int Breastfeed J 2019; 14: 12.doi:10.1186/s13006-0190206-0
- Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. Kangaroo mother care to prevent neonatal deaths due to preterm birth complications. Int. J. Epidemiol2010; 39 (suppl 1): i144-i154. doi: 10.1093/ije/dyq03
- Almeida CM, Almeida AFN, Forti EMP. Effects of Kangaroo mother care on the vital signs of low-weight preterm newborns. Rev. bras. Fisioter 2007; 11: http://dx.doi.org/ 10.1590 / S1413-35552007000100002
- Ezeanosike O, Daniyan O, Anyanwu O, Asiegbu U, Ezeonu C, Onwe-Ogah E, Onyire O. Impact of kangaroo mother care on outcome of very low birth weight preterm newborns in a tertiary hospital in Abakaliki, Nigeria. J Nepal Paediatr Soc. 2019;39(2):95-102.
Foot notes:
Preterm infants – Infants delivered before 37 completed weeks of gestation
Low birth weight infants – Infants with birth weights below 2500g
Contributing author:
Dr Olapeju Daniyan is a Consultant Paediatrician/Neonatologist working at the Newborn Unit Alex Ekwueme Federal University Teaching Hospital Abakaliki
