Physiological Effects of Kangaroo Care - Essay Example

Physiological effects of kangaroo care (skin-to-skin) on the neonate Contents Contents Introduction 2 Aim and Objectives 3 Research Approach 3 Access and Sampling 3 Ethical Considerations 4 Methodology 4 Analysis: Process and Method 5 Timescale and Costing 6 Anticipated Study outcomes and Relationship to Practice 7 Summary and conclusion 8 Bibliography 9 Introduction Implementing and scaling up new health care interventions is very challenging and often demands intensive training or retraining, especially when the objective is to reach a health system on a provincial or national level. Not enough evidence exists that kangaroo mother care is an effective alternative to standard care for low birth-weight babies. Low birth-weight (less than 2500g) has an adverse effect on child survival and development. Care of low birth-weight babies is expensive and requires specialist care. Kangaroo mother care (KMC) involves skin to skin contact between Mothers and their newborns, frequent and exclusive or nearly exclusive breastfeeding and early discharge from hospital. Compared with conventional care, KMC was found to reduce severe illness, infection, breastfeeding problems, and maternal dissatisfaction with method of care and improve some outcomes of mother-baby bonding. There was no difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. More research is needed. The focus of the kangaroo mother care initiative was to introduce KMC in all health care facilities in South Africa, starting with hospitals that provide newborn care, followed by home-based KMC in the community. KMC, the method of choice for hospitals caring for stable immature infants is an alternative to conventional incubator and bassinet care. The infant is positioned skin-to-skin between the mothers breasts and secured firmly. KMC programmes also include the promotion of breastfeeding and the ambulatory support of mothers after discharge. The advantages and practice of KMC, even for unstable low birth-weight infants and healthy newborns, have been well documented and described in the literature. Aim and Objectives The key objective of this proposed study is to understand: The physiological effects of kangaroo care (skin-to-skin) on the neonate To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. In the proposed study, mothers in a KMC group practicing 24-hour-a-day skin-to-skin contact will be compared with mothers in a traditional care group (TC). Furthermore, infants in the TC group will be kept in incubators at the minimal care unit until they met standard discharge criteria. Research Approach The approach is qualitative research with the focus on the physiological factors of the infant. The research would be carried forward by doing sampling of the available population and then recording the outcome. The outcome would be assessed after obtaining the data of the research done. Access and Sampling The hospitals would be contacted and would be explained the significance and the objective of the study. After obtaining consent from hospital to conduct this study in their premise, the parents will be explained the significance of kangaroo care method. The parents of new born would be involved in the study with their prior consent. Two groups of infants will be created- one experimental, indulging in Kangaroo mother care and the other control group where the infants will be kept in NICU under the usual care for the new born. Many control variables have been introduced to optimize data interpretation. They include gestational age at birth, gender, weight, height and head circumference at birth; intrauterine growth diagnosis according to the “Lubchenco classification”; parity; Apgar score at 1 and 5 minutes; diagnoses at eligibility time; age, weight, height, and head circumference at eligibility; family socio-demographic descriptors; and pregnancy and delivery variables. Ethical Considerations There would not be any ethical issues involved as the infants would be provided with adequate care. Methodology Study would be randomized, controlled trial to be conducted in hospital of England involving more than 1000 infants that would be weighed before study and who will be born between April 2009 and April 2010. An infant and mother will be eligible if the mother or a relative would be willing to follow instructions, and if the infant would be able to overcome all major adaptation problems to extra uterine life, have a positive weight gain, and suckle and swallow properly. Infant–mother dyads will be excluded if the infant dies; referred to another institution; possess lethal or major malformations; possess sequel arising from prenatal problems (severe hypoxic–ischemic encephalopathy, pulmonary hypertension, etc); or have been abandoned or given for adoption. Eligible mother–infant dyads will be randomized according to a stratified block randomization procedure prepared in advance. Three strata are defined, based on weight at birth (1200 g; 1200 to 1499 g; 1500 to 2000 g), and blocks of four infants (2 KMC and 2 TC control infants) will be prepared using a random number table. The two groups will be randomized before seeking consent to participate. This procedure, proposed by “Meinert and Tonascia” is chosen because early discharge is very appealing to parents, and it is very likely that many of the families will ask to be assigned to the KMC group. This procedure was accepted by the ethics committee because those assigned to the control group received the usual care provided at the participant institution. Trial quality will be assessed and data will be extracted independently by two reviewers. Statistical analysis will be conducted using the standard Cochrane