Kangaroo Care and Reduced Risk for Preterm Neonates - Essay Example

? Kangaroo Care and Reduced Risk for Preterm Neonates June 4, Draft Version: Kangaroo Care and Reduced Risk for Preterm Neonates Neonatal mortality, for preemies, is a problem all over, in many different countries. Research shows that Kangaroo Care can reduce neonatal mortality. Kangaroo Care emphasizes close mother/newborn bonding, breastfeeding and skin-to-skin contact. This paper will compare and contrast the findings and claims of two research articles, Each one makes a unique contribution on Kangaroo Care and skin-to-skin contact between newborn and mother, found to be particularly efficacious in reducing risk of illness and infant mortality among low birth weight and preterm bsbies. The articles this paper will consider are: Positive effect of kangaroo mother care on long-term breastfeeding in very preterm infants and Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants. For the methodology, the first study used preterm babies of 1-6 months in a longitudinal study. They included very preterm and preterm, singleton infants, and their mothers (Flacking, Ewald, & Wallin, 2011). This is a much larger population sample than the Norwegian study used. KMC sessions were documented by duration and telephone data was collected about continued breastfeeding (Flacking, Ewald, & Wallin, 2011). The Norwegian study applied dual treatments where they alternated music therapy and Kangaroo Care to an group of preterm infants and Kangaroo Care only to the other group. They had a total of 61 pretern infants (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). The articles were similar in that both used samples of pretern infants and neither one directly targeted neonatal mortality of preterm infants. But, indirectly, they did. The first study was interested in how Kangaroo Care furthered breastfeeding after discharge from the hospital (Flacking, Ewald, & Wallin, 2011). This is because breastfeeding significantly reduces risk of illness and infant mortality. It follows logically then, that if Kangaroo Care can encourage longer breastfeeding, then it is a tool in reducing risk for illness and mortality in the preterm baby. The Norwegian study was interested in boosting the efficacy of Kangaroo care, by using another promising treatment, music therapy (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). The research assumptions are different in that the first one considered breastfeeding as a key to the reduced risk of preterm infants illness and mortality (Flacking, Ewald, & Wallin, 2011), while the Norwegian study hypothesized that the supplementation of Kangaroo Care would probably be important, and they collected physiological data which confirmed this (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). . The findings for the first study were most significant for the very preterm infants, the most vulnerable of the babies. Those mothers who were still breastfeeeding 5 or 6 months after discharge from the hospital were those who had spent the most time doing Kangaroo Care with their baby, in the hospital (Flacking, Ewald, & Wallin, 2011). Kangaroo Care cayses breastfeeding to happen for a longer time over-all. Breastfeeding lowers the risk of infant mortality and contributes to good health, so these are pretty exciting findings, especially because the findings were strongest for the infants at most risk. That Kangaroo Care encourages continued breastfeeding is a finding confirmed by Gouchon et al. (Gouchon, Gregori, Picotto, Patrucco, Nangeroini, & Di Giulio, 2010) in their study with cesarean neonates. Gregson and Blackson (Gregson & Blackson, 2011) also conducted a research study which confirmed this finding on Kangaroo Care and improved breastfeeding rates and duration. The findings for the Norwegian study included decreased pulse rate, slowed respiration, increased transcutaneous oxygen saturation, and more stable blood pressure for those neonates who received the dual treatment of alternating Kangaroo Care sessions with music therapy sessions. And also the parents reported that the dual treatment calmed them (63%) and their babies (51%) (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). This was significantly greater than neonates and mothers who had Kangaroo Care alone. The findings are because positive outcomes are shown for skin-to-skin contact. However, the Norwegian study shows a more positive outcome for Kangaroo Care when it is combined with music therapy (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). One of the positive outcomes, oxygen saturation, was confirmed by another study. Responding to the fact that aversive sound stimuli are a familiar problem in neonatal wards, and that it can lead to failure to thrive, and contribute to preterm mortality, a study by Standley and Moore (1995) found that using music to mask aversive stimuli initially triggered higher oxygen satuiration levels, although later the levels dropped upon termination of the music. This study found that music was more effective than listening to the mother’s voice. This study showed that infants treated with music