Kangaroo Mother Care

protocol that recurred repetitively and the Medical Subject Headings (MeSH) terms. The string/Boolean search terms for this review will include kangaroo mother care OR kangaroo care OR skin to skin OR kangaroo-mother care method OR skin to skin con- tact AND parents OR mother OR father OR family caregivers AND low-birth-weight infants OR pre- term infants OR premature infants OR very low birth weight infants AND utilization OR uptake OR compliance AND facilitators OR enablers OR moti- vators OR experience OR perception OR attitudes. The identified studies will be screened using eligibil- ity criteria.

medical conditions like hypoglycemia and sepsis. Thus, came the genesis of Kangaroo mother care (KMC), a modality of newborn care developed by Edgar Rey Sanabria and Hector Martinez, at the Maternal and Child Institute of Bogotá, Colombia in 1979. KMC provides alternative to conventional neonatal care offering benefits to both the baby and mother, and is an effective way to ensure baby’s needs for warmth, breastfeeding, weight gain, stimulation, safety and love. 2 Since then, various

In present study, majority of the HCP believed that KMC maintains child’s temperature, helps in bonding between mother and baby and found useful for LBW babies. In this study KMC was used regularly in the NICU and step down nursery and was applied every day in the ward for care of the babies. We also found that HCP gave information about KMC to the parents, encouraged mothers to participate in KMC, and helped them to adopt KMC. However, in present study we found that HCP did not encouraged fathers to participate (P=0.021) and practice KMC (P=0.002). Shah et al, studied knowledge, attitude and practice of kangaroo mother care among health workers in tertiary health center in Nepal and concluded that parents must be encouraged to adopt KMC, and KMC is hampered due to presence of visitors in the ward. 10

have shown a statistically significant decrease (P < 0.01) in both Pulsatility index and Resisitive index after 30 min of KMC. On the other hand, there has been a statistically sig- nificant increase in the end diastolic velocity (EDV) and the mean velocity. These data suggest that kangaroo mother care leads to improvement of CBF within normal physiological range [27-29].

Background: Kangaroo mother care (KMC) is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival. Many countries find it difficult to take KMC to scale in healthcare facilities providing newborn care. KMC Ghana was an initiative to scale up KMC in four regions in Ghana. Research findings from two outreach trials in South Africa informed the design of the initiative. Two key points of departure were to equip healthcare facilities that conduct deliveries with the necessary skills for KMC practice and to single out KMC for special attention instead of embedding it in other newborn care initiatives. This paper describes the contextualisation and practical application of previous research findings and the results of monitoring the progress of the implementation of KMC in Ghana.

KMC training in the Philippines developed in two stages. After in-house training of staff in the Dr Jose Fabella Memorial Hospital, the Department of Health supported the training of seven more facilities in Manila in 2003. The next training drive started in 2008 with the establishment of the Bless-Tetada Kangaroo Mother Care Foundation Phil., Inc., a duly registered non- government organisation (NGO) operating in the coun- try primarily for the scale-up and national adoption of KMC. A more comprehensive approach to training was initiated, focusing not only on the technical aspects of KMC practice but also on KMC program implementa- tion, empowered by health care values that promote effective teamwork and administrative support. After the initial training of a core group of staff members of a re- gional health centre, there is a period of supportive supervision and internal cascading of training for ac- creditation as a centre of excellence for a specific region. An accredited centre is expected to cascade the program to the community it serves and to other health facilities in the region by conducting its own training, and moni- toring and evaluation activities. Hospitals enter into a partnership with the Foundation under a three-year memorandum of agreement, subject to renewal as both parties may desire. After accreditation, the Foundation continues to support these centres through monitor- ing and evaluation and research to sustain quality im- plementation. The process in the Philippines is an example of a successful continuous public-private KMC partnership.

Abstract- Preterm low birth weight (LBW) babies are unable to control their body temperature and are at greater risk of illness. Conventional neonatal care of LBW babies is expensive and needs both trained personnel and permanent logistic support like the incubator, warmer etc. Kangaroo Mother Care (KMC) is a special way of caring for low birth weight babies has three main components- (a) thermal care through continuous skin to skin contact (b) support for exclusive breastfeeding (c) early recognition and response to complication. This study was conducted to assess the effectiveness of KMC as compared to conventional care. This randomized controlled trial was conducted in the Enam Medical College & Hospital, Dhaka from October 2017 to September 2018. Fifty neonates selected as per inclusion and exclusion criteria. Twenty-five of them were randomly allocated to KMC (Group-I) and 25 of them to Standard Method Care (Group-II). This study was done by χ2, t-test etc. with SPSS version 20.0. During hospital stay hypothermia (Group-I 4% vs. Group-II 24%) and hyperthermia (Group-I 8% vs. Group-II 32%) were significantly low in KMC group. 64% of neonates were group-II and 36% were group-I developed late-onset neonatal sepsis ( LONS) during the study period and the difference was statistically significant (p=0.04). Neonates with KMC care required statistically shorter duration to start direct breastfeeding than standard care group (Group-I 9.6± 2.16 days vs. Group-II 20.12 ± 3.82 days; p=0.04). Total cost during hospital stay was significantly less in the KMC group (Group-I 9508± 4142 takas vs. Group-II 35064± 13352 takas; p=0.01). At 40 weeks corrected gestational age, KMC infants showed significantly higher daily weight gain than standard care group (Group-I 27.08± 3.02 gms vs. Group-II 16.00± 2.76 gms; p=0.002). In this study, KMC an effective method and provides effective thermal control, helps to achieve full eternal feeding, and birth weight achieving in LBW neonates.

