Components of Kangaroo Mother Care

Components of Kangaroo Mother C arThe literature search has been divided in different categories to present the effects of kangaroo fix tutorship (KMC). After stating the organization of the piece the inaugural section leave provide the definition, history, and components of KMC. The secondment section provide describe the Universe of Developmental Care simulate and its components. The next section will reflect on the effects of KMC in maintaining the temperature of premature and LBW babys. The fourth section will present the relationship of KMC with the frequency of feeds and how this interpolation assists in resolving the issues cerebrate to pinhead eating while the fifth section will present the results of KMC with respect to achieving the weight gain. The sixth section will describe the effects of KMC in reducing suspected infections and length of stay in hospital. The last section will summarize the literature retread stating the purpose of the literature review.The Search outlineThe literature search was done on two search engines Pubmed and Science Direct will be use of key terms Kangaroo produce contendfulness (KMC) and skin-to -skin (STS) the Pubmed searched resulted in 100 hits. It was besides filtered by adding the terms low lineage weight (LBW). Fin each(prenominal)y twenty articles were reviewed. Similarly, the database of Science Direct showed 30 relevant articles .The second step was to search database in Google Scholar. The result showed very pertinent articles, including a website of the KMC implantation. This website facilitated the inquiryer in searching the general review and origin of KMC, original articles were so searched from the reference lists of these articles.Definition, History, and Components of Kangaroo Mother Care (KMC)Kangaroo Mother Care (KMC) is an alternative intervention for hypothermia among preterm infants by, keeping the baby close to the mothers skin (Lawn, Mwansa-Kambafwile, Horta, Barros, Cousen s,2010). Dr Edgar Rey Sanabria, a pediatrician initiated the model of KMC at the Department of health in Mobato, Colombia in 1978 Since then, KMC has been well known for provide a quality worry to newborn infants especi in ally to LBW babies in Colombia (Lawn et al.2010).A large range of literature is available that evaluates the physiological, psychological, emotional, and developmental outcomes of KMC. However, this literature review will primarily focus on the physiological and breastfeeding outcomes of KMC in hospital. However, the secondary outcome variables a deal weight gain, infection and length of stay will also be presented in the this literature review.Gradually this model was adopted by many developed countries like US, UK, and Brazil, and in 2003, WHO provided international guidelines to implement KMC. Based on the effectiveness of KMC in hospital settings, it was recommended to incorporate KMC into a package of neonatal care and not as an individual intervention (Pattinson, Woods, Greenfield, Velaphi, 2005). According to Charpak It is not alternative medicine but a scientifically sound, multilevel intervention (Charpak Ruiz-Pelaez, 2001). Though it is initiated in the hospital, it mint be continued at home until rejected by the infant usually towards the completion of gestation at 37 weeks (Charpak Ruiz-Pelaez, 2001).Universe of Developmental Care (UDC)The model is the renewal of Als Synactive theory of neonatal development. The theoretical concept of the model is shared surface the manifestation of the shared surface is the skin. Through the skin the linkages are created among the luggage compartment organism , and the environment. The key concept of the model is that an infants skin is considered as boundary of infant where as the shared surface includes environmental influences. The fixion of these influences is inter- cogitate with care practices and the family (Gibbins, Hoath, Coughlin, Gibbins Franck, 2008).Components of Model This model is based on infant, environment, and supply.InfantInfant is the core component of the model, who occupies key position, as shown in model (refer fig 1.). The first circle immediate to the central position of the infant in the model represents specific physiological systems, such as respiratory, cardiac, and nervous, hematologic, metabolic, immunological, musculoskeletal, integumentry, and gastrology system. These physiological systems are interrelated with individually other and they are highly influenced by the surrounding environment.Care PracticesSpecific care practices behaviors are symbolized as care planets of the UDC model. There are nine care planets surrounding the physiological system which depict care giving behaviors like monitoring/assessment, feeding, positioning, infection program line, safety, sympathizer, ther muchgulation, skin care, and respiratory care (Gibbins, et al., 2008, p. 145).FamilyIn the UDC model family is the central focushowever, staff and institution support is required to provide effective care to the infant, for instance, for any care practice approach like provision of comfort to an extremely low parturition infant. If the parental touch is been replaced in an intensive care unit with staff support and institutions policy, the care planet of comfort will not only be affected, but it may alter the other planets like sleep, positioning, safety, and like. Therefore, within the hospital environment the family is shown as very close to the infant in the UDC model, which demonstrates the natural family-infant dyads