Collaboration methods. Analysis: Process and Method All infants will be evaluated at birth, at time of eligibility, and at term by a team of paediatricians, nurses, social workers and psychologists. The data would be analyzed using various analysis techniques like content analysis, constant comparison or analytical induction. For the data analysis, the tables would be prepared and data would be recorded. Data analyses will be performed with two moderating conditions. The first would be the interval between birth and eligibility, representing the period during which the mother is separated from the infant before beginning the intervention. It has been in trichotomy: 1 to 2 days is the first category, including infants born in fairly good health and randomized shortly after birth. In this subgroup, infants will leave the hospital with their mothers and received either KMC or TC at home. A 3- to 14-day delay makes up the second category, and .14-day delay makes up the third category, representing a long separation before closer mother–infant contact. The second moderating condition is the child’s health, measured by the duration of stay in the NICU. It is dichotomized as “yes” or “no.” This second moderating variable is statistically independent of the delay between birth and eligibility (first moderating variable). Dependent variables are twofold: the first is the mother’s perception of the experience of a premature birth, and the second is the mother and child’s sensitivity to each other in a feeding situation. All statistical analyses were performed using the SPSS 7.5 for Windows. Timescale and Costing The proposed study will involve duration of 12-14 weeks. Anticipated Study outcomes and Relationship to Practice Sleep Time/Colic It is known that Colic is caused by a babys (whether premature or full term) incapability to shift from one sleep position to another - like from an aware condition into a slumber status and back again.  The gas connected from colic is caused by the overindulgence of crying during this change.  It is anticipated that Kangaroo Care performed in a quiet light environment with any baby probable leads to decrease crying and help in the baby easy transition from one sleep state to another.  Apnea, Brady, O2 Saturation, Respiration and Heart Rate The babies instead to be put on respirators and will be placed them on the mother’s chest straight away after birth in the Kangaroo Care situation.  Babies will be with mother till the time respiratory suffering goes - within 48 hours for most babies.  Oxygen hoods and canulas will be used if required. In preterm babies, the effects of Kangaroo Care on these functions are just as dramatic.  Body Temperature and Lactation Kangaroo Care allows for easy access to the breast, and the skin-to-skin contact increases milk let-down.  A receiving blanket, strategically placed to catch extra milk is extremely helpful - especially if the baby is unable to breast feed. Weight Gain/ Shorter Hospital Stay Kangaroo Care allows the baby to fall into a deep sleep, there by conserving their energy for far more important things.   Left alone on a warming table, a baby cries more and sleeps less. This increased weight gain also leads to shorter hospital stays. Summary and conclusion As per the research done up to now it is learned that there are numerous benefits to the infant and parents. For parents, it significantly decreases the stress associated with having a preemie and promotes successful breastfeeding for the mother. For the infant, there is a list of benefits: promotes successful, early breastfeeding decreases time spent in hospital keeps baby warm, promoting optimal temperatures for recovery increases oxygen in the blood increases time spent in deep sleep states lowers the amount of breathing pauses and apnea lowers the number of slow heart rate periods increases bonding between infant and parents provides comfort An advanced research in the above said field is required to understand the pros and cons of Kangaroo care on the Neonates. Bibliography ASSOCIATION, American Psychological. 1996. Psychological Abstracts. American Psychological Association. BEHRMAN, Richard E. 2007. Preterm Birth: Causes, Consequences, and Prevention. National Academies Press. BLACKBURN, Susan Tucker. 2007. Maternal, fetal, & neonatal physiology: a clinical perspective. Elsevier Health Sciences. BORNSTEIN, Marc H. 2002. Handbook of Parenting: Being and Becoming a Parent. Lawrence Erlbaum Associates. BROWNE, Joy V. 2006. Research on Early Developmental Care for Preterm Neonates. John Libbey Eurotext. DAVIS, Deborah L. 2004. Parenting Your Premature Baby and Child: The Emotional Journey. Fulcrum Publishing. FIELD, Tiffany. 2007. The Amazing Infant. Blackwell Publishing. GOLDSON, Edward. 1999. Nurturing the premature infant: developmental interventions in the neonatal intensive care nursery. Oxford University Press US. HINSHAW, Ada Sue. 1999. Handbook of Clinical Nursing Research. Sage Publications. LABATE, Luciano. 2007. Low-cost Approaches to Promote Physical and Mental Health: Theory, Research, and Practice. Springer. MERENSTEIN, Gerald B. 2002. Handbook of Neonatal Intensive Care. Mosby. PRICE, Debra L. 2007. Pediatric Nursing: An Introductory Text. Elsevier Health Sciences. RESEARCH, World Health Organization Reproductive Health and. 2003. Kangaroo Mother Care: A Practical Guide. World Health Organization. SIZUN, Jacques. 2006. Research on Early Developmental Care for Preterm Neonates. John Libbey Eurotext. TECKLIN, Jan Stephen. 2007. Pediatric Physical Therapy. Lippincott Williams & Wilkins. WILLIAM H. MARKLE, Melanie A. Fisher, Raymond A. Smego. 2007. Understanding Global Health. Published by McGraw-Hill Professional. Read More