Kangaroo Care and Nursing

Kangaroo Care and Nursing Kangaroo Care (KC) is an innovative and increasingly popular method of care for preterm and low birth-weight infants. Derived from the way marsupials, such as kangaroos, care for their young, Kangaroo Care involves direct skin-to-skin contact between the mother and the infant, promoting bonding and enhancing the infant’s physiological stability. It has been widely adopted in neonatal intensive care units (NICUs) worldwide due to its numerous benefits for both infants and their caregivers.

What is Kangaroo Care?

Kangaroo Care (KC), also known as skin-to-skin contact (SSC), involves the mother holding her diaper-clad infant upright between her breasts, skin-to-skin, under her clothing. If needed, additional warmth can be provided with a cap and a blanket. In its complete form, KC includes self-regulatory breastfeeding. In developing countries, this method is often referred to as Kangaroo Mother Care (KMC), as mothers are usually the primary caregivers who breastfeed exclusively.

KC originated in Bogotá, Colombia, as a blend of technology and natural care, aimed at improving outcomes for preterm infants who are vulnerable during the critical transition from intrauterine to extrauterine life. It has become widely practiced in regions such as Scandinavia and Africa and is gaining popularity elsewhere due to its proven benefits (Anderson, GC, Moore, Hepworth, & Bergman, 2003).

Theoretical Paradigm

Several theoretical paradigms underpin Kangaroo Care, including:

• Stress and Self-Regulation Theories: Emphasizing the reduction of stress through mutual caregiving and self-regulation, which are critical for infant development (Anderson, GC, 1977, 1989, 1999).
• Physiological and Developmental Theories: Such as programming, inappropriate stress responsivity, and allostatic load, which focus on the physiological and developmental impacts of Kangaroo Care across the lifespan.
• Nursing Models: Including Fitzpatrick’s Rhythm Model, Levine’s Energy Principles, Nightingale’s Model, Orem’s Self-Care Model, Rogers’ Energy Fields, and Roy’s Adaptation Model, which provide frameworks for understanding the holistic and adaptive benefits of Kangaroo Care (Fitzpatrick, JJ, & Whall, 1989).

Five Categories of Kangaroo Care

Kangaroo Care can be categorized into five types based on when the care begins:

1. Late Kangaroo Care: The most common form in the U.S., starting when infants are stable in room air and approaching discharge.
2. Intermediate Kangaroo Care: Used for infants who have completed the early intensive care phase but may still need oxygen and experience episodes of apnea and bradycardia. This category includes infants stabilized with mechanical ventilation and those placed at the breast during gavage feedings.
3. Early Kangaroo Care: Begins as soon as infants are stabilized, usually within the first week or even the first day post-birth, with mothers helping to maintain stability.
4. Very Early Kangaroo Care: Starts in the delivery or recovery room between 15 and 60 minutes post-birth.
5. Birth Kangaroo Care: The infant is returned to the mother immediately after birth, with the rationale that maternal contact helps stabilize the infant quickly.

Extensions in Kangaroo Care

Kangaroo Care has been extended beyond its initial scope, with numerous case studies reported in journals like the American Journal of Maternal-Child Nursing, Acta Paediatrica, Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN), and Neonatal Network, the Journal of Neonatal Nursing.

Examples of these extensions include its use with twins, triplets, intubated preterm infants, full-term infants experiencing breastfeeding difficulties, a near-term infant with gastric reflux, adoptive parents, and mothers with postpartum depression (Anderson, GC, Dombrowski, & Swinth, 2001).

Kangaroo Care Research: Safety and Benefits

Research has demonstrated that Kangaroo Care is safe and offers several health benefits. Studies conducted primarily by nurses in the United States have shown that KC provides adequate warmth, conserves energy, stabilizes heart rate and respiration, reduces apnea, improves oxygenation, increases deep sleep and alert inactivity, reduces crying, minimizes cranial deformity, does not increase infection risk, promotes greater weight gain, and results in earlier discharge from the hospital (Anderson, GC, 1991, 1995, 1999).

Kangaroo Care also enhances lactation and prolongs breastfeeding. It has been found to act as an analgesic for infants, especially during breastfeeding, provided the mother is relaxed. Fathers, grandparents, young siblings, and other significant family members can also effectively provide Kangaroo Care. Additionally, parents often feel more fulfilled, develop a deeper attachment to their infants, and gain confidence in caring for them, even after returning home.

While cost-effectiveness and improved long-term outcomes have been observed, these benefits are not yet fully evidence-based.

Trends in Kangaroo Care Research

Recent trends in Kangaroo Care research include:

• Increasingly Rigorous Research: Studies are becoming more scientifically rigorous, with an emphasis on randomized controlled trials (RCTs) and detailed guidelines.
• Federal Funding: More research projects are receiving federal funding, including from bodies like the National Institute of Nursing Research.
• Detailed Guidelines and Conferences: The publication of detailed guidelines, such as those from the World Health Organization (WHO, 2003), and conferences devoted to Kangaroo Care are increasing awareness and acceptance of the practice.
• Broader Applications: KC is being applied to sicker and more vulnerable infants, as well as full-term infants, to facilitate lactation and breastfeeding, particularly for those experiencing difficulties.
• Very Early Kangaroo Care: There is growing recognition that initiating KC very early (immediately post-birth) can stabilize preterm infants and potentially prevent NICU admissions.

Limitations on Kangaroo Care Research

Despite its growing popularity, Kangaroo Care is not yet universally accepted or implemented across all healthcare settings. Several limitations to its adoption and research include:

• Resistance from Hospital Staff: Resistance from some hospital staff can lead to variable support for parents, and in some cases, the method is not allowed.
• Parental Burdens: Kangaroo Care is dose-related, meaning that its benefits depend on the duration and frequency of practice. However, factors such as parental time constraints, fatigue, discomfort, home responsibilities, stress, and anxiety can limit its implementation.
• Need for Broader Social Support: Creative initiatives, including broader social services, are needed to facilitate relaxation and extend caregiving for parents (Anderson, GC, Chiu, et al., 2003).

Trials in Kangaroo Research

The National Institute of Nursing Research has funded several randomized trials to evaluate the efficacy of Kangaroo Care. These include:

• Six Randomized Trials: Six trials conducted by nurses with preterm infants where Kangaroo Care was the intervention. Five trials led by Ludington involved infants in different care settings (open-air cribs, incubators, and mechanical ventilation) and studied outcomes like sleep, brain development, and pain response (Ludington et al., 2003).
• Additional Trials: One trial focused on healthy infants born between 32–36 weeks, starting Kangaroo Care at an average of 4.5 hours post-birth, and reported significant behavioral organization, early breastfeeding initiation, and competent breastfeeding within 24 hours (Anderson, GC, Chiu, et al., 2003).
• Global Trials: Seven randomized trials in developing countries, multiple studies in Europe, and two in Taiwan have also contributed to the evidence base for Kangaroo Care.

Conclusion

Kangaroo Care is a safe and beneficial practice for both preterm and full-term infants, offering a range of physiological, emotional, and developmental benefits. It is supported by various theoretical paradigms and research evidence, demonstrating its potential to improve outcomes in neonatal care. Despite some limitations in adoption and research, the method continues to gain traction, driven by ongoing research, increased awareness, and broader acceptance within the healthcare community. Future nursing research should continue to explore the potential of Kangaroo Care in improving quality of care, reducing stress, enhancing parental satisfaction, and promoting cost-effective outcomes.