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Kangaroo Mother Care

Kangaroo mother care ensures skin-to-skin contact and promotes exclusive breastfeeding. Discuss KMC daily on doctors round if baby is not on ventilator, in shock or having severe septicemia. KMC not only a treat for healthy babies, but also a treatment for premature babies, low birth weight babies and sick newborns. KMC should be given for as many hours of the day as possible, and attendants should be encouraged to continue the treatment after baby is being discharged.

ELIGIBILITY CRITERIA​

  • All stable low birth weight babies.
  • For babies with birth weight > 1800 g, KMC can be initiated soon after birth if the baby is hemo-dynamically stable.
  • For babies having birth weight 1200 - 1800 g, baby should receive initial stabilization and appropriate management before initiating KMC.
  • Babies having birth weight < 1200 g frequently develop serious prematurity-related morbidity often starting soon after birth. Baby should be hemo-dynamically stabilized prior to starting KMC which may take days to weeks.
  • KMC can be initiated in a baby who is connected to fluids, tube-feeding, oxygen and/or CPAP.
  • Any family member can perform KMC.
  • Family member performing KMC should be free from illness and maintain good hygiene.

BENEFITS OF KMC​

  1. Breastfeeding: Increased breastfeeding rates and increased duration of breastfeeding.
  2. Thermal control: Reduced risk of hypothermia
  3. Early discharge: Babies gain more weight on KMC than on conventional care.
  4. Increasing bonding between baby and mother / father / relatives.
  5. Stabilizing respiration of preterm newborns.
  6. Reducing stress in baby and caregiver.

PREPARATIONS​

  • Assess baby’s temperature, respiration and color.
  • Make sure the baby has a clean diaper.
  • Observe mother and baby closely on the first session of KMC.
  • KMC givers wear gowns from the unit. They are guided in correct hand hygiene, including removing jewellery, bangles, religious threads and watches.
  • Be aware of mothers condition and try to make it as comfortable as possible for her.
  • Recommend continuous KMC for as long as possible and inform about the benefits of KMC.
  • The most stressful aspect of KMC is transferring the baby in and out of the bed. Preferably, the attendant should be taught how to lift the baby out on the chest himself or herself with the nurse supporting the medical equipment.

PROCEDURE​

  • Ask the attendant to stand between the KMC-bed and the baby’s bed and open up the gown. While nurses support the medical equipment, the attendant lifts the baby straight up to the chest from supine or sideways position and holds him or her skin-to-skin. Always maintain open airways. The attendant carefully sits down and gets help to lie down comfortably and carefully. The nurse helps the attendant adjust the baby.
  • Place the baby wearing only diaper between mothers breasts in an upright position.
  • The head in sideline position, slightly extended. Keep airway open and allow eye contact between mother and baby.
  • Legs should be curled up in a fetal position and supported by one hand from mother. Arms flexed.
  • Cover the baby with the gown. Use a woolen cap in wintertime.
  • Mother's epigastrium should be close to babies abdomen. This stimulates the baby’s breathing.
  • Encourage the baby to suckle at breast as often as the baby wants.

OBSERVATIONS DURING KMC​

In general, the same observations have to be made if the baby is under the radiant warmer or in KMC.

  • Continue observing babies breathing patterns and be aware of apneas.
  • Ensure that baby's neck is neutral, not too flexed or extended.
  • Assess the baby’s temperature manually.
  • Teach mother to pay attention and observe her baby. Observe changes in baby’s color.
  • Follow up baby’s feeding and wellbeing. Observe changes in awake and sleeping patterns.
  • Follow up mothers concerns and participation caring for her baby.
  • One staff should always be available.
  • Nurses are responsible for teaching the mothers. Make sure the KMC-giver knows about benefits and observations during KMC.

References​

  • Merenstein & Gardner2011, Neonatal Intensive Care.
  • Bera 2014 KMC Kolkata.
  • KMC India network www.kmcindia.org
  • WHO, Dept. Reproductive Health and Research Kangaroo Mother Care-A practical guide

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Contributors: Senior neonatal project nurse Anne Marie Krokedal
Previous Versions: v1.0