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KMC Kangaroo Mother Care

KMC Kangaroo Mother Care. GIZ Health Programme. We support the health sector in 5 key areas of health systems strengthening; Social Health Protection Quality Health Services (focus on Sexual and Reproductive Health and Rights) Decentralized health Governance

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KMC Kangaroo Mother Care

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  1. KMC Kangaroo Mother Care

  2. GIZ Health Programme We support the health sector in 5 key areas of health systems strengthening; • Social Health Protection • Quality Health Services (focus on Sexual and Reproductive Health and Rights) • Decentralized health Governance • Cooperation with the Private Sector • Civil Society Organizations Our Aim: Important preconditions for equal and sustainable access to quality health services are in place. Through the area of Quality Health Services the “No Baby Left Out” initiative has been established to accelerate the reduction of maternal, newborn and child deaths in Tanzania Where do Newborns die? • Southern Tanzania • Especially in the rural remote area of the regions • High rate of low birth weight infants in southern Tanzania

  3. Introduction • Despite successful reduction of < 5 mortality, reduction in neonatal mortality is still very small by comparison • Neonatal mortality counts 44% of the < 5 mortality • Globally around 3 million neonatal death yearly and 2/3 in South-East-Asia and sub-Saharan Africa (NMR: 34/1000) • 75% of neonatal death occur in the first week of life • Causes of death:Infection 26% • Birth Asphyxia 24% • Low birth weight (LBW)/prematurity 34%

  4. Aims of newborn care • Establishment of respiration at delivery • Prevention of hypothermia • Establishment of breastfeeding • Prevention of infection • Identification of newborns at risk and early treatment

  5. Aims of newborn care • Establishment of respiration at delivery • Prevention of hypothermia • Establishment of breastfeeding • Prevention of infection • Identification of newborns at risk and early treatment

  6. Immediate care after delivery • Keep dry and warm (dry towels and cover the head) • Assess breathing and crying • Clear airway only if mouth and nose are full of secretions • If needed give respiratory support in the first minute of life • Think back to 1, 5, and 10 minutes for APGAR • Initiate breastfeeding within 1 hour after delivery • Give Vitamin K as prophylaxis Preterm Weight under 2,5 kg Malformation Infection Supportive care: e.g. KMC YES NO Continue routine Care

  7. KMC = Kangaroo Mother Care

  8. Indication for KMC • Low birth weight (LBW) = BW < 2500g • Prematurity = < 37 + 0 gestational weeks • Acute infections (e.g. malaria, UTI, asc. GTI) • Chronic infections (e.g. TB, HIV/AIDS) • Premature rupture of membrane • Trauma • Congenital malformation of the fetus (e.g. polyhydramion) • Disease which induce labour (e.g. pre-eclampsia) Causes of LBW / prematurity

  9. Problems of prematurity / LBW • Hypothermia • Feeding difficulties • Breathing difficulties • Apnoe attacks • Necrotizing enterocolitis • Prone to sepsis • Jaundice • Intraventricularbleeding Hypoglycaemia

  10. KMC covers the aims for preterm / LBW care • Is a method of care of preterm infants carried skin-to-skin to • Keep the temperature stable (36.5 – 37.5°C) • Stimulate baby’s breathing • Enables breastfeeding • Promote mother and baby bonding • Promote physical growth • Discharge with adequate support and follow up • It is a powerful and easy-to-use method!

  11. KMC – positioning of the baby Start kangaroo position as soon as possible after delivery!

  12. KMC – positioning of the baby Head position Father involvement Nappy, cap & socks

  13. KMC – positioning of the baby • Interrupt skin-to-skin contact only for changing nappy, hygiene, cord care and clinical assessment when needed

  14. KMC - Feeding • Breast milk is the BEST • Start in the first hour of life with breastfeeding! • Inform the mother about the special situation of breastfeeding preterm babies • In breastfeeding some • points for good • attachment should be • applied

  15. KMC - Feeding • Important for breastfeeding: good attachment

  16. KMC - Feeding • Important for breastfeeding: good attachment

  17. KMC - Feeding • Even though the mother states that the baby is breastfeeding well, but the baby is loosing weight there is a problem of breastfeeding • Poor breastfeeding technique • Mother has not enough milk • The baby is to weak to suck properly • If breastfeeding technique is • improved but still no weight gain • start cup feeding with • expressed breast milk (EBM)

  18. KMC - Feeding • Cup feeding

  19. KMC - Feeding • > 1500g: exclusively oral feeding • < 1500g: combination of oral feeding and IV-fluids • < 1500g: start EBM by naso-gastric-tube (NGT) • 1500 – 1800g: start EBM by cup feeding • > 1800g: start directly with breastfeeding

  20. KMC - Feeding • Naso-gastric-tube (NGT) • Start immediately in • LBW / preterm babies < 1500g • If cup feeding fails • (e.g. severe birth asphyxia)

  21. KMC - Monitoring • Bodyweight once daily • In the first week of life weight loss of up to 15% of the birth weight is acceptable • Birth weight should be regained between 7 to 14 days after birth • Thereafter weight gain should be not less than 15g/kg/d

  22. KMC - Monitoring • Temperature 3x /day • Normal range: 36,5 – 37,5°C • When starting KMC axillary temperature should be measured every 6 hours until it becomes stable for three consecutive days then 3x /day • No rectal temperature (risk of rectal perforation)

  23. KMC - Monitoring • Respiration rate 3x /day • Normal range: 30 – 60/min • Check for difficulties in breathing (nasal flaring, chest indrawings)

  24. KMC – Prevent infection • Keep to general hygiene • Eye-, cord- & skin care

  25. KMC - Discharge • Baby is ready for Discharge if the following have been met: • 1) Baby factors: • Continuous weight gain of at least 15g/kg/d for 3 consecutive days (after birth weight regained) • Regained birth weight and has a minimum weight of 1500g (lower weight if near to follow up facility) • Able to breastfeed and/or feed by cup well • Overall condition is stable for at least three consecutive days (temperature, respiration, feeding, no signs of infection)

  26. KMC - Discharge • 2) Mother factors: • Accepts the KMC method and observed to be confident about caring of the baby with KMC (e.g. feeding and kangarooing) • Able to breastfeed or express breast milk for feeding • Willing to continue KMC at home • Has support from family to continue KMC including spouse/partner or close relatives

  27. KMC - Discharge • Information on Discharge: • How to maintain KMC at home • Cleanliness and hygiene • Feeding • When to return immediately to health facility (danger signs) • Follow up visit: 3 days / 1 week after discharge then 1-2-3 weekly until weight is 2,5 kg (termination of KMC)

  28. Problems of LBW – and the answer is KMC • Hypothermia- kangarooing • Feeding difficulties - special feeding (cup, NGT) • Breathing difficulties - kangarooing • Apnoe attacks - kangarooing • Necrotizing enterocolitis - only breast milk • Intraventricular bleeding - gentle care • Jaundice - close observation • Anemia - iron supplementation • Hypoglycaemia - special feeding • Prone to sepsis - close observation

  29. Asantenisana! For more information visit www.tgpsh.or.tz

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