Kangaroo care worldwide: The human incubator.

Imagine a baby kangaroo, warm and snug as a bug in a rug in its pouch. This is the model for so-called “kangaroo mother care” (KMC). The key component of KMC is placing the infant in direct skin-to-skin contact with the mother on the mother’s chest (where the body is warmest), in an upright position underneath her clothes. How long the infant stays in that position is variable; the aim is for more than 18 hours a day, but this may differ depending on the stability of the infant and what other care he or she requires. In addition, KMC includes support for exclusive and early breast milk provision, a timely discharge from hospital and the appropriate follow-up care, but these components show significant global differences (1).
It started in Colombia

The first country to develop and scientifically investigate KMC for low-birth weight (LBW) infants was Colombia, approximately 30 years ago. Emerging evidence from the first studies on this subject pointed to benefits in regards to morbidity and mortality, so the South American country soon filed KMC under “good alternative to incubator care” and implemented the method in national guidelines.

Since then, the benefits have been corroborated by studies worldwide.

  • Three Cochrane meta-analyses have investigated KMC in LBW infants (in 2000, 2014 and 2016)
  • The 2014 study included 18 trials of continuous KMC initiated before postnatal day ten in infants with a birth weight < 2,500 g. It showed a significantly reduced mortality at discharge / 40-41 weeks (RR 0.60) and a decreased incidence of healthcare-related sepsis (0.45) and hypothermia (0.34), compared to conventional neonatal care, as well as some benefits regarding infant growth, breastfeeding and mother-infant attachment (2).
  • The 2016 analysis included 21 studies and investigated KMC in LBW infants after and before stabilization and in relatively stable LBW infants. In addition to the benefits of the 2014 paper, KMC was associated with an increase in weight, length and head circumference gain (mean difference 4.1 g/d, 0.21 cm/week and 0.14cm/week, respectively) (3).
  • These meta-analyses also demonstrated that KMC promotes colonization with maternal flora and is associated with lower rates of sepsis, necrotizing enterocolitis and pneumonia.
  • Several studies have shown improved motor development due to KMC, with infants scoring higher on Bayle motor scales at six, twelve, and 24 months than infants without KMC (4).
  • A 16-year follow-up of preterm infants who had been under 24/7 KMC from the time they came off oxygen support until an age of 28 days showed that these children had a similar brain motor connectivity as term-born infants and a better motor development than preterm infants without KMC (5).
  • A US-American study demonstrated that preterm babies had significantly fewer oxygen desaturation events and fewer bradycardia events per hour during KMC time versus time spent in an incubator (6).

According to a report on “Prematurity Treatment and Management”, achieving universal KMC coverage could potentially save an estimated 450,000 preterm newborns annually (7). In the light of these numbers, it would seem safe to assume that KMC would be catching on worldwide – but far from it: The current global coverage of KMC is less than one percent. This means a lot of work for a multi-stakeholder group of newborn health advocates who have proposed a worldwide goal of 50 percent coverage of KMC by the year 2020 (8).

So what is the current situation with KMC in various parts of the globe?

KMC in Africa

According to a 2014 World Health Organization (WHO) report, “Fulfilling the Health Agenda for Women and Children”, 44 percent of developing countries worldwide now have national policies in place that recommend KMC in facilities for LBW or preterm newborns, including Benin, Burkina Faso, Ethiopia, Mali and Malawi (9). However, in many cases the implementation is still limited, due to incomplete dissemination of KMC guidelines, inadequate financial resources, shortage of trained healthcare workers and poor availability of basic supplies, says a US-American report (10).

KMC in Asia

A recent report investigated KMC uptake and service coverage in India, Indonesia and the Philippines. The report suggests that progress is slow in these countries. Even though pioneers of KMC introduced it as early as the 1990s and even managed to establish it in a few individual hospitals, the idea failed to spread further in most areas. According to the report, there was an only “patchy uptake and expansion of KMC services” between the late 1990s and 2012 (11).

