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  • 7/28/2019 Skin-To-skin Care (Kangaroo Care)

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    Skin-to-Skin Kangaroo Care WACSClinproc4.18Oct-10

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    WACSClinProc4.18

    Title: Skin-To-Skin Care (Kangaroo care)

    Replaces: New GuidelineDescription: Provision of skin-to-skin care to special care infantsTarget Audience: Midwives, registered nurses and mothercraft nurses, 4NKey Words: Skin to skin care, kangaroo care

    Policy Supported:

    PurposeThe purpose of these guidelines is to support the practice of skin-to-skin care within thespecial care nursery.

    DefinitionSkin-to-skin care is the name given to the practice of a parent holding an infant dressed ina nappy, skin-to-skin in an upright position against his/her bare chest.

    BackgroundKangaroo care was first introduced at the Maternal and Child Institute of Bogota,Columbia, by Edgar Sanabria and Hector Martinez in 1979. Since then this method of carehas demonstrated physiologic, cognitive and emotional gains for both preterm and sickinfants. In the last few decades, health services throughout the world have adopted thispractice into their neonatal care, supported by the practical guidelines developed by WHO

    in 2003.

    CriteriaStable growing babies, > 30 weeks and > 1000grams.

    Baby may be receiving oxygen by headbox (if stable with O2 by blow-by or facemask), or nasal cannula.

    Specific PointsMonitor for drafts. Stop skin-to-skin care if infants temperature drops >0.5C frombaseline.

    Avoid airway occlusion by checking the infants position once in place by ensuringthe babys neck does not flex too far forward.

    Observe infant more closely with parents new to this practice. Reinforce the need tocontain the baby by holding firmly and explain that additional stimulation such astalking or stroking may not be tolerated until the baby is more mature.

    If parent declines skin-to-skin care, attempt to distinguish fear from lack of interest.If the parent is anxious education, patience and support may be beneficial. It shouldnot be forced on a reluctant parent. Offer these parents similar opportunities to holdtheir baby dressed.

    Preparation

    Skin-to-skin care may be initiated by the babys nurse caregiver, LactationConsultant or by the parent, if the above criteria are met and medical permissionhas been obtained.

    Womens & Childrens Services

    Clinical GuidelinesSDMS ID: P2010/0385-001

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    If not previously done, discuss skin-to-skin care with the parents, provide parentinformation pamphlet and answer any questions.

    Advise parent to wear clothing that opens down the front. Encourage mother toremove bra to ensure proper skin-to-skin care.

    ProcedurePlace armchair at bedside and ensure that lines and cords will reach the chair.

    Organise a pillow for parent/infant comfort.Prepare the environment screens for privacy, reduce bright lights and noise andprovide drink for parent.

    Take the infants temperature, heart rate and respiratory rate as a baseline.

    Undress the baby to his/her nappy (or encourage parent to do this). Apply a hat ifbaby < 1800grams until thermal stability during this type of care is established.

    Ensure lines and tubing are secure. Use tape if necessary

    Transfer the baby from cot/crib to the parents bare chest. Because transfers can bepotentially stressful for the infant, use care to flex and contain the babys arms andlegs during the transfer to help the baby remain calm and organized.

    After the infant is placed on the parents chest, tuck a folded warm blanket over thebaby and wrap the parents clothes around the blanket-covered baby.

    For infants on supplemental oxygen, it may be helpful to increase the F iO2 by 10%during the transfer and for a few minutes of skin-to-skin care.

    Some babies remain calm or asleep from the beginning; others may take severalminutes to stop squirming and settle in, gentle but firm containment by theparents hands may help this to happen.

    Take the infants axillary temperature after 30 minutes and hourly thereafter, for thefirst few sessions until thermal stability during skin-to-skin care is established.

    Reinforce parent awareness of infants cues and responses during kangaroo care(i.e. facial expressions, suckling efforts, improved sleep and alert states). Monitor

    baby for stress signs such as apnoea or desaturations.Kangaroo care is organized around feed times and can last for 1-2 hours at a time,and may be repeated 2-3 times/day if the infant is stable. It allows completion ofroutine care such as vital signs, heel prick blood tests and gavage feedings withminimal stress to the baby. The parent may choose to stop skin-to-skin care at anytime.

    Document length of skin-to-skin care, and babys responses.

    BreastfeedingIf baby begins to show interest guide mother in how to place baby in position to

    assist attachment and encourage her to support or shape her breast.Baby may lick and nuzzle at the breast.

    Reassure mother that baby will attach when he/she is ready.

    If kangaroo care is offered frequently and regularly, mother and staff will see babyimprove and mature in their overall behavior.

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    AttachmentsAttachment 1 References

    Performance Indicators: Evaluation of compliance with guideline to be achieved throughmedical record audit annually by clinical Quality improvementMidwife WACS

    Review Date: Annually verified for currency or as changes occur, andreviewed every 3 years via Policy and Procedure workinggroup coordinated by the Clinical and Quality improvementmidwife. November 2009

    Stakeholders: Midwives and medical staff WACS

    Developed by: Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director(Nursing & Midwifery) Womens & Childrens Services

    Dr A Dennis Sue McBeathCo-Director (Medical) Co-Director (Nursing & Midwifery)Womens & Childrens Services Womens & Childrens Services

    Date: _________________________

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    ATTACHMENT 1REFERENCES

    Anderson G C (1993) Kangaroo care, Neonatal Network 12(5):56

    Cantrill R, Creedy D & Cooke M (2004) Midwives knowledge of newborn feeding abilityand reported practice managing the first breastfeed, Breastfeeding Review, 12 (1): 25-33

    Ferber S & Makhoul I (2004) The effect of skin-to-skin contact shortly after birth on theneurobehavioural responses of the term newborn: a randomized, controlled trial,Pediatrics, 113(4): 858-864

    Ludington-Hoe S M (1994) Kangaroo care: Research results and practice implicationsand guidelines, Neonatal network, 13(1): 19-27

    Nyvist, K Hedberg (2004) How can kangaroo mother care and high technology becompatible, J of Human Lactation, 20 (1): 72-74.

    University of Texas Medical Branch, Nursing Practice Standards (2000)Protocol: Skin-to-skin holding ( Kangaroo Care), 1-19.

    Morton, J., (2002) Video A preemie needs his mother.

    World Health Organisation (2003) Kangaroo mother care: a practical guide,Geneva.

    REFER ALSO TO:

    Parent information pamphlet (4N):Providing skin-to-skin (Kangaroo care) for your baby, 2006.

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