Comparison of Radiant Warmer Care and Kangaroo Mother Care Shortly after Birth on the Neurobehavioral Responses of the Newborn

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

A randomized controlled trial was conducted over a 1-year period (November 2001-November 2002) in Addis Ababa to study the effectiveness of early Kangaroo mother care before stabilization of low birthweight infants as compared with the conventional method of care. There were 259 babies weighing less than 2000 g during the study period and a total of 123 (47.5 per cent) low birthweight infants were included in to the study. Sixty-two infants were enrolled as Kangaroo Mother Care (KMC) and the remaining 61 were Conventional Method of Care (CMC) cases. The demographic and socioeconomic characteristics for both groups were comparable. The mean age at the time of enrollment was 10 and 9.8 h for KMC and CMC, respectively (p>0.05 with 95 per cent confidence interval). The mean birthweight was 1514.8 g (range 1000-1900 g) for KMC and 1471.8 g (range 930-1900 g) for CMC (p>0.05 with 95 per cent CI) and the mean gestational age was 32.42 and 31.59 weeks for KMC and CMC cases, respectively. Fifty-eight per cent of KMC and 52 per cent of CMC cases were on i.v. fluid. Twenty-one of 62 (34 per cent) of KMC and 23/61 (37 per cent) of CMC babies were on oxygen through nasopharyngeal catheter. The mean age at exit from the study was 4.6 days for KMC and 5.4 days for CMC. Ninety-one per cent and 88 per cent of babies in KMC and CMC were discharged from the study in the first 7 days of life, respectively. The study showed that 14/62 (22.5 per cent) of KMC vs. 24/63 (38 per cent) CMC babies died during the study (p<0.05 and CI of 95 per cent.) The majority of deaths occurred during the first 12 h of life. Survival for the preterm low birthweight infants was remarkably better for the early kangaroo mother care group than the babies in the conventional method of care in the first 12 h and there after. More than 95 per cent of mothers reported that they were happy to care for their low birthweight babies using the early Kangaroo mother method. It was recommended to study the feasibility and effectiveness of Kangaroo mother care at the community level.

BackgroundHospitalized premature babies often undergo various painful procedures. Kangaroo mother care (KMC) and swaddling are two pain reduction methods.ObjectivesThis study was undertaken to compare the effects of swaddling and KMC on pain during venous sampling in premature neonates.Patients and MethodsThis study was performed as a randomized clinical trial on 90 premature neonates. The neonates were divided into three groups using a random allocation block. The three groups were group A (swaddling), group B (KMC), and group C (control). In all three groups, the heart rate and arterial oxygen saturation were measured and recorded in time intervals of 30 seconds before, during, and 30, 60, 90, and 120 seconds after blood sampling. The neonate’s face was video recorded and assessed using the premature infant pain profile (PIPP) at time intervals of 30 seconds. The data was analyzed using the t-test, chi-square test, Repeated Measure analysis of variance (ANOVA), Kruskal-Wallis, Post-hoc, and Bonferroni test.ResultsThe findings revealed that pain was reduced to a great extent in the swaddling and KMC methods compared to the control group. However, there was no significant difference between KMC and swaddling (P ≥ 0.05).ConclusionsThe results of this study indicate that there is no meaningful difference between swaddling and KMC on physiological indexes and pain in neonates. Therefore, the swaddling method may be a good substitute for KMC.

Objective To explore the effect of kangaroo mother care (KMC) on breastfeeding, behavior, body temperature and weight of full-term newborn. Methods A total of 80 full-term newborns from March to December of 2017 were selected by the convenience sampling method, and were randomly divided into control group and intervention group, with 40 cases each group. Routine obstetric nursing was provided for the newborns in the control group. In addition, one hour of KMC was provided for the newborns in the intervention group. The LATCH scores, neonatal behaviors, body temperature and weight were observed on daily basis. Meanwhile, an interview was conducted to investigate mothers′ attitudes towards KMC. Results The LATCH scores of the intervention group for the second and third days were respectively (6.52±0.81) and (7.75±1.08), which were higher than that in control group (5.95±0.95), (7.02±1.07). The differences were statistically significant (t=2.887, 3.010, P<0.05). The behavioral status of neonates in the intervention group for 3 days was (3.65±1.12), (3.42±0.87), (3.35±1.07), all of which were lower than that in control group (4.57±0.98), (4.50±1.24), (4.65±1.27), and the differences were statistically significant (t=-4.593, -8.285, -7.029, P<0.01). The interviews showed that 100.0% (40/40) of mothers were satisfied with KMC and were very happy in the process.95.0% (38/40) of mothers believe that KMC can increase mother-child relationships.82.5% (33/40) of mothers believe that KMC can keep children quiet.72.5% (29/40) of mothers feel that KMC can relieve pain in the abdomen or perineum. Conclusions In the hospital, 1h of KMC can make breastfeeding more effective and the newborn condition is more stable, which is worthy of clinical application. Key words: Newborn; Kangaroo mother care; Breastfeeding; Infant Behavior