KMC in Europe

A Spanish study compared the policies and practices regarding parental involvement and the kangaroo care position in eight European countries (Belgium, Denmark, France, Italy, the Netherlands, Spain, Sweden and the UK). It found that holding babies in the kangaroo position is widespread in these countries; most have reclining chairs or a dedicated room for KMC (with Italy and Spain having the least). However, in the UK, France, Italy and Spain, many units have restrictions in place regarding frequency (KMC not routinely offered, only sometimes, only at the parents’ request) as well as clinical conditions that prevent the use of KMC, such as mechanical ventilation and the presence of umbilical lines. Also, in these countries, fathers are routinely offered KMC less frequently than mothers (12).

Generally, implementation in western countries has been slow, due to ready access to incubators and technology.

Mark the date: May 15

Since 2011, “Kangaroo Care Awareness Day” has been observed worldwide on May 15. This day aims to increase awareness and to enhance practice of kangaroo care in neonatal intensive care units, post-partum units, labor and delivery wards, and any hospital unit that has babies up to three months of age.

  1. Chan GJ et al, Glob Health 2016;6:010701
  2. Conde-Agudelo A et al, Cochrane Database Syst Rev. 2014;4(4):CD002771
  3. Conde-Agudelo A et al, Cochrane Database Syst Rev. 2016;23(8):CD002771
  4. Barradas J et al J Pediatr (Rio J). 2006;82:475–480.
  5. Schneider C et al, Acta Paediatr. 2012;101:1045–1053.
  6. Mitchell AJ et al, J Neonatal Perinatal Med 2013;6:243-249
  7. Furdon SA, Prematurity Treatment and Management,
  8. http://emedicine.medscape.com/article/975909-treatment
  9. Engmann C et al, Lancet 2013;382:e26-7.
  10. http://www.countdown2015mnch.org/documents/2014Report/Countdown_to_2015-Fulfilling%20the%20Health_Agenda_for_Women_and_Children-The_2014_Report-Conference_Draft.pdf
  11. Vesel L et al, BMC Pregnancy Childbirth. 2015; 15(Suppl 2): S5.
  12. Bergh AM et al, BMC Int Health Hum Rights 2016;16:4
  13. Pallás-Alonso CR et al, Pediatr Crit Care Med 2012;13:568-577

‘Kangaroo care’ key for prem babies.

Mothers carrying babies skin-to-skin could significantly cut global death and disability rates from premature birth, a leading expert has said.

Prof Joy Lawn says “kangaroo care“, not expensive intensive care, is the key.

Premature baby in an incubator

The 15 million babies every year born at or before 37 weeks gestation account for about 10% of the global burden of disease, and one million of them die.

Of those who survive, just under 3% have moderate or severe impairments and 4.4% have mild impairments.

“Start Quote

Unless there are those breathing problems, kangaroo care is actually better ”

Prof Joy Lawn London School of Hygiene & Tropical Medicine

Prof Lawn, from the London School of Hygiene and Tropical Medicine (LSHTM), said: “The perception is you need intensive care for pre-term babies,

“But 85% of babies born premature are six weeks early or less. They need help feeding, with temperature control and they are more prone to infection.

“It’s really only before 32 weeks that their lungs are immature and they need help breathing,

She added: “Unless there are those breathing problems, kangaroo care is actually better because it promotes breastfeeding and reduces infection.”

Speaking ahead of World Prematurity Day on Friday, UN Secretary General Ban Ki-moon, who leads the Every Woman Every Child movement, which promotes improvements to healthcare for women and children, said: “Three-quarters of the one million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities.”

Duncan Wilbur, from the UK charity Bliss, said, “While kangaroo care saves lives in countries such as Africa, it is also incredibly important for babies born too soon all over the world.

“Here in the UK our medical technology is extremely advanced but simply giving a baby kangaroo care or skin-to-skin can help make a baby’s breathing and heart rate more regular, it can help a baby’s discomfort during certain medical procedures and importantly can benefit breastfeeding and bonding between the baby and parents.”

