Immediate kangaroo mother care PPT.pptx

ikmc

1. IMMEDIATE KANGAROO MOTHER CARE ( iKMC )

2. Kangaroo Mother Care Kangaroo Mother Care (KMC) defined by WHO as continuous skin to skin contact and feeding exclusively with breast milk. It is one of the low-cost interventions to reduce mortality, infections, duration of hospitalization and cost of care among LBW infants. WHO guidelines recommend intermittent KMC when the infant’s condition has stabilized. However, there is a knowledge gap regarding the effect of initiating KMC soon after birth and before stabilization with respect to mortality in infants with low birth weight.

3. Immediate KMC: Keep Babies warm at birth Immediate Kangaroo Mother Care (KMC) is continuous skin-to-skin contact of baby on mother’s chest immediately after birth to prevent hypothermia of the newborn and promote early breastfeeding.

4. Benefits of iKMC 1. Survival and Health: Reduced hypothermia, infections, and neonatal mortality rates. 2. Physiological Benefits: Stabilized heart rate, breathing, and temperature. 3. Psychological and Emotional Well-being: Improved bonding and maternal confidence. 4. Long-term Benefits: Improved weight gain, breastfeeding rates, and cognitive outcomes.

5. Mother Newborn Care Unit : Quality Care Initiative in care of small and sick newborns i -KMC study lead to the concept of mother- newborn care unit where mother-baby dyad stay together from birth till discharge which resulted in survival and quality of care of small and sick newborns.

6. i -KMC Intervention : Requirement Three components Continuous skin-to-skin contact with mother or surrogate starting within 2 hours of birth, aiming > 20 hours /day Counselling and support for exclusive breastmilk feeding/ breastfeeding. Provision of required medical care for mother and baby in STS contact without separation, as much as possible.

7. Immediate KMC :Operationalization Initiating KMC in labor room or operation theatre Transportation in KMC position Creating mother’s bed in NICU: against the current norms Creating a mother, baby friendly infrastructure and processes in NICU (Mother- NICU)

8. What is MNCU? Mother in NICU or Mother-Newborn Care unit is a facility where sick or small newborns are cared with their mothers 24x7 with all facilities of level II newborn care and provision for postnatal care to mothers.

9. MNCU- Infrastructure for Care of Mother Mother Examination Cubicle Pantry Toilet and Bathing Room

10. Mother In NICU

11. MNCU Improves Opportunities for KMC STS (hours per day) M-NICU NICU Median 16.9 hours 1.5 hours IQR (13.0-19.7) (0.3-3.3)

12. Provision of Respiratory support with KMC Median Duration of KMC 17 hours/day

13. Improved Oppurtunities for Breastfeeding

14. Provides Opportunity for mother to be the primary care giver in MNCU Mother changing Diaper Developmentally supportive care

15. Improves Opportunities for Counselling the mother –Discharge preparedness Presence of Mother in MNCU gives ample opportunity to healthcare workers to discuss with mother healthy practices of newborn care. Thus, preparing them to take care of newborns after discharge.

16. Challenges in operationalizing Zero Separation: Initiating KMC in labor room or operation theatre Transportation in KMC position Creating a mother and baby friendly infrastructure in NICU- Mother-NICU Optimizing respiratory support in KMC position Monitoring for asepsis/infection control practices Coordination with the obstetrics team for providing care for the mother

17. Initiating KMC in Delivery room Initiating skin to skin contact with mother on delivery table Designated i -KMC area with bed and KMC chair in labour room Initiating KMC with surrogate and transporting to Mother-NICU

18. Transport in KMC from labour room to Mother-NICU Mother needs to be observed for around 2 hours after vaginal delivery and around 6 hours after LSCS Sick newborns need early transfer to NICU Solution :Surrogate in the delivery area for transporting baby to mother-NICU in KMC position

19. Experience of KMC transport KMC transport is feasible : 71% of SSNB in intervention group transported in KMC. Most KMC transport done with surrogates (62.2% vs 8.6%) as these babies need to be transported to M-NICU soon after birth. KMC transport is efficacious : 98.2% babies received in MNCU euthermic following KMC transport. KMC transport is not only safe but also babies stabilized during transport – Babies had less desaturation following KMC transport (4.3% in KMC group vs 9.8% in non-KMC group), less severe chest indrawings (5.9 vs 10.2%), less nasal flaring (2.4% vs 6.4%), less grunting (2.0 vs 7.2%)

20. Optimizing respiratory support in KMC position

21. KMC garment Binder KMC shirt

22. Does Entry of Mother/Surrogate in MNCU increases Infections? A major concern of Pediatricians and policy makers that presence of mothers in NICU will bring more infections. Systematic review 2014 : strong evidence that KMC reduces nosocomial infection. Experience of MNCU suggests mothers can be easily trained to follow asepsis routines. *Conde-Agudelo A, Díaz-Rossello JL. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD002771.

23. Incidence and case fatality of neonatal sepsis

24. Care of Mothers in M-NICU A major challenge in MNCU as these mothers have just delivered Essential care package developed for immediate post-natal care, in which neonatal nurses are trained. Obstetric team to see and care for mothers in the MNCU unit Equal Partnership & strong collaboration and co-ordination with the obstetricians a must.

25. Implications : System Changes POLICY : to permit Mother & Surrogate 24/7 MNCU : to keep the mother and baby together right from birth with zero separation Revolutionize the way Neonatal intensive care is currently practiced

26. To make zero separation a reality, we need changes in policy, infrastructure , processes and, most importantly, the mindset of health professionals The presence of the mother in the NICU 24x7 is a paradigm shift in the care of small and sick newborns