KANGAROO MOTHER CARE

1. KANGAROO MOTHER CARE Dr. M. Karanja Kenyatta National Hospital

2. Principles of KMC • Skin to skin contact between infant and parent or other helpers • Exclusive Brest milk feeds • Early discharge with continued KMC

3. KMC COMPONENTS • Kangaroo Position (skin to skin contact) • Kangaroo Nutrition • Kangaroo Support • Kangaroo discharge

4. What is Kangaroo Position? • Infant in upright position against mothers bare chest between breasts • Infants Kept naked except for nappy, socks and woollen cap • Infants Exhibits specific not-stress behaviour patterns such as crawling towards the nipple and self attachment. • Both Mother and infant are usually covered by a blanket or shirt.

5. What is Kangaroo Nutrition? • Exclusive breastfeed on demand • With KMC, Most infant breastfeed or feed on expressed breast milk • Infants have easy assess to mothers breasts. • KMC increases the volume of breast milk that a mother produces. • Immature infants as 30 weeks can begin breastfeeding partially or completely as it has been noted.

6. What is Kangaroo Mother Care? • Is skin to skin care. The mother uses her own body temperature to keep her infant warm • It is useful for nursing low birth infant below 2500gm • Provides basic needs for survival i.e. Warmth, stimulation, breast milk, love and protection. • NB Mothers Kangaroo care for her infant in a special pouch day and night. In the pouch, the infant is war, protected and able to suckle anytime it wants.

7. Where Did Kangaroo Care Start? • Skin to skin against mother bare breast is not a new idea. The idea was made popular in modern health times by healthcare worker in Bogota (Capital of Colombia in South America) • From here, it was introduced to many developed and developing countries. NB. Doctors Rey and Mertines first started KMC in Bogota in 1979 in response to a crisis with the • Large numbers of low birth weight infants • Shortage of staff and facilities • Overcrowded nurseries • High mortality due to hospital infection.

8. What is Kangaroo Support? This is physical and emotional support • Nursing and Medical staff to assist and encourage mothers to provide KMC • Whole family should be informed about KMC so that they also support the mother. Rest and sleep are essential for mother. Father or partner is important in support. • Mothers own mother has a very important role to play in helping her give KMC. • Community need to be told about KMC. A community support helps mother succeed. • In hospital, clinics staff also require support. • Education support on KMC so that it I meaningful and can continue in hospital and after discharge.

9. What is Kangaroo Discharge? • Mother leaves the hospital with her infant in the Kangaroo position and continues to provide at home. • Predischarge plan is important each mother to practise KMC in the hospital and make arrangement for discharge home. • The family be told that the infant will be receiving KMC at home.

10. Advantages of KMC Mother • Has more confidence and bonding to the infant. Mother feels less stressed. • Empowered to play active rolein the Infant care • Breast feeding is promoted • Less neglect and abandonment • Able to choose breast feeding above formula feeding Fathers • Able to play a greater role in the care of infant • Improves bonding between father and infant and important in countries with high rate of violence towards children

11. Advantages Continued Infants • Can be kept warm, stable with KMC • Serious infection is less • Less apnoea • Less stressed as mother and infant are together • Reduces mortality Health care provider • Fewer staff and less staff needed. • Conventional incubators are expensive, often used incorrectly are broken and cannot be repaired. They are not cleaned properly and regularly, power supply often unreliable. • Infants can be discharged home early • It is cheaper

12. Advantages Continued NB: KMC should be started as soon as possible. Infants of normal weight are gestational age can also benefit from KMC especially in cold conditions. Infants receiving KMC exhibit a vagal response which promote growth and development and speeds up the adjustment from an intre-uterine an extra-uterin existence.

13. Is KMC Safe? Yes • The infant is kept war, heart rate and respiratory rates are normal, less apnoea and bradycoardia and fewer episodes of cyanosis. KMC should be demonstrated and supervised by trained staff. • Mother should be taught what danger signs to look for (e.g. breathing difficult or cyanosis.

14. How does KMC keep infant warm? • Temperature over the mothers breast warms the infants naked skin. • This keeps infant warm or warms a cold infant. • If the infant is cold, the mothers skin become warmer of if war, the mother’s skin cools down. • A woollen cap keeps baby warm during KM. In cold weather the infant can wear a cotton jacket with an open in front. NB: The temperature of an infant receiving KMC is slightly higher that that of incubator in KMC, the mother’s skin temperature may rise as much as 2oC to keep the baby warm.

