KANGAROO MOTHER CARE

PRESENTOR :DR. SRIRAM P

MODERATOR : DR. PRAGNA

Department of Pediatrics
Rajarajeswari medical college and hospital
INTRODUCTION:

 Kangaroo is an animal found in Australia. She

invariably delivers a premature baby. The
premature, baby kangaroo stays in the pouch of
her mother, where it gets warmth and exclusive
breast feeding till it is mature enough to survive
outside.
 • Team of pediatricians started KMC in Instituto
19 Materno-Infantil (IMI) in Bogota, Colombia
78
• KMC was introduced in India.
Milestones 19
94
in 20
• WHO formally endorsed KMC and published
KMC practice guidelines
KMC 03
• Centre's of excellence established at three centres
History 20
04
AIIMS, PGI Chandigarh & KEM, Mumbai

• MOHFW, Government of India’s Operational

20 guidelines on KMC & optimal feeding of LBW
14
 DEFINITION:
 Kangaroo mother care (KMC) is a simple method of care for low birth weight
infants that includes early and prolonged skin-to-skin contact with the mother (or a
substitute caregiver) and exclusive & frequent breastfeeding.
 Practice of providing continuous skin-to-skin contact between mother and baby,
exclusive breast milk feeding, and early discharge from hospital.
 Kangaroo mother care is recommended for the routine care of newborns weighing
2000 g or less at birth, and should be initiated in health-care facilities as soon as the
newborns are clinically stable
TYPES OF KMC:
INTERMITTENT

• Varies from Hours /day to only few days in a week.

• For Infants who are very small but still needs Incubator care

CONTINUOUS

• Continuous throughout the day except during Breastfeeding and

changing diapers.
• When Neonate no longer requires incubator & almost ready for
discharge.
 SKIN-TO-SKIN CONTACT
However, KMC should not be confused
with routine skin-to-skin care at birth.
“World Health Organization (WHO)
recommends skin-to-skin care immediately
after delivery for every newborn,
irrespective of the birth weight”
KEY FEATURES:
 Early, continuous and prolonged skin-to-skin contact between the mother and the
baby
 Three major components are:

1. Kangaroo position: Skin to skin contact.

2. Kangaroo nutrition: exclusive breast feeding.
3. Kangaroo early discharge and regular follow up.

 Mothers at home require adequate support and follow-up.

KMC IN DIFFERENT SETTINGS :

 KMC MAY BE USED IN 3 DIFFERENT SETTINGS:

1. No specialized care for LBW Neonates : Neonates born at home or at 1st level
health care center as no possibility of being transferred to higher Healthcare unit.
2. Specialized care but limited Resources: Allows better utilization of available
resources as alternative
3. Specialized care & Adequate resources: Used as adjunct to establish healthy
bonding between mother and newborn and to increase the breastfeeding rates.
REQUIREMENTS FOR KMC IMPLEMENTATION:

1. Appropriate health facility: Room for KMC near NICU & proper settings in
postnatal wards.
2. Appropriate supporting staff and professionals: Adequate training of staff,
presence of nurse all the time, Educational material.
3. Good quality follow-up: Early discharge is ensured if proper Adequate follow-
up is ensured.
4. Institutional , Social and Community support: Support to mother , Family
support, Community awareness about the benefits of KMC
  Counseling: Effective counseling for the
initiation of KMC is a pre-requisite to
overcome socio-cultural barriers and
anxiety towards handling a low birth
weight infant by the mother and health
care providers.
HOW TO  Clothing:

PROVIDE KMC?
1. Mother: Any front-open, light dress as
per the local culture, not mandatory to
have any special dress.
2. Infant: should be dressed in cap, socks ,
disposable diapers and front-open
sleeveless shirt or ‘Jhabala’ made of a
soft natural fabric like cotton.
KANGAROO POSITIONING