bonding.EnvironmentThe macro-environment of the model, based on the infrastructure and physical environment such as lay -out, lighting, noise levels, units physical design, affects the shared surfaces. Moreover, interpersonal behavior and hospital culture are also considered as part of enviroment in the UDC model (Gibbins, et al., 2008, p. 145). These environmental influences can affect any of the care planets of the general model. Due to interdependence of care planets of the UDC model, the care practice that alters any one of the care planet will automatically affect the other care planets. (Ludington, 2009). dear like the laws of solar system movement, an infant is expected to respond to the environmental influences by showing some developmental behaviors (Gibbins, et al., 2008, p. 143).StaffThe position of staff in the model is just as a protective orbit that supports family of very high risk and critical infants. The authors have emphasized the role of education and staff training in the context of UDC model in order to apply the theoretical concepts of developmental care model in clinical practices (Gibbins, et al., 2008, p. 144).Application of the ModelThe UDC model is applicable for infants care providing clinical approach for nurses to follow. The model captured an extensive list of nursing care, which involves holistic developmental care. Therefore, it can be easily u tilise as bedside practice in addition this model provides opportunities to the nursing researchers to explore any one of the care planets and then identify its interdependence with other care planets. Since the model is based on Nightingale, environmental theory can be widely applied in nursing care practices.However, a lot of research work is needed to validate the concept of shared surfaces of the model. The literature review,so far,has not interpret any scholarly work for the application of the model to kangaroo mother care, though it is one of the essential components of the models comfort care planet( Ludington, 2009).The intention of the current study is to apply this model to explore the physiological and developmental effects of kangaroo mother care among low birth weight and preterm infants. The application and modification of the model would be discussed in detail in chapter 3. However, the model also guided us to present the effectiveness of KMC with literature review. ThermoregulationKangaroo Mother Care (KMC) has been recognized as an effective model for thermic stability (Charpak et al., 2005 Ludington-Hoe, Nguygen, Swinth Satyshur, 2000 Cong, 2006). Due to large body surface, little fat size LBW infants are at high risk of heat loss. When this loss exceeds the ability of infant to produce heat, hypothermia develops (WHO, 1997). Infants are more convincible to hypothermia immediately after birth, during bath or during weighing. It has been found that countries with high neonatal morbidities deaths showed higher rates of hypothermia (Kumar, Shearer, Kumar Darmstadt, 2009). Therefore, to minimize the risk of hypothermia a set of procedure has been recommended for thermal regulation of newborn infants. These procedures include warm delivery room, drying of infants body and skin-to-skin contact, breast feeding and postponing bathing and weighing of infants and keeping mother-infant together etc. In baptismal font of breaking in this warm- chain infant can be at risk of cold stress (WHO, 1997). In such cases thermal protections can be ful pig outed by either keeping infant in warmer incubator or under radiant heat. The positive outcome of randomized trials among preterm has suggested the KMC as an alternative of incubators (Bergman et al., 2004 Cattaneo et al., 1998 Chwo et al., 2002 Kadam et al., 2005 Ludington-Hoe et al., 2000 Ludington-Hoe et al., 2004). The abdomen of mother due to the appropriate temperature for newborn is considered as the best means for immediate postnatal interventions (AAP AAH, 2000). It is also suggested in the guidelines of World Health Organization that skin-to-skin contacts should be continue during transfer as well as after shifting of infant in ward (WHO, 2003).The consistence findings of KMC among various trials and metaanalysis (conde, et, al, 2010), systemic review of kangaroo care (Brett, Staniszewska, Newburn, Jones, Taylor, 2011) and literature review by (Bulfone, Nazzi, Tenore, 201 1) made it possible to include kangaroo care as one of the integral component of newborn care (Carlo, et al., 2010 Darmstadt et al., 2006 Kumar et al., 2008 Moore McDermott, 2004 Senarath, Fernando, Rodrigo, 2007 Tinker, Paul, Ruben, 2006), including preterm infants.Bergman et al. (2004) investigated effects of one hour dose of KMC after birth to assess the rate of hypothermia. Out of 20 LBW infants 18 maintained their temperature with KMC, whereas in control concourse six out of 14 infants maintained their temperature. Similarly, Cattaneoet al. (1998) assessed the KMC interventions by continuous skin-to-skin contact, day night with an average of 20 hrs /day by mothers. Researcher found 13.5 episodes of hypothermia in a sample of 100 infants in intervention group as compared to 31.5 episodes in control group.It is highly recommended from literature that staff need to be sensitize about this serious issue Kumar, et al, 2009). It has been observed that in the study settings that on that point are modern equipment to provide warmth to infants are available. However, space and equipment remain the limitation of any organization due to high influx of premature and LBW infants delivery. Though