had significantly fewer oximeter alarms than thos neonates treated only with their mother’s voice (Standley & Moore, 1995). Another research study compared the effects of recorded music vs live music, on preterm infants, and found that after the live music, infants had a reduced heart rate and scored higher on a behavioral scale, and their mothers were also happier with the live music (Arnon, et al., 2006) Based on the findings of the two articles, and the confirmation by other research, and their credible methodology, it is reasonable to support these findings: that Kangaroo Care encourages breastfeeding and that Kangaroo Care combined with music therapy has even more positive and beneficial outcomes for preterm neonates. Kangaroo Care and Reduced Risk for Preterm Neonates Neonatal mortality, with preterm birth, is a problem around the world, even in this modern age. According to a recently-released report from Save the Children (Save the Children, 2013), one million babies die on the very day they are born, and three million die within their first month of life. Of all industrialized countries, The United States has the highest rate of first day newborn deaths (11,300 per year), 50% higher than all the rest of the industrialized countries together. One in eight babies in the USA are preterm. Of industrialized nations, only Cyprus has a higher rate of preterm birth. A third of the newborn deaths, in the USA, are due to the complications of being born preterm (Save the Children, 2013). Since poverty is identified as being the biggest culprit (Save the Children, 2013), what is needed, for these vulnerable newborns are affordable, simple solutions for minimizing their vulnerability and maximizing their survival capacity. Simple, affordable solutions are available. Research has indicated that Kangaroo Care may provide a partial solution. Kangaroo Care emphasizes close mother/newborn bonding, breastfeeding and skin-to-skin contact. This paper will compare and contrast the findings and approaches of two relevant research articles Kangaroo Care has been found to be efficacious in reducing risk of illness and infant mortality among low birth weight and preterm neonates. The articles this paper will consider are: Positive effect of kangaroo mother care on long-term breastfeeding in very preterm infants (Flacking, et al., 2011) and Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants (Teckenberg, 2011). Breastfeeding is a variable known to have a strengthening and protective effect on the infant. Exclusive breastfeeding reduces infant mortality, in both rich and poor countries, by protecting against common illnesses, especially gastrointestinal tract infections, often resulting in diarrhoea and dehydration, and helps the baby to recover more quickly from illness, according to research (Kramer, Bogdanovich, & Ovohinikov, 2001). To encourage exclusive and sustained breastfeeding for six months, WHO and UNICEF recommend that breastfeeding should begin within the first hour after birth and should be on-demand (WHO, 2013). Kangaroo Care encourages close skin-to-skin mother/baby contact and breastfeeding, immediate and sustained, on demand. The first study, therefore, looks at whether Kangaroo Care has any impact on breastfeeding selected preterm babies of 1-6 months (corrected age) for a longitudinal study. They included 103 VPT (< 32 gestational weeks) and 197 PT (32-36 gestational weeks) infants, and their mothers (Flacking, Ewald, & Wallin, 2011). This is a much larger population sample than the Norwegian study used. Kangaroo Care sessions were documented by duration, and telephone data was collected about continued breastfeeding (Flacking, Ewald, & Wallin, 2011). The Norwegian study applied dual treatments of alternating music therapy and Kangaroo Care to an experimental group of preterm infants and Kangaroo Care only to the control group. The population sample included 61 pretern infants (gestational age 24-36 weeks) (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). The articles were similar in that both used samples of pretern infants and neither one directly targeted neonatal mortality of preterm infants. Indirectly, they did. The first study was interested in how Kangaroo Care furthered breastfeeding after discharge from the hospital (Flacking, Ewald, & Wallin, 2011). This is because breastfeeding significantly reduces risk of illness and infant mortality. If Kangaroo Care can encourage longer breastfeeding, then it is a tool in reducing risk for illness and mortality in the preterm baby. This should then inform nursing practice by alerting nurses to the importance of encouraging Kangaroo Care for newborns, especially preterm newborns. The Norwegian study took a different approach. It was interested in boosting the efficacy of Kangaroo care, by using another promising treatment, music therapy (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). Nurses should remain up-to-date on techniques which, singly or in combination, are promising for reducing infant mortality. The research assumptions in the two articles are different. The first one considered breastfeeding as a