Pregnancy risks

Studies to be published this weekend in the Pediatric Research journal show boys are 14% more likely to be born prematurely – and boys who are premature are more likely to die or experience disability than girls.

Common disabilities include learning disorders and cerebral palsy.

Prof Lawn said: “One partial explanation for more preterm births among boys is that women pregnant with a boy are more likely to have placental problems, pre-eclampsia, and high blood pressure, all associated with preterm births.”

She added: “Baby boys have a higher likelihood of infections, jaundice, birth complications, and congenital conditions, but the biggest risk for baby boys is due to preterm birth.

“For two babies born at the same degree of prematurity, a boy will have a higher risk of death and disability compared to a girl.

“Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed.

A New Study Says We Can’t Prevent Most Preterm Births, So What Now?

When Kate McCasland came into this world early almost 18 years ago, there was no global movement to reduce deaths of preterm babies. And the staff at the Texas hospital where she was born had never before tried the simple technique that her mom believes saved her life. But Saturday’s World Prematurity Day is all about getting that same technique and other high-impact care to the millions of preterm babies who need it most.

A new study out in The Lancet today makes it clear that training and equipping health workers to care for preterm babies is the key to saving the 1.1 million such babies who die every year. That’s because we still know very little about how to prevent babies from being born too soon. A distinguished research team led by Save the Children has found that even if the United States and other high-income countries did everything science currently tells us could help, the vast majority of these early births — 95 percent — would continue.

In contrast, good care at birth allows us to save 99 percent of the half-million preterm babies born in this country each year. And even in communities around the world where high-tech intensive care is not realistic and where most preterm deaths occur, low-tech, low-cost care could save 75 percent of these young lives. Now is the time to get that proven-effective, lifesaving care to the babies who will die without it.

Back to Kate in Texas. The simple technique that helped her could, by itself, save the lives of 450,000 preterm babies born in developing countries every year. In an interesting twist, Kate’s mom, Jane McCasland, actually learned about Kangaroo Mother Care one sleepless night while watching a late-night TV documentary set in Africa. Jane’s mind raced as she saw how the mother on TV was able to help her tiny baby survive by keeping the shirtless baby wrapped to her own bare skin.

When incubators are not an option, this technique gives tiny babies the warmth their own bodies have to fight so hard to produce. It also promotes breastfeeding, another proven lifesaver. But as Jane was to find out, there were less quantifiable benefits, too.

The next day she told the staff at the Harris Methodist Fort Worth Hospital that she wanted to try the kangaroo method, only to be told that the doctors thought Jane was too small to even try. But one night soon after, a trusted nurse came to Jane and told her that Kate was having a rough night in the incubator and that her heart rate was up above 200. “Now’s the time,” she told Jane.

“I have a feeling she was totally defying some doctor’s orders,” Jane recounts today. “But a mom holding her baby, it’s the most natural thing in the world. Her heartbeat dropped, and within about three minutes she was sound asleep. She gained an ounce that very night. When you’re talking about a baby who weighs 1 pound 7, that’s a lot.”

Jane believes her daughter survived thanks to Kangaroo Mother Care, “one gutsy nurse” and the medical team who quickly supported the method once they saw how effective it was. They learned from Kate’s case, applied that to helping other babies and eventually put the picture you see above on hospital literature promoting their use of Kangaroo Mother Care.

Jane brought Kate home on what should have been her due date, nearly four months after her birth. Now a high school senior, a driven and passionate Kate has become an advocate for newborn health around Texas and around the world. And she’s decided that she wants to become a neonatal nurse herself. She told her mom that it’s a nice way to say “thank you” to the health workers who saved her life.

Jane couldn’t be prouder of her daughter or more thankful to the team at Harris, so she has nominated them for a REAL Award, a first-of-its kind award initiative designed to honor health workers and their lifesaving work around the world.

“I still look back and think, ‘Oh my gosh, how did she make it?'” Jane says. “There were no egos. It wasn’t about them. It was about getting my daughter home, and you don’t forget people like that.”