Kangaroo mother care (KMC) is a nonconventional low-cost method of newborn care. Our aim was to assess the effect of sustained KMC on the growth and development of low birthweight Indian babies up to the age of 12months. We enrolled 500 mother and baby pairs, in groups of five, in a parallel group controlled clinical trial. The three infants with the lowest birthweight in each group received KMC, while the other two received conventional care. All babies were exclusively breastfed for 6months. Babies in the intervention group were provided KMC until the infant was 40weeks of corrected gestation or weighed 2500g. Weight, length and head, chest and arm circumferences were evaluated at birth and at the corrected ages of 0, 3, 6, 9 and 12months. Development was assessed using the Developmental Assessment Scales for Indian Infants (DASII) at 12months. The KMC babies rapidly achieved physical growth parameters similar to the control babies at 40weeks of corrected age. But after that, they surpassed them, despite being smaller at birth. DASII motor and mental development quotients were also significantly better for KMC babies. The infants in the KMC group showed better physical growth and development than the conventional control group.

The effects of kangaroo mother care on physiological parameters of premature neonates in neonatal intensive care unit: A systematic review

Aims: To study the effect of Kangaroo Mother Care (KMC) on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates.Materials and methods: This was a single-blind cross over study in which total 140 neonates were enrolled. Pain stimulus was given in the form of heel-lance before and after giving KMC and data were recorded.Results: The effect of KMC on heart rate variability was statistically significant in preterm (30–34 wks) and very low birth weight (1.0–1.5 kg) neonates. The mean fall in SpO2 from base line was less in KMC group as compared to without KMC group at 60 s (1.63% versus 2.22%) and 120 s (0.45% versus 2.22%). The mean duration of cry was less in the KMC group (15.05 s) as compared to without KMC group (24.82 s) and the difference was statistically significant (p < 0.05). The mean duration of cry was reduced by 36% in KMC group as compared to the without KMC group. The effect of KMC on pain scores (premature infant pain profile (PIPP)) were significantly lower after heel-lance in KMC at 60 s (p < 0.01).Conclusion: KMC is a most physiological, non-pharmacological and easy intervention that involves parents: to manage procedural pain that can be implemented for physiological or behavioral stability in their premature infants.

Objectives. To determine the effect of kangaroo mother care (KMC) on anxiety and depression of mothers of low-birth-weight neonates during the immediate newborn period.&#x0D; Method. Eligible participants were mothers of low-birth-weight infants (birth weight ≤2500 grams) admitted at a tertiary hospital's neonatal intensive care unit. Mothers were instructed on providing KMC daily to their infants during the study period (first seven days of life).&#x0D; Main Outcome Measure(s). The primary study outcome was the effect of KMC in improving maternal anxiety and depression scores in the immediate postpartum period using the locally validated Hospital Anxiety and Depression Scale-Pilipino (HADS/HADS-P).&#x0D; Results. A total of 171 mothers were enrolled in the study. Only 79 mothers provided KMC, and the rest (92) did not provide KMC. The anxiety and depression scores improved significantly from day 1 to 7 postpartum in both groups (p&lt;0.05). Frequency of mothers categorized as having severe anxiety significantly decreased over time whether they provided KMC or not (KMC: 40.5%, 13.9%, 7.6% at Day 1 and 7 postpartum and day of discharge; No KMC: 35.9% and 27.2% at Day 1 and Day 7 postpartum). There was a significant reduction in the percentage of mothers categorized in the depressed group from Day 1 to Day 7 postpartum, among those who rendered KMC compared with those who did not (KMC: 7.6%, 2.5%, 0% at Day 1 and 7 postpartum and at the day of discharge vs. No KMC: 7.6% and 10.9% at Day 1 and 7 postpartum). There were no significant differences in the anxiety and depression scores at any period between mothers who rendered KMC &gt; 6 hours and KMC ≤ 6 hours/day.&#x0D; Conclusion. Anxiety and depression scores significantly decreased over time in both mothers who rendered and did not render KMC to their infants. However, there was a significant reduction in the percentage of mothers categorized as having severe depression over time among those who rendered KMC compared to those who did not. Other factors aside from KMC may affect the maternal anxiety and depression states, such as instability of the infant.