an infant gets thermal control in nursery setting but there is need to implement some strategies which protect high risk infants in the ward environment and mother need to educate about monitoring of infant. She should be acknowledging about its management as well.In order to compare the effects of environmental temperature and kangaroo care interventions, three groups of newborns were selected. One group was given skin-to-skin contact in prone, while another group was prone to mother chest with clothes, while third group of neonates were kept in nursery. After 90 minutes of repeat measures of temperature post birth (30-120 minutes after birth) the infants who were in skin-to-skin contact showed more variation in temperature than their counterparts. This variation was found to be related with sensory foreplay caused by mother infant skin to skin contact. Moreover, researchers have concluded that early eat promotion also facilitated in oxytocin release which further enhanced metabolism and heat production(Bystrova et al., 2007).The literature review supports the concept of shared surface of UDC model also. The relationship between infants brain and environment is apparent through skin-to-skin contact. As parasympathetic nervous system gets stimulated which enhances peripheral circulation (Bystrova et al., 2007) and manifestation of this process is apparent through infants skin temperature. According to the recent meta-analysis of KMC, there is a world-shattering reduction of hypothermia (Conde, 2010). Developing counties like India and Bangladesh have shown progress in implementing KMC in low and high technical settings. It can be applied for all healthy newborn 28 weeks of gestation and weight 600 grams safely (Browne, 2007). Initially preterm and LBW infants were given KMC for 24 hrs. Gradually his model was modified to intermittent kangaroo care for minimum 30 to 60 minutes (Nyqvist, 2009). The researchers found KMC effective in thermal protection even if was given for short duration (Boo Jamli, 2007). In addition to it KMC can be applied to all newborn care setting. There is no need to have a separate setting to implement this model other than privateness to practice in clinical settings.Some of the challenges identified in implementation of KMC model initially in India (Ramanathan, Paul, Deorari, Taneja, George, 2001) participated mothers showed reluctance at the initial stage to trade the traditional behavior of neonatal care. Similarly, in Uganda values and beliefs of mother were challenging. As mother considered vernix as napaki and it should be removed, and infant cannot be placed on mothers abdomen before bathing (Byaruhanga, Bergstrm, Tibemanya, Nakitto, Okong, 2008). some other challenge is reluctance in modifying the newborn care policies and protocols. Despite multiple benefits of KMC, there is still a respite in application of this model (Byaruhanga et al., 2008). One Pakistani study also found cultural beliefs as barrier to provide thermal protection mothers mat up blood on newly born infant as napaki and they were not in favour of breastfeeding infant soon after birth (Aziz, Akhtar, Kaleem). This way all live healthy born infants were given bath before feeding. This behavior is considered as one of the major hazard for newborn health this gap can be fulfilled by research evidences in our cultural context and by following the international guidelines of newborn care.Effects of KMC in Promoting LactationAnother major challenge of preterm births is ineffective breastfeeding. These infants need a great deal of struggle while attachment to mothers breasts. The epidemiological studies have provided sufficient evidences that breast feeding contributes in reducing morbidities and mo rtalities of infants (Heinig, 2001). It was further manifest that preterm and LBW infants who received donors breast milk were at lower risk of necrotizing enterocollitis than those who ply formula feed (McGuire Anthony, 2003). A width of literature supports kangroo care as one of the best way to promote early attachment of infants to mother breast.A number of barriers to breast feeding among preterm infants are, vernal systems, shortsighted coordination while sucking, and difficult to keep them awake (Ludington, 2010). As a result mother does not receive sufficient stimulation from infants sucking. Therefore, infants are fed supplement milk either with spoon, gavage or bottle feeding. Since exclusive breast feeding is strongly associated with child survival (Bhutta, 2008) it is recommended that breast feeding should be initiated within an hour of birth to produce sufficient calories and to keep the infant warm (WHO, 1996). KMC has shown substantial improvement in promoting exc lusive breastfeeding. The literature review has shown suckling outcome of preterm infants with KMC (WHO, 1996). Even one hour session of KMC for two weeks was found to be helpful in attachment of infants with mothers breasts. (Nyqvist et al., 2006). The researchers found increase in breast feeding rate and duration among 32 -35 weeks of gestation (Nyqvist et al., 2006). This early attachment behavior of infants with the help of Skin-to-skin contact, stimulates sucking behavior and more oxytocin releases to produce more milk (Matthiesen, Ransj Arvidson, Nissen, Uvns Moberg, 2001). The experimental study on infants exposed to skin-to-skin contact immediately after birth shows that they continue to nurse more efficiently. There was a significant production of milk and weight gain (Andreson, 2004 Charpak 2001 