KMC- Miracle of 21st Century-F.pptx

KMC in Preterm

1. Kangaroo Mother Care Miracle of 21 st Century

2. There is no indicator in human biology which tells us so much about the past events and the future trajectory of life.. as the weight of an infant at birth

3. Causes of NMR(Neonatal Mortality Rate) in India 5 Three causes accounted for 78% (0.79 M/1.01 M) of all neonatal deaths in India: prematurity & low birthweight (0.33 M; 99%CI 0.31-0.35 M), neonatal infections (0.27 M; 99%CI 0.25-0.29 M) and birth asphyxia & birth trauma (0.19 M; 99%CI 0.18-0.21 M).Nov 12, 20 Causes of neonatal and child mortality in India: nationally representative mortality survey For the Million Death Study Collaborators * Lancet 2020Nov27,376,1853-1860 Why??

4. Background In an updated Cochrane review Conde Aguldelo , Diaz Rosello Belizan , assessed 35 studies There is now sufficient evidence to recommend KMC as a standard of care for all LBW babies It can prevent up to half of infant deaths due to LBW It ensures early discharge 40% less risk of mortality 66% less risk of hypothermia 61% less risk of nosocomial infections Decreased re-admission rate 15 million preterm babies are born every year in the world, 95% in developing countries 8 million, 27% are in India 80% neonatal deaths occur in LBW babies More deaths occur outside the health facilities Survivors face a life of compromised growth, disabilities including learning, visual and hearing handicap UNICEF,Lawn et al, 2020

5. CREATION OF KMC 1978 Dr. E dgar REY SANABRIA , Pediatrician, Mother and Child Institute, Columbia

6. KMC-Definition 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 health and well being of- Low birth weight babies with birth weight less than 2500G Preterm babies born before 37 weeks

7. THREE COMPONENTS OF KMC Kangaroo position Kangaroo nutrition-Exclusive breastfeeding Kangaroo discharge & follow up

8. Kangaroo position supports physiological stability and motor development Being supine was the worst position for the infant Physiological stability especially cardiorespiratory begins within minutes of KC. Cochrane. Improves oxygenation Reduces episodes of poor oxygenation Improves lung volume Head up position improves apnoea and bradycardia Helps infants acquire motor milestones earlier and helps prevent asymmetrical postures

9. EFFECTS OF OXYTOCIN Myelinated Vagus (Nucleus ambiguous) Muscle tone Head & Face Muscle Tone Pharynx, soft palate & larynx Muscle Tone GIT Release of GI enzymes Eye contact, facial expression, voice differentiation Sucking, swallowing, breathing Tone lower esophageal sphincter, motility Improved digestion Cues, engagement with parents Feeding Decreased symptoms of reflux, constipation; Improved enteral feed tolerance

10. Thermoregulation Skin to skin contact is as efficient as incubator to maintain adequate temperature in preterm /LBW babies. Hence KP can safely be implemented till baby is able to maintain its own temperature. KMC reduces the risk of hypothermia(RR 0.3,95%CI) Level of evidence- RCT Strength of evidence –moderate Recommendation- Strong recommendation in favor of intervention

11. KMC REDUCES PAIN Conclusion - KMC is a most physiological, non-pharmacological intervention that involves parents to manage procedural pain that can be implemented for physiological and behavioural instability in their children All painful procedures viz IV lines, removal of adhesive tape, giving IM injections, ROP check should be done while baby is receiving KMC

12. APNOEA OF PREMATURITY There is direct evidence that KP prevents incidence or severity of Apnoea of Prematurity Preterm infants frequently present with apnoea which put their lives and integrity at risk. Studies show that physiologically stable infants have less episodes of apnoea than those in incubators Level of evidence –RCT, Strength of evidence- moderate Recommendation- strong recommendation in favour of KMC

13. Physiological Outcome KMC in a stable infant maintains and improves vital parameters. Several authors have studied impact of KMC on physiological stability of preterm infants-analysing heart rate, vagal tone, respiratory rate,oxygen saturation, desaturation episodes,cerebral oxygenation, oxygen consumption,metabolic indicators. Their studies conclude that regardless of heterogenous contions of Preterms /LBWs ,KMC maintains and improves physiological stability of LBWs Level of evidence- Randomised Controlled trials, Strength of evidence- moderate Recommendation - Strong Recommendation in favour of intervention GRADE table EBG-2017 www.fundacioncanguro.co

14. KMC promotes sleep KMC induces longer duration of quiet sleep shorter duration of active sleep Decreased arousal from sleep Completion of sleep cycle better than being in an incubator

15. KMC: Effect on Sleep Organization Increases quantity of Quiet Sleep Non-chaotic sleep pattern Normal sleep cycling Less sleep arousals HR and RR variation according to sleep cycles Preterm sleep cycles generally require 60 minutes to complete and within 5 minutes of the onset of KMC, cycling begins

16. When to begin KMC? Ideally KMC begins in LR or OT as soon as baby is born

17. Duration of KMC Each session: should be of 90 minutes so effective sleep cycle of 60 minutes received for better neurodevelopment out come Terminology- Less than 4 hours- short duration 4-6 hours- Extended duration 6-12 hours- long duration More than 12 hours- continuous

18. Father & other family members can also provide skin-to-skin care Father Grandmother Teaching Aids: ENC KMC- 20 Who can provide KMC? Any family member. Hence renamed - Kangaroo Family Care(KFC) Any family member