15. How does KMC reduce risk of apnoea and braclycardia ? • Probably the constant temperature, together with the mothers movement, breathing heart sounds that simulate the infant and reduce apnoea, braclycardia. • Incubators makes a constant sound and does not move. Incubator babies cry more and sleep deep from exhaustion. • KMC babies require less oxygen and have better oxygen saturation in their blood. They also sleep longer.

16. How is Breast feeding Promoted by KMC? • Breast milk production is better and baby breast feed longer. KMC promotes well-being of the mother as she can see and touch her infant all the time. This stimulates milk production and helps with let down reflex. • The secretion of both prolactin and oxytocin is inhibited when a mother is anxious, unhappy, worried and separated from an infant. • Breast feed even formula fed babies benefit from KMC.

17. Why does KMC improve Mother’s Confidence ? • They feel satisfied, relaxed and fulfilled by the experience. • It restores a mother’s self esteem, which is often low after delivering a low birth weight infant.

18. Why do infants receiving KMC have fewer infections? • Infants being given KMC become coloised by mothers own skin bacteria. • The cells and antibodies in the mother breast milk are specially protective against those bacteria which colonise her baby. • They have less of sever infections as necrotisingenterocolities

19. How can KMC save Money? • Breast feeding save cost of formula • Fewer nurses are needed as mothers provides most of the care to her infant • Less hospital equipment • Less infection, less infants are admitted in intensive or special care units. • Small infants are discharged home sooner.

20. When can infants receiving KMC discharge home. When; • They are healthy and gaining weight • They are breast feeding or cup feeding well • Mother is confident and able to manage her infant • Good follow-up care is provided.

21. KMC Can be Intermittent For infants who are vey small but still needs incubator care. Continuous When baby no longer requires incubator and almost ready for discharge

22. What is a KMC Ward? • Special ward where mothers and their infants are kept together so that KMC is given all the time • Though supervised by nursing staff, mothers take responsibility for all their infants care. • In a KMC ward mothers support and learn from each other. • A KMC ward provides wonderful opportunity to also teach mothers about primary healthcare (immunization, family planning, good nutrition. • NB: Intensive care infants can receive KMC if they are more stable and no longer ill, but have to be monitored. • HIV positive mothers can also give KMC

23. Using KMC Care How can health workers be persuaded to accept KMC • Often not easy, any new idea is difficult to introduce at first • Clear description of KMC, advantages safety must be presented to all staff including senior management. • Visit to established KMC facilities • Staffs must buy this new method

24. Kangaroo Implementation • Staff acceptance of KMC • Adopting KMC policy • Writing KMC guidelines • Training staff on KMC • Establishing KMC facilities • Managing ambulatory KMC • Educating the community to accept KMC All staff must e encouraged and trained to help mothers provide KMC to their small infants. KMC policy written statement to give benefits of KMC and commits the service to implement and promote KMC

25. Implementation continued • NB: Bogota declaration on KMC at the 2nd international workshop on KMC in Colombia in 1998, declares that KMC is a basic right of the newborn and should be integral part of the management of low birth weight and full term new born in all setting and at all levels of care and in all countries.

26. Who Promotes KMC? • KMC should be promoted as safe, affordable method of caring for newborn. • The nurses, doctors, administrators, as community members should do this. General public should also know it. • Infants grandmothers should also be trained to support KMC in hospitals and home.

27. How are mothers informed about KMC? • Benefits, safety and method must be explained to the mother. • Mothers should be talked to once a low birth infant is born. She needs to know that she may nave to stay in hospital longer, give KMC when discharged home and attend follow-up clinic

28. How can you inform public about KMC? • Teaching KMC in Schools • Showing KMC in Media, specially TV and local news papers • Discussing the benefits of KMC in the media especially Radio and Magazines • Using KMC posters or video presentation in primary health care clinic NB: All pregnant women should know about KMC in the antenatal clinic

29. Method of KMC • Baby should be in frog position • Keep infant upright to prevent vomiting • Make sure airway is not obstructed. • Head turned to one side, neck not flexed over extended • If mother lying she and her infant should be at an angle of 45o C

30. Special Group • Teenage mothers may be rebellious by nature-may require special support. • Other mothers may need to go home briefly for social reasons. Ambulatory KMC done when mothers and infant are well, mother can walk about with baby in KMC as she does her duties. KMC for Transport NB: Severely ill infants who are going to die can also be given KMC (Compassionate KMC) Many parents want to hug or hold their dying infants.