KANGAROO MOTHER CARE ppt for nursing students

angaroo mother care (KMC) is a nursing method that involves skin-to-skin contact between a mother and her newborn to help establish bonding and meet the baby's biological and emotional needs. It's a simple way to care for low birth weight infants (LBWIs), who are born with a weight below 2500 grams, and is especially important because 20 million LBWIs are born worldwide each year.

1. GUESS THE TOPIC

2. Kangaroo Mother Care

3. Kangaroo Mother Care (KMC) 3

4. Background (1/2) 4 The global prevalence of low birth weight (LBW) is 15.5%, which amounts to about 20 million LBW infants born each year (WHO, 2003). Among which, 96.5% occur in developing countries.

5. Background (2/2) 5 Globally, low birth weight (LBW) contributes to 60% to 80% of all neonatal deaths. Preterm birth and small for gestational age is the most common direct cause of newborn mortality, is one of the reason for low birth weight. Prematurity is the primary cause of newborn death accounting to 31% (NENAP, 2016).

6. What is Kangaroo Mother Care? 6 Kangaroo Mother Care (KMC) is care of newborn infants secured skin-to-skin to the mother KMC is a powerful and easy to use method to promote the health and well- being of Low birth weight (LBW) - infants with birth weight below 2500g Preterm infants – infants with gestational age less than 37 weeks Full term infants

7. Reasons why KMC was implemented (1/2) 7 In 1979, while working in hospital of Bogota, Colombia, Dr. Edgar Rey & Hector Martinez , found out that: Large numbers of LBW & preterm infants were delivered because of: Poor Antenatal Care attendance High incidence of toxaemia of pregnancy, anaemia & infections Shortage of staff & inadequate equipment

8. Reasons why KMC was implemented (2/2) 8 High in f ec t i o n & m o r t ali t y r a t e b ec a u s e of overcrowding L a r ge n u m b e r s o f i n f a n t s w h o w er e aba n don e d by their mothers

9. KMC Practice in Colombia 9 Maternal-infant skin-to-skin contact was introduced to stable LBW infants surviving the first few weeks of life Exclusive breastfeeding was encouraged As long as infants could feed and were gaining weight, they were discharged, regardless of weight

10. This practice resulted in: Improved outcome for LBW infants Decreased hospitalisation time Less overcrowding Less abandoned infants Improved staff morale 10

11. Scientific evidence showed 11 “Incredible survival of Kangaroo Babies hence KMC practiced in rest of the of the world”

12. Why is it called Kangaroo Mother Care? 12 A newborn baby kangaroo (joey) is very immature at birth and very small in size. The mother kangaroo’s pouch provides warmth, safety and a constant supply of food (milk) to the joey.

13. Similar to kangaroo care giving the human infant is also immature and especially the LBW infant benefits from skin-to-skin care because it provides warmth, safety and food. 13

14. Additionally… 14 As incubators and radiant warmer are expensive, require skilled staff and reliable electric power, many hospitals do not have them or not enough. Babies born in hospitals who need incubators or radiant warmer to keep them warm often have to share them.

15. Sharing incubators is risky because if one baby becomes ill he can easily pass the infection to the other baby. KMC was developed as a way to maintain the n o r m al b o d y temperature of low birth weight and premature babies born in hospitals t h a t d o n ot h a v e enough incubators. 14

16. Types of KMC 16 Continuous KMC or full KMC Partial or intermittent KMC

17. Continuous KMC 17 When KMC is practiced ideally for 24 hour except cleaning the diaper, or breast feeding. At least 18 hours is compulsory. KMC may discontinue for very short periods when the mother has to bathe or attend to other personal needs. It requires support from the family members, including the husband.

18. Partial or intermittent KMC 18 L e ss t h an 1 8 ho urs bu t it s h o uld n o t b e l ess t h a n 3 hours a day. The duration of condition of the mother. intermittent in f ant and KMC depends t he a v ail a bili t y o n t h e o f t h e

19. Components of KMC 19 Continuous skin to skin contact between baby’s front and mothers chest. Exclusive breastfeeding.

20. 1. Continuous skin to skin contact between baby’s front and mothers chest 20 P l ace t he b a by be t w ee n t he m o t h e r ’ s b r e a s ts in an upright position Continuous or intermittent

21. Eligibility Criteria for KMC: Baby 21 All stable low birth weight babies are eligible for KMC. S ick b a bi e s n e e ding s p eci a l ca r e s h o uld b e c a r e d under radiant warmer initially. KMC - st a r t ed a f t er t he b a b y i s h e m o d y n a m i c al l y stable. HEMODYNAMICALLY STABLE: IS A MUST!!

22. G uide l i nes f or prac ti c i ng KMC accord i ng to weight allows initiation of KMC. Birth weight > 1800 g: These babies are generally stable at birth. Therefore, in most of them KMC can be initiated soon after birth . Birth weight 1200-1799 g: It might take a few d a y s f or s t a b il i za t i o n b e f o r e K MC can be initiated. Bi rth w e i g h t < 1 2 g : F r e q u en t l y , t h e s e babies develop serious prematurity-related morbidities often starting soon after birth. It may take days to weeks before baby's condition 21

23. Eligibility Criteria for KMC: Mother 23 Willingness General health and nutrition Hygiene Supportive family Supportive community

24. 2. Exclusive Breastfeeding 24 The kangaroo position is ideal for breastfeeding. The cloth that wraps around the mother and baby is loosened to breastfeed. Initially tube or cup feeding before breastfeeding is established.

