Kangaroo Care and the

Ventilated Neonate

By Karen Black (MNursSci, RNC)

Kangaroo Care (also known as
Skin-to Skin Contact)
 Was developed by Rey and Martinez (1983) in Bogotá,
Columbia as an alternative to incubator care (WHO, 2003)

 Was initially defined as: “The

care of preterm infants carried skin-to-skin with the mother.”
(WHO, 2003)

 Its key features were described as:

1. Early, continuous and prolonged skin-to-skin contact between
the mother and the baby.
2. Exclusive breastfeeding (ideally)
3. Being initiated in hospital and continued at home
4. Providing small babies with the opportunity to be discharged
early. (WHO, 2003)
Current definition of Kangaroo
Care:

“A form of parental caregiving where the newborn

low birthweight or premature infant is
intermittently nursed skin-to-skin in a vertical
position between the mother’s breasts or against
the father’s chest for a non-specific period of
time.” (Kenner & Lott, 2003)
Benefits of Kangaroo Care
 Maintaining physiological stability.

 Increasing immunity.

 Optimising breastfeeding.

 Facilitating parent-infant bonding

(Shiau and Anderson, 1997; WHO, 1997; WHO, 2003).
Kangaroo Care as an alternative to
cots in rural Tanzania
In a setting as affluent as our own
to what extent should Kangaroo
Care be promoted?
Kangaroo Care and the Intensive
Care Infant
 Cochrane review states that Kangaroo care
should not be routine practice in the
technological setting. (Conde-Agudelo, et al, 2003)

 Decision to ‘Kangaroo’ infants generally left to

individual nurses clinical judgment (Nyqvist, 2004).

 Many infants miss out on opportunity to consider

this practice.
Aims and objectives
 To examine the application and limitation of
Kangaroo Care with intubated LBW or very
premature infants requiring mechanical
ventilation.

 To critically examine the literature.

 To provide recommendations for practice.

Physiological Stability
Type of Sample
Researcher(s) Findings
Study group
● Infants responded to Kangaroo care with
increased quiet sleep and decreased Oxygen
Drosten-Brookes (1993) case study 2 requirement.
● Highlight possible benefits and need for
further research.
● During KC period pulse, oxygen and
respiratory rate remained within normal
parameters for infants of ≥30/40 or >1.2kg.
Gale, Frank & Lund
Quantitative 25 ● Infants <30/40 or
(1993)
<1.2kg showed signs of restlessness,
tachycardia and decreased oxygenation during
prolonged kangaroo care.
●a 27-day old neonate weighing 894g received
Ludington-Hoe, Ferreira
case study 1 SIMV at a rate of 12 breaths per minute whilst
& Goldstein (1998)
receiving Kangaroo Care for 45minutes.
●The physiological observations of Infants <1kg
Ludington, Ferreira &
Quantitative 12 remained stable during KC and decreased
Swinth (1999)
oxygen requirement.
●Infants oxygen requirements increased and
Smith (2001) Quantitative 14
body temperature dropped.
Transfer Technique
 Indicated to be the greatest contributing factor to
heat loss and increased stress, resulting in
tachycardia or apnoea (Ludington-Hoe et al, 1998)
 Lifting commonly associated with oxygen
desaturation (Danford et al, 1983; Peters, 1992).
 Physiological disruption occurred in both parent and
nurse led transfer techniques (Neu et al, 2000).
 Involving 2-3 nurses in transfer minimises the risk of
extubation or physiological disruption (Ludington-Hoe et al,
2003).
Breastfeeding
 The diverse range of benefits of breastmilk for
premature infants are widely documented.

 Admission to NICU and necessity for intubation

affects decisions to breastfeed (Jaeger et al, 1997).
 Those who chose to breastfeed often have
difficulty establishing expression and sufficient
supply during period of intubation and tube
feeding (Furman and Kennell, 2000).
Advantages of Kangaroo Care
to breastfeeding
 Stimulates endocrine pathway and enhances
flow of milk (Bier, 1997; Whitlaw et al, 1998).
 Reduces harmful anxiety and stress emotions
(Whitlaw et al, 1998).

 Promotes family centred care and breaks

down barriers to expression of milk (Jaeger et al,
1999).
Parental benefits of Kangaroo Care
 Reduction in stress and anxiety improves parents
perception of the infants’ admission to NICU and
subsequent ventilation (Legault & Goulet, 1995).
 Reduces feelings of inadequacy, anxiety and
frustration experienced by fathers (Neu, 2004).
 Facilitates closeness and bonding (Neu, 2004).
 Case reports detail benefits in reducing
complications associated with maternal eclampsia
(Anderson et al, 2001) and post-natal depression (Dombrowski et
al, 2001)
Adverse effects of Kangaroo
Care

 Increased stress on dislodgement of venous

or arterial lines or accidental extubation.

 Feelings of guilt if infant becomes

physiologically unstable during Kangaroo
period.
Evaluation of evidence
 Benefits in breastfeeding, nutrition and
parental satisfaction if undertaken safely.

 Practice can benefit physiological stability if

carried out for an appropriate length of time
and utilising a safe transfer technique.

 Kangaroo care can be conducive with

mechanical ventilation.
Limits in research evidence
 Compatibility of ventilation method.
 Accessing haemodynamic stability.
 Drug contraindications.
 Limit of gestational age or size of infant.
 Studies from British units.
 Randomized control trials.
Barriers to Kangaroo Care with
ventilated neonates in practice
 Medical
Fear of arterial
staff reluctance
or venous line dislodgement
 Fear of accidental
Difficulty administering
extubation
care during KC
 Safety
Staff concerns
issues forforvery
parental
low birthweight
privacy infants
 Inconsistency
Lack of experience
in technique
with KC
 Nurses’ feelings
Insufficient time for
thatfamily
their work
care during
load increased.
KC
 Nursing
Belief that
reluctance.
technology is better than KC

(Engler et al, 2002)

Recommendations for practice
 Development of evidence based policy at
Trust level.

 Incorporate an inter-disciplinary approach.

 Remain aware of limitations of policy

implementation
Recommendations for
education
 Comprehensive education detailing the
benefits and risks.
 Up to date evidence based information.
 Incorporated into new staff induction or
learning beyond registration study days.
 Encourage critical reflection on experiences
of Kangaroo care with ventilated infants.
References
 Anderson, et al (2001). Kangaroo care: Not just for stable preemies anymore. Reflections on Nursing
Leadership. 14, 33–34, 45.
 Bier et al (1997) Breastfeeding infants who were extremely low birthweight. Pediatric. 100: 773–812.
 Bliss (2004) Available at: www.bliss.org.uk (Accessed 14.11.04 updated 01.10.04).
 Conde-Agudelo et al (2003). Kangaroo mother care to reduce morbidity and mortality in low birthweight
infants. The Cochrane Database of Systematic Reviews. 2.
 Drosten-Brooks, F. (1993). Kangaroo Care: Skin-to-skin contact in the NIVU. Maternal Child Nursing.
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 Dombrowski et al . (2001). Kangaroo (skin-to-skin) Care with a postpartum woman who felt depressed.
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