1. The infant should be placed between the ◻mother’s

breasts in an upright position.
2. The head should be turned to one side and in a slightly
extended position.
3. The hips should be flexed and abducted in a “frog”
position; the arms should also be flexed.
4. The infant’s abdomen should be at the level of the
mother’s epigastrium.
5. Support the infant from the bottom with a sling/binder.
Mother in the KMC position can walk, stand, sit, or
engage in activities. If comfortable, mother can sleep
in KMC position with her infant
Also given by Father..
MONITORING
 Babies receiving KMC should be monitored carefully especially in the
initial stages.
 Should make sure that neonates neck position is neither too flexed nor too
extended, Airway is clear, Regular breathing, Pink color and neonate is
maintaining temperature.
 Mother should be involved in observing the neonate during KMC.
DURATION:

 Skin-to-skin contact should start gradually in the nursery, with a smooth transition
from conventional to continuous KMC.
 Sessions that lasts less than 1 hour should be avoided because frequent handling
may be stressful to neonate.
 The length of Skin-to-skin contacts should be gradually increased upto 24 hours a
day, interrupted only for changing diapers and during Breastfeeding.
THE SUPPORT BINDER

 This is the only special item needed

for KMC. It helps mothers hold
their babies safely close to their
chest
CARRYING POUCHES FOR KMC BABIES
CLOTHING FOR THE BABY

 When the ambient temperature is 22-

24°C, the baby is carried in kangaroo
position naked, except for the diaper, a
warm hat and socks (fig next slide)
ADVANTAGES OF KMC:

1. BENEFITS TO THE BABY

2. BENEFITS TO MOTHER
3. BENEFITS TO THE FAMILY
4. BENEFITS TO THE NATION
BENEFITS TO THE NEWBORN :
 Stabilizes body temperature .
 Decrease morbidities; better neurodevelopment.
 Early discharge.
 Promotes breastfeeding; prevents infection.
 Encourages bonding in mother & Child

Short: 4 hours daily* extended: 5-8 hours daily* long: 9-12 hours
daily* Continuous: More than12 hours daily*
 BENEFITS TO MOTHER

 KMC promote better mother infant bonding.

 Mother is less stressed during KMC as the mother is more actively
involved in the care.
 BENEFITS TO THE FAMILY

 KMC is economical to the family.

 KMC promotes early discharge of baby.
 KMC facilitates bonding between the baby, mother and the
family.
BENEFITS TO THE NATION:

 KMC decrease neonate and infant mortality and morbidity

 KMC is simple easily applicable, cost effective.
 KMC results in healthier and more intelligent babies.
KANGAROO POSITION & THERMO- REGULATION:

 Preterm/LBW Infants can not regulate their Body temperature, they need to be in a
neutral thermal environment to maintain adequate body temperature without extra
energy Expenditure.
 When Healthy preterm infants are placed in Kangaroo position, the infant body
temperature rises.
KANGAROO POSITION & OXYGEN SATURATION:

 Oxygen saturation may increase between 2-3 % during KMC as

compared with the incubator even during painful procedures.
 The evidence helps to confirm that Oxygen saturation is variable , but
remains within acceptable clinical standards.
KANGAROO POSITION & NEUROLOGIC
DEVELOPMENT:

 The Kangaroo position fosters Early Neurological development in the

preterm infant ,improving behavioral organization: Maturation of
neurological and psycho-motor functions a measured by standardized
tests.
 A greater complexity in brain has been observed in 32 -40 weeks of
gestational age placed in Kangaroo position, as opposed to those who
were not.
2. KANGAROO NUTRITION :

 Kangaroo nutrition is the delivery of nutrition to “kangarooed” neonates as soon

as oral feeding is possible.
 GOAL: To provide Exclusive or nearly Exclusive Breastfeeding with
fortification ,if needed.
 Mother should be explained how to Breastfeed while neonates in KMCC position.
 Holding the neonate near the Breast stimulates milk production.
 She may Express the milk while neonate is still in KMC Position .
 The Neonate could be fed with Paladai, Spoon or Tube, depending on the neonate
condition.
 Paladai

