Nursing and Concept of Kangaroo Care

What is Kangaroo Care

    Most
nurses working in an intensive care nursery have witnessed parents expressing
in tense need to hold their ill preterm infants. A new method of care
addressing this need is “kangaroo care,” a term derived from its
similarity to the way marsupials’ mother their immature young. 

    During kangaroo
care (KC), mothers simply hold their diaper clad infant underneath their
clothing, skin to skin, and upright between their breasts; if needed for
warmth, a cap and a blanket across the infant’s back may be added. In complete
kangaroo care mothers allow self-regulatory breast feeding. 

    In developing
countries, the method is called kangaroo mother care (KMC), because mothers are
usually the central figure responsible for care and they breast feed
exclusively. Kangaroo care, also known as skin-to-skin contact (SSC), is
widespread in Scandinavia and Africa and is proliferating elsewhere. 

    The
method, which originated in Bogotá, Colombia, represents a blend of technology
and natural care. Full term infants also are vulnerable during the
physiologically demanding intrauterine extrauterine transition following birth
and therefore benefit from kangaroo care (Anderson, GC, Moore, Hepworth, &
Bergman, 2003).

Theoretical Paradigm

    Relevant
theoretical paradigms include stress, mutual caregiving, and self-regulation
(Anderson, GC, 1977, 1989, 1999), programming, inappropriate stress
responsivity, and allostatic load, all of which are physiological/developmental
and life span in nature; and Fitzpatrick’s Rhythm Model, Levine’s Energy
Principles, Nightingale’s Model, Orem’s Self-Care Model, Rogers’ Energy Fields,
and Roy’s Adaptation Model (Fitzpatrick, JJ, & Whall, 1989).

Five Categories of Kangaroo Care

    There
are five categories of kangaroo care, based primarily on how soon kangaroo care
begins (Anderson, GC, 1995). Late Kangaroo Care, still the most common category
in the US, begins when infants are stable in room air and approaching
discharge. 

    Infants given Intermediate Kangaroo Care have completed the early
intensive care phase, but usually still needed oxygen and probably had some apnea
and bradycardia. 

    Also included in this category are infants who are stabilized
with mechanical ventilation and infants who, although too weak to nurse, are
placed at the breast during gavage feedings, a method that facilitates
lactation. 

    Early Kangaroo Care is used for infants who are easily stabilized
and begins as soon as infants become stable, usually during the 1st week and
perhaps even the 1st day post birth. The idea is that mothers can help maintain
stability by giving kangaroo care. 

    Very Early Kangaroo Care begins in the
delivery or recovery room between 15- and 60-minutes post birth. With Birth
Kangaroo Care the infant is returned to the mother immediately following birth.
The rationale in these last two categories is that the mother can help to stabilize
her infant.

Extensions in Kangaroo Care

    Numerous
important extensions of kangaroo care have been reported as separate case
studies, mostly in MCN. 

    The American Journal of Maternal-Child Nursing;
Examples are with twins, triplets, an intubated preterm infant, full-term
infants having breast feeding difficulties, a near term infant with gastric
reflux, adoptive parents, and a mother who felt depressed during early
postpartum (Anderson, GC, Dombrowski, & Swinth , 2001). 

    Other journals that
frequently carry kangaroo care articles include Acta Paediatrica (formerly Acta
Paediatrica Scandinavica); Journal of Obstetric, Gynecologic, and Neonatal
Nursing (JOGNN); and Neonatal Network, the Journal of Neonatal Nursing.

Kangaroo Care Research Safety and Benefits

    Kangaroo
care is safe and has health benefits based on evidence (Anderson, GC, 1991,
1995, 1999). In the United States nurses have done most of this research. 

    Findings included adequate warmth, energy conservation, regular heart rate and
respirations, fourfold decrease in apnea, adequate oxygenation, more deep sleep
and alert inactivity, less crying, less cranial deformity, no increase in
infections, fewer days in incubators, greater weight gain, and earlier
discharge; lactation and breastfeeding increase and last longer. 

    Kangaroo care,
especially during breastfeeding, was analgesic for infants, provided mothers
feel relaxed.     

Fathers also gave kangaroo care effectively, as do grandparents,
young siblings, and selected important others. 

    Parents feel more fulfilled,
become deeply attached to their infants, and feel confident about caring for
them even at home. Cost effectiveness and improved long term outcomes exist but
are not yet evidence based.

Trails in Kangaroo Research

    The
National Institute of Nursing Research has funded nurses to conduct six
randomized trials with preterm infants in which kangaroo care was the
intervention. 

    Five trials have been conducted by Ludington; three completed
trials were with infants in open-air cribs, in incubators, and on mechanical
ventilation (eg, Ludington et al., 2003). Two trials are in progress: one on
sleep and brain development measured by electroencephalogram and the other on
blunting of pain measured by heart rate variability. 

    The sixth trial was with
32–36-week healthy infants beginning kangaroo care on average 4.5 hours post
birth (eg, Anderson, GC, Chiu, et al., 2003). 

    In a pilot trial for the funded
trial, 34-36-week infants began almost continuous kangaroo care by 30 minutes
post birth, had remarkable behavioral organization, began breast feeding
exclusively by 2 hours, and were breast-feeding competently within 24 hours. 

    Importantly, two infants had developed respiratory distress (grunting) by the
time kangaroo care began, but this disappeared quickly while the infants stayed
in kangaroo care and received warmed humidified oxygen via ox hood; the warmth
and humidity are essential (Anderson, GC, 1999). 

    Seven randomized trials done
in developing countries, numerous others in Europe, and two in Taiwan have led
to additional publications.

Limitations on Kangaro Care  Research

    Although
fully implemented in some hospitals, use of the kangaroo care method generally
remains scattered. The method is not allowed in some hospitals and may not last
in others due to resistance from some hospital staff with resultant variable
support for parents.     

    An elegant model for introducing the method and effecting
desired change and implementation is described by Bell and McGrath (1996).

    Because kangaroo care benefits are dose-related, parental burdens such as time
required, fatigue, discomfort, home related responsibilities, stress, and
anxiety warrant creative initiatives including broad social services to
facilitate relaxation and extend caregiving (Anderson, GC, Chiu, et al., 2003).

Trends In Kangaroo Care Research

    Other
trends in kangaroo care include increasingly rigorous research, federal
funding, publication of detailed guidelines (eg, by WHO (2003a), available
online), conferences devoted to kangaroo care, kangaroo care for sicker infants
and for full-term infants.

    Kangaroo care provided by selected family members or
friends, consumer awareness of and desire for kangaroo care, and increased use
of kangaroo care to facilitate lactation and breast-feeding especially for
dyads having breast-feeding difficulties. 

    The new realization that very early
kangaroo care can help stabilize some preterm infants and prevent NICU
admission has increased interest in giving kangaroo care as soon as possible
post birth, as often as possible thereafter, and for as long as possible each
time. 

    Nursing research is needed to document the great potential that kangaroo
care in its various forms has for quality care, mutual relaxation and stress
reduction, improved outcomes, parental satisfaction, and cost reduction.