SATYA NURSING COLLEGE ROHTAK

SEMINAR
ON
KANGAROO
MOTHER CARE

Submitted To Submitted By

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 INDEX

Sr. No. CONTENTS Page No.

1. ABSTRACT
2. Introduction of Kangaroo 3
Mother Care
3. Benefits of KMC 4
4. Requirement for KMC 5
Implementation
5. Eligibility Criteria for KMC 5
6. Preparation for KMC 6
7. KMC Procedure 6
8. Psychological support to 7-8
Mother
9. Discharging Criteria 8

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Introduction
Caring low birth weight baby is a great challenge for the neonatal care unit and
the family. Number of low birth weight baby is still far beyond the expected target in our
country. The cost of quality management of these babies is increasing day by day. Kangaroo
mother care is a low cost approach for the care of low birth weight baby. This method of care
was introduced and popularized by Dr Edger Rey, in 1978. It was then developed by Dr
Martinez and Dr Charpak.

Definition
Kangaroo Mother care (KMC) is a special way of caring low birth weight
(LBW) infants by skin-to-skin contant. It promotes their health and welling by effective
thermal control, breastfeeding and bonding. KMC is initiated in hospital and continued at
home. Three important aspects of KMC are kangaroo position, nutrition and follow-up.

Components of KMC
In KMC, the infant is continuously kept in skin-to-skin contact by the mother
and breastfed exclusively to the utmost extent. The two components of KMC are:
1. Skin-to-skin contact: Direct, continuous and prolonged skin-to-skin contact is
provided between the mother and her baby to promote thermal control.
2. Exclusive breastfeeding: Skin-to-skin contact promotes lactation and feeding
interaction with exclusive breastfeeding for adequate nutrition and to improve desired
weight gain.

Prerequisites of KMC
A. Support to the Mother: Mother needs support in hospital and home from care-givers
and family members. Counseling and supervision should be provided to the mother by
the health personnel in hospital, whereas mother requires assistance and co-operation
from her family members at home.
B. Postdischarge follow-up: KMC should be continued at home after discharge from
hospital. For safe and successful KMC at home, a regular follow-up should be
arranged to solve problem and to evaluate health status of the infant.

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Benefits of KMC
1. KMC helps in thermal control and metabolism. Prolonged, continuous and direct skin-
to-skin contact between mother and neonate provides effective thermal control and
reduces risk of hypothermia.
2. KMC results in increased duration and rate of breastfeeding.
3. KMC satisfies all five senses of the infant. Baby feels warmth of the mother through
skin-to-skin contact (touch), listen to mother voice and heartbeat (hearing), sucks the
breast to feed (taste), smells the mother’s odor (olfaction) and makes eye contact with
mother’s (vision).
4. During KMC, the baby has more regular breathing and less predisposition to apnea.
5. KMC protects against nosocomial infection and reduces incidence of severe illness
including pneumonia during infancy.
6. Daily weight gain is slightly better with KMC, thus duration of hospital stay may be
reduced. LBW baby receiving KMC could be discharged from the hospital earlier than
conventional care.
7. KMC facilities better mother-infant bondage due to significantly less stress during
kangarooing than the incubator care of the baby.
8. KMC is one of the best methods of transporting small babies by keeping them in
continuous skin-to-skin contact with mother or family members.
9. Mother feels increased confidence, self-esteem, sense of fulfillment and deep
satisfaction with KMC. Father feels more relaxed, comfortable and better bonded.
10. KMC does not require additional staff compared to incubator care.
According to the Cochrane Review in 2011, KMC was found to reduce infant
mortality and lower rates of severe infection/sepsis, nosocomial infections, hypothermia,
lower-respiratory-tract diseases and severe illness in neonates. It also found that there is
reduction of length of hospital stay in sick and preterm neonates. The review also revealed
that KMC resulted in improved weight gain, increase in length and head circumference,
improved breast feeding, mother infant bonding and maternal satisfaction. Other studies on
KMC show that there is almost no fluctuation of temperature among KMC babies. There is
reduced response to painful stimuli in neonates and decreased postpartum depression among
mothers by practice of KMC. In a meta-analysis in 2010, it is found that KMC significantly
reduced neonatal mortality.

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Requirements for KMC Implementation
 Training of nurses, doctors and other staff on KMC, specially who are involved in
care of mother and baby.
 Educational materials like information booklet, pamphlets, poster, video film, etc. on
KMC in local language.
 Reclining chairs or beds with adjustable backrest or pillow or ordinary chair.
 KMC does not require extra staff. Once KMC is implemented, care-givers appreciate
it because of health benefits to the babies and the satisfaction expressed by the
mothers.