25. 25

26. Pre-requisites for KMC 26 Support to the mother Post discharge and follow up

27. Support to the mother 27 Health care staff support in hospital Emotional support – The mother needs encouragement if she is to give KMC Teaching mothers the skill to take care of their LBW infants After discharge infants need regular follow- up to check satisfactory weight gain at clinics close to home Support from the family at home to help mother take care of her infant and practice KMC at home.

28. Any family member can do it! 28

29. Early discharge and follow up 29 T he m o t h e r c o n t i n u es t o p rac t ice KMC a f t e r t h e infant is discharged. Eligibility criteria for discharge: Baby’s general health is good and there is no concurrent disease such as apnoea or infection F eedi n g w ell, and is e x clusiv e l y or predominantly breastfed

30. Follow-up visits ensured G a ini n g w e i g ht ( at le a s t 1 5 g / k g /da y f o r a t l e ast t h r e e consecutive days) Temperature is stable in the KMC position Mother is confident 30

31. Benefits of KMC 31 To the baby To the mother To the hospital To the nation

32. Benefits to the baby 32 b e s t Ba b y k e pt w a rm 2 4 h o u r s a s m o t h er is t h e incubator Breathing becomes regular as it reduces apnoea Breastfeeding better and gains weight faster I n f a n ts are m u c h less st r e s s e d a n d t his p r ovid e s neurological protection to the infant Better organized sleep patterns

33. Benefits to the Mother 33 Confidence in caring for her infant is boosted Improved bonding between mother and infant due to the physical closeness between them Mothers are empowered to play an active role in their infants care Mothers are enabled to become the primary care giver of their infants Breastfeeding is promoted

34. Benefits to the Hospital 34 Significant cost-savings as well as better outcomes Less dependence on incubators Less nursing staff necessary Shorter hospital stay Improved morale & quality of care Better survival

35. Benefit to the Nation 35 KMC r e sult in h e a l t hi e r a n d m o r e in t ellec t u a l b a bi e s and thus adds to the nation wealth. Decrease neonatal mortality and morbidity. Simple and applicable everywhere and cost effective.

36. Preparing for KMC (1/4) 36 Initiation of KMC Counselling W h e n b a b y is r e a d y a r r a n ge a time t h at is convenient to the mother and baby De m o n s t r a te he r KMC p r oc e d u re in a ca r i n g , gentle manner with patients

37. Preparing for KMC (2/4) 37 Answer her all her queries and allay her anxieties Allow her to bring other family members during this time It helps in building positive attitude of the family and ensuring family support to the mother which is particularly crucial for post-discharge home-based KMC. It is helpful if the mother starting KMC interacts with someone who is already practicing KMC.

38. Preparing for KMC (3/4) 38 Mother's clothing KMC can be provided using any front-open, light dress as per the local culture. KMC works well with blouse and sari , gown. Baby’s clothing Baby is dressed with cap, socks, nappy, and front open sleeveless shirt, Bhoto in winter.

39. Preparing for KMC (4/4) 39 Supporting garment ▶ To carry the baby in kangaroo position – KMC sling or 3.5 meter cloth that will allow the mother or the father or the relatives to sleep with the baby in that position.

40. Time of Initiation 40 KMC can be started as soon as the baby is stable. Babies with severe illnesses or requiring special treatment should be managed according to the unit protocol. Short KMC sessions can be initiated during recovery with ongoing medical treatment (IV fluids, Oxygen Therapy).

41. Procedure of KMC 41 p r i v ac y : S i nce it r e q u ir e s s o m e ▶ Provide exposure o f m o t h er c ul t urally a c c e p t a ble privacy should be given in nursery, wards and NICU.

42. Kangaroo Position (1/2) 42 Baby should be placed between mother’s breast in upright position. Head should be turned to one side in slightly extended position. The slightly extended head keeps the airway open and allows eye to eye contact with mother.

43. Kangaroo Position (2/2) 43 Hips should be flexed and abducted in a “frog” position and arms should also be flexed. Baby’s abdomen should be at the level of mother’s epigastrium. Mother’s breathing stimulates the baby thus reducing apnoea. Support the baby’s bottom with a sling/binder.

44. Feeding 44 Explain about breastfeeding while in KMC Can give ex p r e s s b r e a s t milk c u p / s p o on, o r o gas t ric tube

45. Mon i tor i ng 45 Important especially in early stage Make sure neck in slightly extended position Airway clear Regular breathing Pink in colour Temperature normal

46. Can the mother continue KMC during sleep and resting? 46 The mother can sleep with baby in kangaroo position in reclined or semi recumbent position about 30 degrees from horizontal. This can be done with an adjustable bed or with pillows on an ordinary bed. A comfortable chair with an adjustable back may be used for resting during the day.

47. When to stop KMC? 47 Till baby finds it comfortable and cosy Once baby’s weight >2500gm and gestation >37 weeks

48. Post-Discharge Follow-up (1/2) Close follow up is a fundamental pre-requisite of KMC practice. Baby is followed once or twice a week till 37-40 weeks of gestation or till the baby reaches 2.5 – 3 kg of weight. Thereafter, a follow up once in 2 – 4 weeks 48 m a y b e eno ug h till 3 m o n th s o f p o s t - conception age. Later, the baby should be seen at an interval of 1-2 months during first year of life.

49. Post-Discharge Follow-up (2/2) 49 The baby should gain adequate weight (15-20 gm/kg/day up to 40 weeks of post-conception age and 10 gm/kg/ day subsequently). More frequent visits should be made if the baby is not growing well or his condition demands.

50. THANK YOU!! 50