Kangaroo care in pre-term or low birth weight babies in a postnatal ward

In the early 1980s, paediatricians working in Colombia recognized and researched the medical benefits of Kangaroo mother care, defined as a combination of skin-to-skin contact, exclusive breastfeeding (where possible), early discharge and adequate follow up (Rey and Martinez, 1983). Their research found that this practice was an alternative to the conventional method of care for premature and low birth weight infants in an incubator, separate from their mothers, and that this simple, inexpensive intervention led to a significant drop in mortality rate for premature infants from 70% to 30%. Approximately 30 years later, a Cochrane review (Conde-Agudelo et al, 2011) compared 16 clinical trials investigating Kangaroo care in developing countries involving mothers and premature or low birth weight babies. It concluded that Kangaroo care reduces the risk of mortality, infection/sepsis, hypothermia and length of hospital stay and that it has also been found to increase some measures of growth, breastfeeding and mother–infant attachment. The World Health Organization (WHO) (2003) has now produced a practical guide on what is needed to introduce and carry out Kangaroo care in settings where resources are limited. Further studies have also found that skin-to-skin contact (Kangaroo care) alone also has significant benefits for pre-term and term babies, especially in low income countries, including better temperature regulation, shorter hospital stay (Charpak et al, 1997), more contented babies (Ludington-Hoe, 1992; Ludington et al, 1992), fewer infections (Sloan et al, 1994; Charpak et al, 2001), better breastfeeding rates (Bier et al, 1996), improved cognitive (Charpak et al, 2005) and motor development (Ferber and Makhoul, 2004; Dodd, 2005) and trends towards increased maternal attachment and bonding (Moore et al, 2007). These studies have led to calls for skin-to-skin contact from birth (Kangaroo care) to be more widely implemented in affluent countries as well as impoverished environments (Franck et al, 2002; Ruiz-Pelaez et al, 2004; DiMenna, 2006). Many neonatal intensive care units (NICUs) in the UK are now implementing some form of Kangaroo care contact for mothers and babies, although a note of caution is advised in light of the findings of a recent meta-analysis (Mori et al, 2010) which found that Kangaroo care is effective at increasing body temperature, but is also associated with a decrease in oxygen saturation. The authors therefore recommend monitoring of oxygen saturation and respiration for unstabilized low birth weight infants babies at risk of apnoea of prematurity until more is known about this subject. During the last decade, most maternity hospitals in the UK have designated an area on the postnatal ward for mothers with babies who are premature or low birth weight (below the second centile for gestational age) and do not require neonatal intensive care, to stay together with help and support from midwives and ancillary staff. To date there has been no research investigating whether the ‘routine’ adoption of Kangaroo care for these babies cared for in this setting, who are otherwise well, can improve outcomes, especially in relation to length of stay, feeding and parent satisfaction. This is therefore the purpose of this study. Abstract Objective: To compare the efficacy of Kangaroo care (skin-to-skin contact with mother) with standard care (next to the mother in a cot) for premature, low birth weight and babies of diabetic mothers in a transitional care ward setting. Method: This was a cohort study undertaken in a transitional care/postnatal ward of a UK district general hospital. The study involved 214 babies (107 in the study group, 107 in the control group) with a gestation 34–36+6 weeks, small for gestational age and babies of diabetic mothers. Babies in the study group had Kangaroo care following birth up to 6 weeks of age. Control group had standard care (in the cot next to the mother). The main outcome measure was the length of hospital stay. The secondary outcome measures were breastfeeding at discharge from hospital and at 6 weeks, admission to neonatal intensive care unit (NICU) and parent satisfaction. Results: There was a significant reduction in mean length of stay (4.33 vs. 5.01 days, P = 0.017, 95% CI 3.93–4.73 and 4.58–5.44) in the study group compared to the control. There was also an increase in exclusive breastfeeding rates on discharge from hospital in the study group (72% vs. 55% P = 0.01, OR 2.09, 95% CI 1.18–3.69). There were no differences in feeding outcomes at 6 weeks, or in admission to NICU. Conclusions: Kangaroo care is a simple intervention that reduces length of hospital stay and improves breastfeeding rates on discharge from hospital for babies cared for in a transitional care/postnatal ward setting. Parents rate Kangaroo care highly, especially in the first 2 weeks following birth.