SummaryBackgroundPreterm birth is the leading cause of death in children younger than 5 years worldwide. WHO recommends immediate Kangaroo Mother Care (KMC); however, its effects on mortality in sub-Saharan Africa and its relative costs remain unclear. We aimed to compare the effectiveness, safety, costs, and cost-effectiveness of KMC initiated before clinical stabilisation versus standard care in neonates weighing ≤2000 g.MethodsWe conducted a parallel-group, individually randomised, controlled trial in five hospitals across Uganda. Singleton or twin neonates aged <48 h weighing 700–2000 g without life-threatening clinical instability were eligible for inclusion. We randomly assigned (1:1) neonates to either KMC initiated before stabilisation (intervention group) or standard care (control group) via a computer-generated random allocation sequence with permuted blocks of varying sizes, stratified by birthweight and recruitment site. Parents, caregivers, and health-care workers were unmasked to treatment allocation; however, the independent statistician who conducted the analyses was masked. After randomisation, neonates in the intervention group were placed prone and skin-to-skin on the caregiver’s chest, secured with a KMC wrap. Neonates in the control group were cared for in an incubator or radiant heater, as per hospital practice; KMC was not initiated until stability criteria were met. The primary outcome was all-cause neonatal mortality at 7 days, analysed by intention to treat. The economic evaluation assessed incremental costs and cost-effectiveness from a disaggregated societal perspective. This trial is registered with ClinicalTrials.gov, NCT02811432.FindingsBetween Oct 9, 2019, and July 31, 2022, 2221 neonates were randomly assigned: 1110 (50·0%) neonates to the intervention group and 1111 (50·0%) neonates to the control group. From randomisation to age 7 days, 81 (7·5%) of 1083 neonates in the intervention group and 83 (7·5%) of 1102 neonates in the control group died (adjusted relative risk [RR] 0·97 [95% CI 0·74–1·28]; p=0·85. From randomisation to 28 days, 119 (11·3%) of 1051 neonates in the intervention group and 134 (12·8%) of 1049 neonates in the control group died (RR 0·88 [0·71–1·09]; p=0·229). Even if policy makers place no value on averting neonatal deaths, the intervention would have 97% probability from the provider perspective and 84% probability from the societal perspective of being more cost-effective than standard care.InterpretationKMC initiated before stabilisation did not reduce early neonatal mortality; however, it was cost-effective from the societal and provider perspectives compared with standard care. Additional investment in neonatal care is needed for increased impact, particularly in sub-Saharan Africa.FundingJoint Global Health Trials scheme of the Department of Health and Social Care, Foreign, Commonwealth and Development Office, UKRI Medical Research Council, and Wellcome Trust; Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Background: Twin low-birth-weight (LBW) neonates are exposed to the increased risk of mortality and morbidity due to poor prognosis. The present study aimed to evaluate the effectiveness of kangaroo mother care (KMC) in the management of twin LBW neonates. Methods: This prospective, observational study was conducted on 150 neonates with the birth weight of <2,200 grams during one year. The neonates were divided into three groups of KMC I (receiving KMC; n=60), KMC II (singletons receiving KMC; n=30), and twins receiving conventional method of care (CMC; n=60). The neonates were assessed before and after the intervention in terms of thermoregulation, growth rate, breastfeeding, and self-confidence of the mothers managing the neonates based on a Likert scale. The subjects were followed-up until reaching the target weight of 2.5 kilograms. Data analysis was performed in SPSS software 20.0. Results: Neonates in the KMC groups were euthermic. Mean weight gain increased in KMC I (13.48±1.76 g/kg/day) and KMC II (13.15±1.66 g/kg/day) compared to the CMC group (11.99±1.20 g/kg/day) (P=0.0014). Length (43.55±1.90, 43.86±1.34, and 43.40 ± 1.94 cm, respectively) (P=0.567) and head circumference (31.13±0.77, 31.43±1.15, and 31.30±1.07 cm, respectively (P=0.498) were comparable in the CMC, KMC I, and KMC II groups. Early initiation of breastfeeding was observed in KMC I (2.68±1.55 days) and KMC II (2.97±2.88 days) compared to the CMC group (5.17±2.65 days) (P<0.0006). In addition, the mothers’ self-confidence to manage the LBW neonates was significantly higher in both the KMC groups compared to the CMC group (P<0.0001). Conclusion: According to the results, KMC is a cost-effective, humane intervention, which could effectively alleviate the burden of managing twin and singleton LBW neonates in low-income countries.