key to the reduced risk of preterm infants illness and mortality (Flacking, Ewald, & Wallin, 2011). The Norwegian study considered the supplementation of Kangaroo Care to be important, and they collected physiological data which confirmed this (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). The findings for the first study were most significant for the very preterm infants, the most vulnerable of the neonates. Those mothers who were still breastfeeding 5 or 6 months after discharge were those who had spent the most time in Kangaroo Care, in the hospital (Flacking, Ewald, & Wallin, 2011). Kangaroo Care supports breastfeeding. Breastfeeding lowers the risk of infant mortality and contributes to good health. Furthermore, Kangaroo Care neonates had a 14% reduction in hospital staym compared with non-Kangaroo Care babies. So these are very positive findings, especially so because the findings were strongest for the infants at most risk. That Kangaroo Care encourages continued breastfeeding is a finding confirmed by Gouchon et al. (Gouchon, Gregori, Picotto, Patrucco, Nangeroini, & Di Giulio, 2010) in their study with cesarean neonates. Gregson and Blackson (Gregson & Blackson, 2011) also conducted a research study which confirmed this finding on Kangaroo Care and improved breastfeeding rates and duration. Findings for the Norwegian study included decreased pulse rate, slowed respiration, increased transcutaneous oxygen saturation, and more stable blood pressure for those neonates who received the dual treatment of alternating Kangaroo Care sessions with music therapy sessions. Furthermore the parents reported that the dual treatment calmed them (63%) and their babies (51%) (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). This was significantly greater than neonates and mothers who had Kangaroo Care alone. The findings are similar in that positive outcomes are shown for skin-to-skin contact. However, the Norwegian study shows a far more positive outcome for Kangaroo Care combined with music therapy (Teckenberg-Jansson, Huotilainen, Polkki, Lipsanen, & Jarvenpaa, 2011). One of the positive outcomes, specifically oxygen saturation, was confirmed by another study. Responding to the fact that aversive sound stimuli are a recognized sitaution in neonatal wards, and that it can lead to failure to thrive, contributing to preterm mortality, a study by Standley and Moore (1995) found that using music to mask aversive stimuli initially triggered higher oxygen satuiration levels, although later the levels dropped upon termination of the music. This study found that music was more effective than listening to the mother’s voice. Furthermore, this study showed that infants treated with music had significantly fewer oximeter alarms than thos neonates treated only with their mother’s voice (Standley & Moore, 1995). Another research study compared the effects of recorded music vs live music, on preterm infants, and found that after the live music, infants had a reduced heart rate and scored higher on a behavioral scale, and their mothers were also happier with the live music (Arnon, et al., 2006) Based on the findings of the two articles, and on confirmation by other research, and credible methodology, it is reasonable to support these findings: that Kangaroo Care encourages breastfeeding and that Kangaroo Care combined with music therapy has even more positive and beneficial outcomes for preterm neonates. Further research should focus on using Kaangaroo Care with music therapy and other concurrent therapies. These are therapies which empower vulnerable babies, their mothers, and the nurses who help them to survive and thrive. References Arnon, B., Shapsa, A., Forman, L., Regey, R., Bauer, S., Litmanovitz, I., et al. (2006). Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth , 33(2):131-6. Flacking, R. U, & Wallin, L. (2011). Positive effect of kangaroo mother care on long-term breastfeeding in very preterm infants. Journal of Obstetrics, Gynecology and Neonatal Nursing , 40(2):190-7. Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroini, M., & Di Giulio, P. (2010). Skin-to-skin contact after cesarean delivery: An experimental study. Nursing Research , 59(2):78-84. Gregson, S., & Blackson, J. (2011). Kangaroo care in pre-term or low birth weight babies in a postnatal ward. Journal of Midwifery , 19(9):566-75. Kramer, M. S., Bogdanovich, B. C.-P., & Ovohinikov, L. (2001). Promotion of breastfeeding intervention trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association , 285(4):413-420. Save the Children. (2013). State of the world's mothers. Westport: Save the Children. Standley, J., & Moore, R. (1995). Therapeutic effects of music and mother's voice on premature infants . Pediatric Nursing , 21(6):509-12, 374. Teckenberg-Jansson, P., Huotilainen, M., Polkki, T., Lipsanen, J., & Jarvenpaa, A.-L. (2011). Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants. Nordic Journal of Music Therapy , 20(1);22-42. WHO. (2013). Exclusive Breastfeeding. Retrieved June 9, 2013, from World Health Organization: http://www.who.int/nutrition/topics/exclusive_breastfeeding/en Read More