is often missed especially in clinics where nurses are few and in homes where parents are uneducated or unaware. The Hypothermia Alert Device (Made by Bempu Health) is a simple neonatal bracelet which continuously monitors the infant day and night for 4 weeks in the hospital and home setting. If the infant is hypothermic, the device sounds an alarm alerting the mother to perform kangaroo care to warm the infant well before injury or death can occur. Should the baby continue to be hypothermic despite warming actions, the device continues to alarm nudging the mother to seek skilled care since hypothermia is a sign of sepsis. To further investigate, authors designed a randomized control trial to test the effects of the Bracelet on newborn weight gain and parent compliance to Kangaroo Mother Care (KMC). Currently there is no published literature showing the efficacy of the Bracelet in reducing the incidence rate of hypothermia or promoting healthier weight-gain, thereby warranting this study.

Kangaroo mother care (KMC) is a human-based technique with well- established short- and mid-term effectiveness and safety, suitable for use in all settings. It is based on 3 components: (1) kangaroo position (ie, continuous skin-to-skin contact between mother and infant), which provides appropriate thermal regulation, among other benefits; (2) exclusive breastfeeding when possible; and (3) timely (early) discharge with close follow-up. KMC was originally developed in Colombia as an outpatient alternative to a neonatal minimal care unit, in which infants remain in an incubator while they gain weight. 8

Kangaroo Mother Care (KMC) 1,2,3,4,5 is a special way of caring of low birth weight(LBW) babies carried out by skin- to-skin contact with the mother. It was developed by Dr. Edgar Ray Sanbaria & Dr. Martinezin Bogota, Colombia in 1978 as an alternative to inadequate & insufficient incubator care in developing countries but now considered as the most feasible, readily available, and preferred intervention for decreasing neonatal morbidity and mortality in developed and developing countries 1,6,7 .

A systematic review of randomized controlled trials that comparing KMC and conventional neonatal care found compelling evidences which support KMC could im- prove breastfeeding rates in high-income countries in which conventional neonatal care is unavailable [10, 23]. In this meta-analysis, preterm and low birthweight in- fants in the KMC intervention group initiated breast- feeding 2.6 days earlier than conventional care method. This is in line with the previous systematic review stud- ies in which KMC group initiated breastfeeding 1.6 days earlier than conventional neonatal care [10]. It was ob- served that infants who exposed to KMC showed signifi- cantly better emotion regulation than infants who exposed to the usual standard care which again initiated early breastfeeding [24, 25]. Furthermore, KMC has a significant role in starting breastfeeding among preterm and LBW infants [26–28]. Sloan NL et al. also reported that women in the community kangaroo mother care group initiated to breastfeed earlier than the control group [29]. This confirms the conclusion that KMC pro- motes early initiation of breastfeeding as compared to conventional care methods.

We used a qualitative descriptive design and an inductive thematic analysis approach based on semi-structured in- depth interviews with mothers of preterm infants in the NICU. Interviews were conducted by the second author, a doctoral candidate specializing in early life health and de- velopment, using an interview guide created by the author team and designed based on their subject matter know- ledge and clinical expertise. The interviewer asked a stand- ard set of questions across interviews, but allowed divergence from these questions based on interviewee re- sponses. The interviewer probed mothers on their experi- ences having a preterm infant, their knowledge of and experience with kangaroo mother care, and perceived bar- riers and facilitators to engaging in skin-to-skin contact, breastfeeding, and breast pumping. We focus on skin-to- skin contact and breastfeeding and pumping, but not early discharge, as we expect these factors to be most affected by barriers and facilitators to caregiving during hospitalization. Interviews included open-ended questions such as “How do you decide when to come to the hospital to visit your baby?” Interview questions were crafted to elicit mental, emotional, and physical elements of mothers’ experiences and to identify any structural barriers, such as logistical or financial difficulties, that may have affected mothers’ ability to care for their children. While there was no quantitative survey component to the study, participants were asked a short set of limited demographic and logistical questions, allowing authors to assess certain self-reported characteris- tics such as mother’s age, insurance status, or distance from the hospital to provide context to the findings.