Spoon

Feeding tube
Cup
Feeding progression: Infant should progress from the initial method through the
intermediate steps to feeding exclusively from the breast directly.
Principles of advancing feeding modes
MONITORING OF INFANTS FOR ADEQUATE
FEEDING
Infants lose weight in the first few days, loss would not exceed 10-15% of the
birth weight.
They regain their birth weight by about 2 weeks and then 15-20 grams per
kilogram of their own body weight per day.
For infants below 1,500 grams (less than 32 weeks), use a postnatal growth chart
to plot weight every day until they are of 40 weeks PMA or 2500 grams.
If the infant has inadequate weight gain, the provider should check the amount of
intake, and assess and spluttering/ spillage.
Nipple and breast problems in the mother should be looked for.
3. KANGAROO EARLY DISCHARGE & FOLLOW-UP:

 EARLY DISCHARGE CRITERIA :

1. Baby’s general health is good.
2. Gaining weight at least 15-20g/kg/day for 3 consecutive days.
3. Maintaining body temperature for at least 3 consecutive days in room
temperature.
4. Feeding well and receiving exclusively Or predominantly Breast milk.
5. Mother and family members are confident to take care of baby.
WHEN TO DISCONTINUE KMC:

 KMC is continued for as long as possible at health facility and at home.

 Desirable until gestation reaches term or weight around 2500gm.
 The time when the infant starts wriggling to show that she is uncomfortable,
pulls her limbs out , cries and fussed everything the mother tries to put baby
back to skin-to-skin is the time to wean Infant from KMC.
 FOLLOW-UP CRITERIA:
1. The infant is followed once or thrice a week till 37-40 weeks of gestation or till
reaches 2.5 to 3kg of Weight.
2. Thereafter, follow-up once in 2-4 weeks till 3 months of post-conception age.
3. Later baby should be followed up at an interval of 1-2 months till 1 year of age.
4. Baby should gain adequate weight 15-20gm/kg/day unto 40 weeks of post-
conception age & 10mg/kg//day subsequently.
RESEARCH AND EXPERIENCE
 KMC is at least equivalent to conventional care (incubators), in terms of safety and
thermal protection, if measured by mortality.
 KMC, by facilitating breastfeeding, offers noticeable advantages in cases of severe
morbidity.
 KMC contributes to the humanization of neonatal care and to better bonding
between mother and baby in both low and high-income countries.
RECORDS TO BE MAINTAINED

1. when KMC began (date, weight and age);

2. condition of the baby;
3. details on duration and frequency of skin-to-skin contact;
4. whether the mother is hospitalized or is coming from home;
5. predominant feeding method;
 observations about lactation and feeding;
 daily weight gain;
 episodes of illness, other conditions or complications;
 the drugs baby is receiving;
 details on discharge: condition of the baby, maternal readiness, conditions
at home that make discharge possible; date, age, weight and post-
menstrual age at discharge; feeding method and instructions for follow-up
(where, when and how frequently).
 The follow-up record should contain, besides the usual data on the baby, the
following information:
1. when the baby was first seen (date, age, weight and post-menstrual age);
2. feeding method;
3. daily duration of skin-to-skin contact;
4. any concerns mother may have;
SAMPLE RECORD -KMC

Date of visit 1 2 3 3 4

Age

Weight weight gain

Feeding method

Average daily duration of skin-

to-skin contact

Complaints

Readmission to hospital

Weaned Date Reasons for weaning and other comments

Age (in days)
Post-menstrual age Weight
 KMC ROLL OUT PLAN:
The aim is to advocate KMC to be practiced for all infants eligible
for KMC at public health facilities.

• KMC services to be provided in all SNCUs

and well-functioning NBSUs (at CHCs and
FRUs) across the country
 O U… .
A N KY
TH