This World Prematurity Day, Nov. 17, take a moment to celebrate health workers whose lifesaving work includes making sure babies born too soon are not born to die. Read about the global honorees and nominate an American health worker who has touched your life at www.TheRealAwards.com.

Souce: http://www.huffingtonpost.com

Fragile newborns survive against the odds.

TAMALE, Ghana, 7 August 2012 – Awintirim Atubisa spent the first two months of his life tied to his mother’s chest in a cloth ‘pouch’, just like a baby kangaroo.  When he was born, six weeks premature, he weighed 1.3kg and was at risk of hospital-acquired infection, severe illness and respiratory tract disease.

But he survived, thanks to the UNICEF-supported Kangaroo Mother Care program.  The program encourages mothers to wrap their premature and underweight newborns to their chests using a ‘pouch.’  Snuggled against their mother’s skin, the babies’ body temperatures stabilise, their heart rates steady and they begin to breathe more easily.

Kangaroo Mother Care has been particularly successful in the Upper East and Central regions of Ghana, where babies who might have once died for want of an expensive incubator are now surviving.

Skin-to-skin care

Awintirim’s mother, Lydia Atubisa, says skin-to-skin contact, which is the cornerstone of Kangaroo Mother Care, calmed her baby son.

“When he was alone, he would start to shake and cry. But he becomes still as soon as I tie him to me and hold him. The heat of my body makes him feel like he is still in the womb,” she said.

Margaret Kugre, the nurse in charge of the program at the Upper East Regional Hospital, said that constant skin contact between mother and baby saves the lives of fragile babies in a region where incubators are scarce and unreliable. Before Kangaroo Mother Care was introduced in 2008, up to four tiny babies would have to share the maternity ward’s only incubator, which was often broken for months at a time.

Exclusive breast feeding is another key aspect of the program.  Babies are fed nothing but breast milk for the first six months of life, avoiding illnesses from contaminated water or breast milk substitutes.

The program encourages mother and baby to go home as soon as possible, to reduce the risk of hospital-acquired infection.  Lydia and her son were in the hospital for one month after the birth, but as soon as he was stable and gaining weight and she could confidently tie her cloth pouch and breastfeed, they moved back home to Sandema.  Awintirim and Lydia only return to the hospital for monthly weigh-ins.  At his latest check-up, six weeks after delivery, he weighed nearly 2kg.

In the first six months of 2011, 99 underweight babies were born in the Bolgatanga Municipal area in Ghana’s Upper East Region.  All were introduced to the Kangaroo Mother Care program and all survived.

Lydia is confident her son will become strong and she has big dreams for his future: “I want him to be a doctor so he can save lives, like the doctor who saved him.”

Culture adapts to new approach

The kangaroo program has been quickly adapted into Ghanaian culture. Ms. Kugre said mothers were happy to carry their newborns on their chests but nurses also involve a woman’s husband and mother-in-law.  “Carrying the baby on the back is preferred in Africa,” she said. “We work with the whole family so it is not so strange to them. In the ward, we wrap the babies onto the mother-in-law so she can feel what it’s like.”

Derek Bonsu, the Medical Superintendent at Saltpond Hospital in Central Region, said Kangaroo Mother Care empowers mothers. “They get to play an active role in the saving of their child. And no one monitors a vulnerable baby better than a desperate mother.”

Central Region also enjoys success

The program has saved hundreds of lives since it was introduced to the Central Region in 2008. Mr. Bonsu said premature and underweight babies were common and often died before Kangaroo Mother Care was introduced.

“We are in the middle of an area with social and economic problems. There is a lot of illiteracy and poverty, an early age of sexual initiation, a tradition of harmful practices, malnutrition… Mothers have had anaemia, malaria and other parasites and infections, all having an effect on the pregnancy, delivery, and health of the unborn baby. Many of the babies are born preterm or with too low a birth weight.  This should not be deadly, but we did not have a functioning incubator in the hospital and were losing the babies.”

The success of the program is clear. Before June 2008, 9 out of the 16 underweight babies born at the hospital died.  After the program started in June, all 12 babies born underweight lived.

Source: UNICEF