The aim of this study was to determine the effect of kangaroo mother care, provided in the early postpartum period, on the breastfeeding self-efficacy level and the perceived insufficient milk supply. This study was conducted as the quasi-experimental design. The population of the study consisted of the mothers and their infants, to whom they gave birth in a university hospitals located in either eastern or western Turkey, between December 2016 and June 2017. In this study, mothers and their infants were randomly assigned to the experimental group (kangaroo mother care, n = 30) and the control group (n = 30). This study included 2500 to 4000 g birth weight infants who had no serious health problems and no sucking problems. The Introductory Information Form, the Breastfeeding Self-Efficacy Scale, and the Perception of Insufficient Milk Questionnaire were used to collect the data. In this study, kangaroo mother care was provided as a nursing intervention for the mothers in the experimental group twice a day until they were discharged. Any other application was not performed in the control group's mothers apart from the routine application. Ethical principles were adhered in all stages of the study. The breastfeeding self-efficacy mean score (65.50 ± 3.95) of the mothers who performed kangaroo mother care was higher than the mean score of the mothers who did not perform kangaroo mother care (55.50 ± 7.00) (P < .001). In addition, mothers in the experimental group (46.60 ± 3.40) perceived their milk more sufficiently than mothers in the control group (30.17 ± 11.37) (P < .001). In the study, a statistically significant correlation was determined between breastfeeding self-efficacy levels of mothers in the experimental group and the perceived insufficient milk supply (P < .05). In the study, kangaroo mother care increased breastfeeding self-efficacy perception of the mothers and reduced the perceived insufficient milk supply. This shows that kangaroo mother care can potentially have an important effect on breastfeeding perceptions.

A quasi-experimental study was undertaken to study the effect of Kangaroo Mother Care (KMC) on neonatal temperature and weight among newborns in SCB Medical College and Hospital, Cuttack. A sample of 40 newborns in the post-natal wards was selected among which 20 were put in the control group and 20 in experimental group. The mothers of the experimental group were educated about KMC, and made to practice the KMC method on their babies. Thereafter the temperature and weight of the babies were checked for 4 consecutive days. Mean, standard deviation, standard error and paired ‘t’ test were compared from the row score obtained in pre-test and post-test. It was observed that the babies in the experimental group showed better thermoregulation and weight gain than those in the control group. The study concluded that KMC promotes good temperature control and better growth for pre- and term newborns.

Background and aim: The maternity blues is the most common postnatal mood disturbance.The purpose of this study was to assess the effect of kangaroo mother care on maternity blues Material and Methods. A clinical trial was conducted to assess the effect of kangaroo mother care on maternity blues. The sample of the study consisted of 96 pregnant women with gestational age 37 -42 weeks, which were assigned to intervention and control groups. The mothers in intervention group provided kangaroo care for 10 consecutive days. Data were collected by Beck depression scale, General Helth Qustioner, , Stein's Blues Scale Vinfild and Tighmen’s social support scale and Peghle’s adverse life events scle . Maternal blues was measured at the 1st -3rd -5th and 10th days during the study. Data were analyzed by SPSS statistical software. Findings: Results of the study showed higher scores of maternal blues in the control group. There was a significant diference between the maternal blues scores of the intervention and control group at 3rd ,5th and 10th days of the study( P<o.o5). The results showed a significant correlation between the numbers and durations of kangaroo care and maternal blues scale. The results suggest the positive effect of kangaroo mother care on reducing the post -partum blues among mothers . Conclusion: This study shows the positive effect of kangaroo mother care on maternal blues Key words: maternal blues-skin to skin contact- Kangaroo mother care