Dewey, 2003). The literature supports KMC to achieve successful breastfeeding among 90% of infants compared to 61% in hospital (Bier et al., 1996). Moreover, infant on KMC found t o be relaxed therefore, gut is prepared by hormones to digest milk adequately. This helps again in reducing the chances of necrotizing of gut and infants gain weight, resulting in a shorter stay at the hospital(Bergman, Linley, Fawcus, 2004).In addition improve frequency and duration of breastfeeding it is also evident from literature that mothers receive extra support for lactation from nurses while giving intervention of KMC. This support also motivates mothers to continue breastfeeding (Carfoot Moore, 2005). Due to sustained breastfeeding cholecystokinin releases more and it further stimulates parasympathetic nervous system which aids in growth and development of infants. A comparative study of three group of infants discussed in the section of thermal regulation (Bystrova et al., 2007) also support early sucking reflexes with skin-to-skin contact. A systemic review by Ahmed and Sands (2010) found eight studies to support breastfeeding outcome among preterm infants.Effects of KM C on Weight GainAs discussed earlier the preterm and LBW infants are prone to hypothermia, poor lactation, and infections during hospitalization which contribute to infants weight gain or prolonged stay in hospital just to gain weight. KMC has been found to be effective in growth of infants (Ali, 2009 Anderson, 1991 Boo, 2007 Conde, 2010 Rao, 2007). However, Charpaks study did not suggest significant difference in weight gain of infants (Charpak, 2005). On the other hand, KMC also did not show untoward effects and none of the studies found that infants with KMC intervention were failing to thrive. Thus the literature shows positive effect of KMC in terms of improving the feeding of LBW infants and weight gain. Studies among LBW infants depicts significant improvement in growth of infants, with mean weight gain of 29gms among infants Effects of KMC in prevention of Infection and length of stay reductionRecently it is evident from the literature that KMC reduces the morbidities and m ortalities among infants (Lawn, 2010). Total 15 trials were reviewed and researchers found significant decrease in mortalities i.e. (RR =0.49) and morbidities which was (RR= 0.34).The scientist are predicting that by placing infants in skin-to-skin contact may improve barrier run low of the skin (Abufatteh, Ludington, Burant -Visscher, 2011). The researchers found only one case of infection at the time of completion of KMC. The progress of KMC in reducing infection is also depicted in developing countries. A substantial reduction in infections among LBW Infants is demonstrated from the literature. For instance Ali in (2009) found 6.9% of sepsis in KMC group as compared to 23.2% in control group during hospitalization. In addition the research findings were consistent at follow-up incidences of severe infections were high in control group (17.9%) as compared to (5.2%) in KMC (Ali, 2009). This impact is also associated with improvement in breastfeeding through skin-to-skin contacts. The Immunoglobulin and lactoferrin properties of human milk help in prevention of infection. (FurmanKennell, 2000).Reducing the length of stay is another goal of KMC which is highlighted by many studies from developing countries (Ali, 2009 Boo, 2007 Charpak, 2001 Ramanthan, 2001). Infants discharged 7.4 days earlier than control group (Ramanthan, 2001). Similarly, Boo found difference of nine days (Boo, 2007). This major impact is further contributing to cost-efficient management. Parents of LBW and preterm infants face dual burden of complication of prematurity as well as economic constraints. Thus, KMC could be an appropriate cost-effective intervention for this population. However, it has not been explored in Pakistan to our knowledge. Therefore, keeping in mind the efficacy of KMC there is a need to implement such trial in Pakistan to fill the gap.ConclusionThe literature review suggests KMC as an effective intervention to achieve thermal stability and breast feeding among LBW and preterm infants. Complications such as infections can be minimized by the help of protective environment of mothers skin contact and breastfeeding component. Thus countries with scarce resources like Pakistan can benefit from this intervention to promote the health of high risk newborns.Aziz, N., Akhtar, S., Kaleem, R. Newborn Care Practices Regarding Thermal Protection Among Slum Dwellers in Rachna Town, Lahore, Punjab. Annals of King Edward Medical University, 16(1 SI).Bergman, N. J., Linley, L. L., Fawcus, S. R. (2004). Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatr, 93(6), 779-785.Byaruhanga, R. N., Bergstrm, A., Tibemanya, J., Nakitto, C., Okong, P. (2008). Perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care in a periurban hospital in Uganda. Midwifery, 24(2), 183-189.Bystrova, K., Matthiesen, A. S., Vorontsov, I., Widstrm, A. M., RansjArvidson, A. B., UvnsMoberg, K. (2007). maternal axillar and breast temperature after giving birth effects of delivery ward practices and relation to infant temperature. Birth, 34(4), 291-300.Charpak, N., Ruiz-Pelaez, J. G. (2001). A randomized, controlled trial of kangaroo mother care results of follow-up at 1 year of corrected age. Pediatrics, 108(5), 1072.Heinig, M. J. (2001). Host defense benefits of breastfeeding for the infant effect of breastfeeding duration and exclusivity. 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