An alternative approach for providing better thermal care and improving survival of preterm and LBW infants is the Kangaroo Mother Care (KMC). This approach is both effective and affordable. A team of pediatricians in the Maternal and Child Institute in Bogota, Colombia created and developed the strategy of KMC. First KMC was invented by Dr. Edgar Rey in1978, and then developed by Dr. Hector Martinez and Dr. Luis Navarrete until 1994, when the Kangaroo Foundation was created [4].

Kangaroo Mother Care improved the growth and reduced the problems of low birth weight babies such as hypothermia, hypoglycaemia and prolonged hospital stay. Hence, it should be recommended in the care of all these high-risk neonates. Thus, kangaroo mother care is an effective alternative to conventional care for the management of stable low birth weight infants. This practice can be continued at home and is a very feasible option in the Indian scenario.

The purpose of the study along with importance of breastmilk and kangaroo mother care in growth and development of the baby was explained to both the parents and who gave consent for to participate in the study were included. Data of these babies were collected and documented in preformed structured questionnaire, after taking consent from the parents. Data regarding personal history of mother, family history, obstetric history, socio-economic status, pregnancy complications, and reason for LSCS, Birth history were collected from mother. Reason for NICU admission and reason for not initiating breastfeeding were ascertained after taking history and examining the baby and the information was documented in the questionnaire.

The term kangaroo is derived from practices similar to marsupial care, in which the infant is kept warm in the maternal pouch and close to the breasts for unlimited feeding. Kangaroo care is defined as skin-to-skin contact between a mother and her low birth weight (LBW) infant in a hospital setting, a practice that originated in Bogota, Columbia to provide tactile, kinaesthetic, and vestibular stimulation and to transmit heat from the parent's to the infant's body. In 1978, Ray and Martinez created the concept of kangaroo mother care at the instituto materno infantil in Bogota, Columbia. This has evolved into a practice that includes frequent breastfeeding. 5 The three major

Background: Globally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long- term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries.

In developing countries like India, use of incubators in the management of Low Birth Weight babies exerts a heavy financial burden on parents of low birth weight babies. Incubators are not affordable by the family members of low birth weight babies because of high cost. Hence equally effective and low cost methods to manage the Low birth weight babies like Kangaroo Mother Care are to be made aware for mothers of low birth weight babies. Kangaroo Mother Care not only prevents hypothermia in low birth weight babies but also improves bonding between baby and mother. And nurses play a prime role in educating mothers of low birth weight babies regarding Kangaroo Mother Care as they are the one who interact more with parents than any other health team member. [12]

births in Iran 3. According to the Millennium Development Goal [MDG] 4, should reduce from 26 to 22 per 1000 live births until 2015 4 . Reducing NMR is a main goal to reduce U5MR. A significant proportion of deaths among preterm and low birth weight infants are preventable. As described by World health organization [WHO], KMC is the early, prolonged and continuous skin-to-skin contact between the mother [or adult substitute] and her baby—both in hospital and after discharge— with support for feeding [ideally exclusive breastfeeding] and close follow-up after early discharge from the hospital 5 .There is evidence that kangaroo mother care [KMC], when compared to conventional neonatal care in resource–limited settings, significantly reduces the risk of mortality in infants born in facilities who are clinically stable and weighing less than 2000 g [2, 6, 7]. Meta-analysis of three RCTs commencing KMC in the first week of life showed a significant reduction in neonatal mortality relative risk [RR] 0.49, 95% confidence interval [CI] 0.29-0.82] compared with standard care 2. Several other beneficial outcomes have been reported by using KMC as a method of care [1]. Five RCTs suggested significant reductions in serious morbidity for babies <2000 g [RR 0.34, 95% CI 0.17-0.65], 7. Research from various countries also suggests that KMC is a cost-effective method for treating preterm infants [8, 9], that mothers who have practiced KMC may find it acceptable [10, 11] , and that KMC can have a positive impact on the health of mothers in certain cases. Moreover, KMC was found to increase weight, length and head circumference gain and exclusive breastfeeding at discharge or 40 to 41 weeks' postmenstrual age and at one to three months' follow-up 12 . These better growth results could

Through complicated mechanisms, Kangaroo Mother Care (KMC) in addition to its positive effect on the phys- ical growth of the newborn, occasions the newborn’s body to conform to the mother’s and develops mother- infant affection (Keshavarz & Bolbol Haghighi 2010a). Moreover, such care is an easy, safe, inexpensive, and reliable method for the newborn and the mother (Arzani et al. 2012). Studies conducted so far in this field have mostly focused on the effect of this type of care on vari- ous aspects of the newborn’s health; However, a few of those studies have attended to its effect on the mother who is the primary caregiver to her newborn child. Fur- thermore, in our country no studies have been conducted to determine the effect of this type of intervention on the psychological aspects of mothers of preterm infants. Therefore, the present study was performed with the aim of examining the effect of KMC on the self-esteem of mothers of preterm infants hospitalized in NICUs.