19. Benefits to the Mother Benefits in infancy and childhood Benefits to the Hospital Increased confidence and satisfaction Better bonding Empowerment Better milk production Early discharge Lower Stress Lower post partum depression Growth Neurodevelopment Increased IQ Better Executive Function Physiologic organization Lower Stress Better Parent Infant Interaction Lower Admission Rate Early Discharge Significant cost saving as well as better outcome Less dependence on incubators Less nursing staff necessary Improved Morale and quality care Better survival Decreased Readmission Rate Decreased Biomedical waste DECREASED SEPSIS DECREASED ANTIBIOTICS

20. WHEN TO STOP KANGAROO MOTHER CARE? Continue KMC as long as the mother and baby are comfortable (in the hospital & at home). Wean the baby gradually from KMC – When s/he starts wriggling to show that s/he is uncomfortable Pulls her/his limbs out Cries and fusses every time the mother tries to put her skin-to-skin contact

21. KMC during COVID-19 pandemic WHO/UNICEF: COVID-19 Guidance:Maternal & Child health Early skin to skin contact- between mother & baby should be promoted, soon after birth excepting those neonates who require resuscitation or any other immediate lifesaving interventions Mothers & infants should be enabled to remain together/zero separation Practise rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding , whether they or their infants have suspected, probable or confirmed COVID-19 virus infection. Mother should observe suitable precautions like Respiratory hygiene Hand hygiene including proper hand washing before & after feeding & touching any surfaces Cleaning surfaces & other measures of infection prevention & control of COVID 19 infection .

22. WHO Recommendations: Kangaroo Care During Covid-19 Dr S Malik

23. Kangaroo Mother Care 33 Humane, low cost method of care for LBWI Significant reduction in neonatal morbidity & mortality with KMC Most of the needs & problems of LBWI are answered directly or indirectly by Kangaroo Care KMC is life-saving, cost-saving & brain-saving Courtesy-Nair Hospital, Mumbai Dr S Malik

24. Advantages of KMC in COVID pandemic Maintaining this most coveted bonding is especially important & challenging for PT /LBW babies. Now, the COVID-19 pandemic has made this bonding even more challenging The admission to the NICU frequently is stressful for a family. This is especially significant as we battle Covid-19. Kangaroo Care can help to decrease this high stress & foster bonding & healing & an overall sense of wellbeing for our families. In low birthweight newborns (< 2000 g) & in preterms who are clinically stable, KMC reduces mortality

25. Home Based KMC 21/05/2019 Meeting at Nandurbar 35

26. Team Training i n November 2018 How??

27. Training module, IEC material

28. KMC(Kangaroo Mother Care) kits

29. HOME VISITS TO COUNSEL MOTHERS FOR CARE OF lBWs

30. Results Data Period: April 2020 till Oct 2021 Low Birth weight Babies identified- 94 Total Deliveries- 936 Prevalence- 10.04%

31. BNMC direct intervention- LBW Babies Analyzed data- April’21 to Oct’21 Data Points Data Percentage Total newborns with LBW identified 94   Total Newborn in whom first examination form filled 78 83% Total Newborn in whom follow-up form is filled 91 97% Below indicators- Denominator is number of children in whom follow up form was filled KMC -less than 6 hours 44 48% KMC -6-12 hours 37 41% KMC-more than 12 hours 5 5% KMC data not available 5 5% New-born gained weight 58 64% New-born lost weight 1 1% Newborn whose weight remained constant 0% Newborn in whom current weight is not available 32 35%

32. Date of birth-11-11-2020,IGMH Birth weight-2000 G Present weight- 3.5 kg on 28-12-2020 KMC given-5 hours daily B/O Afsana

33. 1998-Bagota Declaration Kangaroo Mother Care is a basic right of the new-born and should be an integral part of the management of low birth weight and full term infants in all settings at all levels of care in all communities

34. WHO- iKMC trial Methods We conducted a randomized, controlled trial in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania involving infants with a birth weight between 1.0 and 1.799 kg who were assigned to receive immediate kangaroo mother care (intervention) or conventional care in an incubator or a radiant warmer until their condition stabilized and kangaroo mother care thereafter (control). The primary outcomes were death in the neonatal period (the first 28 days of life) and in the first 72 hours of life. . Conclusions Among infants with a birth weight between 1.0 and 1.799 kg, those who received immediate kangaroo mother care had lower mortality at 28 days than those who received conventional care with kangaroo mother care initiated after stabilization; the between-group difference favoring immediate kangaroo mother care at 72 hours was not significant

35. EFCNI-European Foundation for Care of new born infants

36. Kangaroo Mother Foundation of India April 2022 Joint declaration of KMFI with NNF, IAP,BPNI to promote and support KMC and policy of zero separation of LBW and mother

37. Miracle of KMC!

38. Carry home messages Covid 19 Pandemic is here to stay but if this window of opportunity of KMC/ Exlusive BF is lost, benefits of both will be lost. KMC when started after stabilization reduces neonatal mortality by 55% KMC when started soon after birth reduces sepsis by another 18% KMC when started soon after birth i -KMC, reduces neonatal mortality due to sepsis by another 36% Zero separation of mother and newborn is effective way of reducing both neonatal morbidity and mortality

39. Acknowledgements: Prof Sushma Mallik , Mumbai Prof Somshekhar Nimbalkar , Karamsad THINK KMC! Believe in KMC!! Practice KMC!!! THANK YOU