Kmc

kangaroo mother care

1. KANGAROO MOTHER CARE -BY Khyati Chaudhari

2. Kangaroo mother care is a special way of caring for both low birth weight(LBW) babies. It improves their health and well being by promoting effective thermal control, breast feeding, infection, infection prevention and bonding. In KMC the baby is continuously kept in skin to skin contact with the mother and is breastfed exclusively.

3. The 3 major components: Kangaroo position:- skin to skin contact. Kangaroo nutrition:- exclusive breast feeding Early discharge and regular follow up. COMPONENTS OF KMC

4. Skin to skin contact between the mother and the baby in strict vertical position between the mother’s breast and under her clothes is known as kangaroo position. Mother serves as source of warmth and stimulation. The baby’s temperature is maintained within normal values due to heat from mother’s body. 1. KANGAROO POSITION

5. Research studies have revealed that the temperature, heart rate, respiratory rate, oxygenation and other physiological parameters are maintained within normal values while the baby is in kangaroo position.

6. Kangaroo mother care is an important way of maintaining lactation. KMC increases prevalence, breast milk production, duration, rate of exclusive breast feeding. It also increases the competence of mother to breastfed. Scientific evidences have proved that beneficial effects of KMC on breastfeeding. 2. KANGAROO NUTRITION

7. Babies in KMC are discharged from hospital early and counseled to come for regular follow up. KMC is continued at home after early discharge from hospital. Recent studies have shown that KMC has increased chances of survival of low birth weight babies and reduced have hospital stay of babies. 3 . KANGAROO EARLY DISCHARGE AND REGULAR FOLLOW UP

8. ADVANTAGES/ BENEFITS OF KMC KMC is human and low cost method of care of low birth weight infants and it significantly decreases neonatal morbidity and morality.

9. 1. BENEFITS TO THE BABY Prolonged skin to skin contact between the mother and her preterm or LBW baby provides effective thermal control with reduced risk of hypothermia. KMC facilitates physiological stability of baby. KMC reduces apnoea, oxygen requirement and risk of infection to the baby. KMC helps in early discharge of babies from NICU thus helps in reducing the risk of nosocomial infection. KMC induces sound sleep in the baby.

10. 2. BENEFITS TO THE MOTHER As the mother is more actively involved in the care of her baby she is more relaxed and satisfied. KMC promotes better mother-infant bonding. Mothers are less stressed during KMC a compared with a baby kept in incubator.

11. 3. BENEFITS TO THE FAMILY KMC is economical to the family as the family does not have to pay any charges for keeping the baby warm. KMC promotes early discharge of baby which is beneficial for the family. KMC facilitates bonding between the baby, mother and family members involved in giving KMC to the baby.

12. 4. BENEFITS TO THE NATION KMC deceases the neonatal morbidity and mortality rate and thereby reduces the burden on health resources. KMC is simple, easily applicable, cost effective and possible even at home, where 75% of Indian women deliver. KMC results in healthier and more intelligent babies and thus adds to the nation’s wealth.

13. ELIGIBILITY CRITERIA FOR KMC All mothers can provide KMC, irrespective of age, parity, education, culture and religion. The mother must be willing to provide KMC and should be free from any serious illnesses to be able to provide KMC. All stable low birth weight babies are eligible for KMC. However, very sick babies needs special care those babies can be cared under radiant warmer initially.

14. 1) Birth weight >= 1.8 kg :- These babies are generally stable at birth. In most of them KMC can be initiated soon after birth. 2) Birth weight 1.2 kg to 1.8 kg :- Many babies in this birth weight group have significant problems in neonatal period. It might take a few days before KMC can be initiated. Such babies should be kept in NICU where specialized services are available.

15. 3) Birth Weight <= 1.2 kg :- frequently these babies develop serious prematurity related morbidities, soon after birth. They will get benefit when they undergo institutional delivery with NICU facilities. It may take days to weeks before baby’s condition allows initiation of KMC.

16. PROCEDURE OF KMC

17. 1. PREPARATION FOR KMC When the baby is ready for KMC, mother and family members should be counselled so that a positive attitude is created for KMC. Mother should be provided with a front open gown or any front open light dress that can retain the baby for extended period of time. Baby is dressed with cap, socks, nappy and front open sleeveless shirt.

18. 2. (a) KANGAROO POSITIONING Baby should be placed turned between the mother’s breasts in an upright position. Baby’s head should be turned to one side and in a slightly extended position. This slightly extended head position keeps the airway open and allow eye to eye contact between the mother and her baby.

19. CONTINUED…… Hips should be flexed and abducted in a “frog like position” The 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 the occurrence of apnoea. Baby’s bottom should be supported with a sling/binder.

20. (b) MONITORING Babies receiving KMC should be monitored carefully especially in the initial stages. Baby should be monitored for neck position(it should neither be too flexed nor too extended) Airway clearance, regular breathing, body colour and temperature.

21. (c) FEEDING Mother should be explained how to breast feed the baby in KMC position. Holding the baby near the chest stimulates milk production. She can also express this milk while the baby is still in KMC position. The baby could be fed this expressed breast milk with palladia, spoon, katori, nasogastric tube depending on the baby’s condition. PALADAI

22. (d) PRIVACY KMC unavoidably requires some exposure on the par of mother. The hospital staff or family members should respect the mother’s sensitivities in this regard.

23. TIME OF INTIATION KMC can be started as soon the baby becomes stable. Babies will severe illnesses or those requiring special treatment should be managed according to the unit protocol. KMC can be provided while the baby is being fed via orogastric tube or is on oxygen therapy.

24. DURATION OF KMC Skin to skin contact should stat gradually in nursery with a smooth transition from conventional care to continuous KMC. Sessions that last less than one hour should be avoided because frequent handling maybe stressful for the baby. The length of skin to skin contact should be gradually increased up to 24 hours a day. KMC should be continued at home.

25. DISCHARGE CRITERIA

26. (a) Criteria for transfer of the baby from nursery to ward Stable condition of baby Weight gain Mother should be confident to look after the baby.

27. (b) Discharge criteria from hospita l When baby’s general health is good and there is no evidence of infection. Baby is feeding well. Baby’s maintaining body temperature. Mother can continue KMC at home.

28. If the mother and baby are comfortable KMC can be continued for as long as possible. Often KMC is desirable until baby’s gestation reaches term and weight is around 2.5 kg.