Eligibility Criteria for KMC

For Baby
 All stable LBW babies are eligible for KMC. It is particularly useful for caring LBW
infants weighing below 2000 gm.
 In a stable baby, KMC can be initiated soon after birth.
 KMC should be started after the baby is hemodynamically stable.
 Sick LBW infants may take a few days to initiate KMC. So the sick baby needs
transfer to a proper facility immediately.
 Infants of birth weight less than 1200 g with serious prematurity related morbidity
may take days to weeks to allow initiation of KMC.
 KMC can be initiated who is otherwise stable but may still be on IV fluid therapy,
tube feeding and/or O2 therapy.

For Mothers
 All mothers can provide KMC irrespective of age, parity, education, culture and
religion.
 Mother should be free of serious illness and able to take adequate diet and
supplements recommended by her doctor.
 She must be willing to provide KMC to her baby.
 She should maintain good hygiene, daily bath/sponge, change of clothes, hand
hygiene, short and clean finger nails, etc.
 She should have supportive family and community to be encouraged to continue
KMC to her baby.

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Preparation for KMC
Counseling
 Explain the benefits of KMC to the mother and the family members.
 Demonstrate the procedure to the mother gently with patience.
 Answer the questions as asked by the mother and the family members to remove
anxiety.
 Allow the mother to interact with someone who have already practicing KMC for her
baby.
 Discuss about the procedure to the mother-in-law, husband or any other members of
the family.

Mother’s Clothing
Mother should wear front-open, light dress, as per local culture. Mother can wear sari-
blouse, gown, shawl, etc.

Baby’s Clothing
Baby should be dressed with front-open sleeveless shirt, cap, socks, nappy and hand
gloves.

KMC Procedure
Kangaroo Positioning
 The Baby Should be placed between the mother’s breast in an upright position.
 Baby’s head should be turned to one side and in a slightly extended position which
helps to keep the airway open and allow eye to eye contact between mother and baby.
 Baby’s hip should be flexed and abducted in a froglike position. The arms should also
be flexed and placed on mother’s chest.
 Baby’s abdomen should be placed at the level of mother’s epigastrium.
This position helps to reduce the occurrence of apnea, as mother’s breathing and
heartbeat stimulate the baby. Baby can be supported with a sling or binder or
especially prepared KMC bag.

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Monitoring during KMC
 During initial stage of KMC the baby should be monitored for airway, breathing, color
and temperature. Hands and feet should be examined to assess the warmth. Airway
must be kept clear with regular breathing, normal skin color and temperature.
 Baby’s neck position should be neither too flexed nor too extended.

Feeding
 Mother needs help to breastfeed her baby during KMC. Holding the baby near the
breast stimulates milk production and the Kangaroo position makes the breastfeeding
easier.
 Baby could be fed with paladai, spoon and tube depending upon the baby’s condition.

Psychological Support To Mother

 Mother need motivation to continue KMC.
 She should be encouraged to ask questions to remove anxieties.

Privacy
Privacy should be maintained to avoid unnecessary exposure on the part of the mother
which makes her nervous and demotivating.

Time of Initiation of KMC

 KMC should be initiated gradually with a smooth transition from conventional care to
continuous KMC.
 KMC can be started as soon as the baby is stable in the neonatal care unit.
 Short KMC sessions can be initiated during recovery with ongoing medical treatment,
i.e. IV fluid, O2 therapy, etc.
 KMC can be provided while the baby is with gavage feeding.

Duration of KMC
 Duration of KMC should not be less than one hour to avoid frequent handling which
may be stressful to the baby.

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  Gradually the length of KMC sessions should be increased up to 24 hours a day.
Interruption only can be done for changing of diapers.
 KMC should be continued in postnatal ward and home.
 It may not be possible for mother to provide KMC prolonged period in the beginning.
Encourage her to increase the duration each time to provide KMC as long as possible.
 When mother is not available then other family members such as father, grandmother,
aunty can provide KMC.

Can the Mother Continue KMC during Sleep and Resting?

 Mother can sleep with baby in KMC position in a reclined or semi-recumbent position
about 15 to 300 from above the ground.
 A comfortable chair with adjustable back may be useful to provide KMC during sleep
and rest at ward or home.
 Adjustable bed or several pillows or an ordinary bed can be used to maintain the
position, which usually decreased the risk of apnea of the baby.
 Supporting garment can be used to carry the baby in kangaroo position during sleep
and rest.
 Father and family members can provide KMC to relieve mother during and rest.

Discharging Criteria
The baby should be transferred from the Neonatal Care Unit to the postnatal ward,
when the baby is stable and gaining weight and the mother is confident to look after the baby.
The baby should be discharged from hospital when the baby is having the following
conditions:
 General health is good and there is no evidence of infection and apnea.
 Feeding well exclusively with breast milk.
 Gaining weight 15 to 20 g/kg/day for atleast three consecutive days.
 Maintaining normal body temperature satisfactorily for atleast three consecutive days
in room temperature.
 Mother and family members are confident to take care of the baby at home and would
be able to come regularly for follow-up visits.
 Home environment should be suitable and congenial for continuation of KMC.

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