Background: Preterm birth is the leading cause of death in toddlers by 7.5% - 12.5% in various regions of the world. Premature is one of the causes of low birth weight and is a factor that increases the risk of hypothermia. Kangaroo Mother Care is a powerful and easy-to-use method for improving the long-term health and well-being of premature babies. This study aimed to estimate the average effect of Kangaroo Mother Care therapy on increasing body weight and temperature of premature infants. Subjects and Method: This was a meta-analysis and a systematic. The articles used were obtained from PubMed, Science Direct and Google Scholar. The inclusion criteria used were full text articles with the Randomized Control Trial (RCT) design, the study subjects were premature infants, the treatment provided was Kangaroo Mother Care with a comparison of conventional care, weight and temperature assessment of premature infants using stan­dard scales and thermometers, articles publish­ed in English. The PICO research problems are as follows. Population= prema­ture babies. Intervention= Kangaroo Mother Care. Com­pa­rison= Conven­tional Method Care. Out­come= weight and temperature of premature infants. This study used the effect size (Standardized Mean Difference). Meta analysis was performed using RevMan 5.3 with a Random Effect Model. Results: A total of 15 articles conducted a meta-analysis review of this study. The meta-analysis of 11 articles showed that Kangaroo Mother Care increased weight gain in prema­ture infants compared to conventional method care (Standardized Mean Difference= 0.54; 95% CI= 0.17 to 0.92; p= 0.004). Meta analysis on 4 articles showed that Kangaroo Mother Care increased the temperature in preterm infants higher than the conventional method of care, statistically not significant (Standardized Mean Difference = 0.48; 95% CI= -0.23 to 1.19; p=0.190). Conclusion: Kangaroo Mother Care is effective in increasing body weight and temperature in premature infants Keywords: Kangaroo care, skin-to-skin contact, weight, temperature, preterm infant Correspondence: Ines Ratni Pravitasari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: inesratnip@gmail.com. Mobile: +6285­649507909. Journal of Maternal and Child Health (2020), 05(05): 563-578 https://doi.org/10.26911/thejmch.2020.05.05.10.

Background: Preterm birth is the leading cause of death in toddlers by 7.5% - 12.5% in various regions of the world. Premature is one of the causes of low birth weight and is a factor that increases the risk of hypothermia. Kangaroo Mother Care is a powerful and easy-to-use method for improving the long-term health and well-being of premature babies. This study aimed to estimate the average effect of Kangaroo Mother Care therapy on increasing body weight and temperature of premature infants. Subjects and Method: This was a meta-analysis and a systematic. The articles used were obtained from PubMed, Science Direct and Google Scholar. The inclusion criteria used were full text articles with the Randomized Control Trial (RCT) design, the study subjects were premature infants, the treatment provided was Kangaroo Mother Care with a comparison of conventional care, weight and temperature assessment of premature infants using stan­dard scales and thermometers, articles publish­ed in English. The PICO research problems are as follows. Population= prema­ture babies. Intervention= Kangaroo Mother Care. Com­pa­rison= Conven­tional Method Care. Out­come= weight and temperature of premature infants. This study used the effect size (Standardized Mean Difference). Meta analysis was performed using RevMan 5.3 with a Random Effect Model. Results: A total of 15 articles conducted a meta-analysis review of this study. The meta-analysis of 11 articles showed that Kangaroo Mother Care increased weight gain in prema­ture infants compared to conventional method care (Standardized Mean Difference= 0.54; 95% CI= 0.17 to 0.92; p= 0.004). Meta analysis on 4 articles showed that Kangaroo Mother Care increased the temperature in preterm infants higher than the conventional method of care, statistically not significant (Standardized Mean Difference = 0.48; 95% CI= -0.23 to 1.19; p=0.190). Conclusion: Kangaroo Mother Care is effective in increasing body weight and temperature in premature infants Keywords: Kangaroo care, skin-to-skin contact, weight, temperature, preterm infant Correspondence: Ines Ratni Pravitasari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: inesratnip@gmail.com. Mobile: +6285­649507909. Journal of Maternal and Child Health (2020), 05(05): 563-578 https://doi.org/10.26911/thejmch.2020.05.05.10.