Paradigm of Kangaroo Care in the Preterm Neonate - Essay Example

Paradigm of Kangaroo Care in the Preterm Neonate All Preterm Neonates are born extremely immature, with the biological skills and behaviors of a full-term baby, and their healthy growth is dependent on uninterrupted gestation outside the womb. For achieving this objective, creating an ideal environment outside the womb, is skin-to-skin contact with the mother and providing nutrients through breastfeeding. Anthropological evidence and normal human behavior suggest that newborns and babies should be in constant contact with mother and exclusively breastfed. “Physiology and research provides overwhelming evidence that Kangaroo Mother Care is not only safe, but superior. Kangaroo Care is defined as “intra hospital maternal-infant skin-to-skin contact” (Bergman 2005). “Kangaroo Care originated in Bogotá, Columbia in 1983 by Neos Edgar Rey and Hector Martinez when they developed the “Kangaroo Mother Care” program to decrease the high mortality rate among preemies” (Collard 2007). Dr. Nils Bergman is considered as the propagator of Kangaroo Mother Care concept, by putting breast feeding into a biological, evolutionary, and anthropological context after observing commonalities of breastfeeding behavior in all mammals, and defining a paradigm for it. He emphasized that “a paradigm is determined by things such as tradition, culture, and experience more than science or research” (Albright 2001). Bergman found that all newborn mammals exhibit a sequence of behaviors that leads to initiation of breastfeeding, and calls for care-taking responses from the mother. In an anthropological perspective it appears that human brain growth at birth is about 25 percent and 80 percent growth is achieved 12 months after birth, which means the human new born completes its gestational brain growth outside the womb. “It has been suggested that this is an evolutionary compromise to the narrowed pelvic structure of humans as they began walking on two legs” (Albright 2001). In the case of babies born premature it is an early shift from the natural ‘habitat’ and requires a favorable environment for brain growth. Thus, a comparable and conducive place for such babies is skin-to-skin contact with the mother, like a Kangaroo. It has also been argued that “care patterns in Western society have been evolved away from “carry care” to one of “cache care,” where the infant is lying still, feedings are scheduled, typical of “nestling care,” and infants are expected to sleep alone” (Albright 2001). The four types of Mammalian Care Patterns are: Cache feeds-about every 12 hours; Nest feeds-about every four hours; Follow feeds- about every two hours; and Carry feeds- about every 30 minutes, or nearly continuously. It clearly indicates that in Carry feeds, like the Kangaroos, infants are fed continuously, which is a basic requirement for over all growth and survival, and it is the driving force behind ‘Kangaroo Mother Care’ concept. Hence, the two essential components of Kangaroo Mother Care (KMC) are skin-to-skin contact (SSC) and breastfeeding (BF) as SSC represents the correct “habitat” and BF represents “niche” or pre-programmed behavior designed for that habitat. In the uterine habitat the four basic biological needs, such as oxygenation, as well as warmth, nutrition and protection is provided through the placenta and the cord. Birth represents a change in habitat, though the basic need remain the same. “Newborns have a brain wiring (neurophysiology) that craves and requires mother’s presence in order to stabilize, in order to achieve adjustment to a new environment and physiological homeostasis” (Bergman 2005). Kangaroo Mother Care gives the key message: “NEVER SEPARATE MOTHER AND HER NEWBORN,” that means skin to skin contact between mother and her newborn baby has remarkable effect, and benefits are even more crucial for a premature baby” (Bergman 2005). For premature deliveries mothers often have a sense of guilt and anxiety and are prone to post-natal depression. Whereas, under KMC the mother becomes central to the caring team, feel she is giving her child the best possible care, and are mobile and return to normal daily life sooner. According to the results of a strict scientific trial by Dr. Nils Bergman, under Kangaroo Mother Care, “survival of Very Low Birth Weight newborns increased from 10% to 50%”. It was found that skin to skin care was much better for the newborn than the incubator. “Babies were warmer and calmer, breathed better, and had a more stable heart rate with skin to skin care” (Bergman 2005). Babies with less than 1200 grams body weight are found more stable under Kangaroo care than in incubator, which is in opposition to the conventional belief about incubator care. It was found that babies under KMC stabilize faster on the skin to skin care than incubator care, will have stable heart rate, stable temperature in relation with mother’s core body temperature, oxygen rates and breathing. It has direct correlation with breast milk production, as skin to skin contact stimulates breast milk production, and the babies can breastfeed more often than in incubator. In neonates stomach capacity at birth is only 5ml, after one week it is 30 ml, which only lasts for 90 minutes that require feeding every one and a half to two hours. It was also found that on the mother’s chest the baby gets gestation as well as specific breast milk containing all of the nucleotides necessary for brain growth, and mother’s colostrums carries the antibodies needed to protect the newborn with immunity. In addition, babies cry less, leading to reduced somatostatin, a stress hormone, circulation, so there is less brain bleeding and build long term emotional stability. In skin to skin care babies have less health problems as they are in a relaxed mode and hormones prepare the gut to absorb food maximally. Major benefits found was that babies on KMC grow at 30grams per day, which is three times that of an incubator baby, which means less time in hospital. Mothers are also benefited from KMC as it bonds her with the baby immediately and sooth her with the release of oxytocin making the mother calmer. In addition, “secretions of hormones during breastfeeding help to contract the uterus, resulting in less blood loss” (Bergman 2005). Bergman argues that “current paradigm of separation of infant from its mother has turned prematurity from an early habitat transition into a disease state.” Thus, essential requirement to overcome the habitat transition into a disease state is providing the optimal habitat through Kangaroo Mother Care. For full-term infant skin-to-skin support could be provided by father, healthcare workers, or other family members, without creating a separation between mother and infant so that breastfeeding is not interrupted. In the case of premature infants, along with physical support advanced healthcare interventions may also be required. Major emphasize is given on frequent breastfeeding and comfortable positioning of baby in skin-to-skin contact. On the basis of research findings Bergman suggests that around six weeks of age the baby may be ready to move beyond the neonatal habitat of mother’s chest in skin-to-skin contact. Literature reviews further suggest that “Kangaroo care facilitates bonding and enhances maternal-infant acquaintance, even in the neonatal intensive care unit environment. Mothers found that Kangaroo care calmed them and their newborns” (Gale Roller 2005). Though various literature reviews have shown only positive results of Kangaroo Mother Care, promoting research is very much needed to establish universal acceptance of this paradigm. Probable Questions and areas for research: 1. Why some hospitals allow Kangaroo care only when the baby is ‘stable’ or off all breathing machines? 2. Stress on studying nursing and healthcare factors affecting utilization of KC research results. 3. Comparative study of KC and ‘ventilated preterm’: Physiological response of preterm and maternal stress. 4. Cleaning of solid and fluid waste (Urine and feces) may expose infants to extreme temperature fluctuations and temporary detachment from skin-to-skin contact. Frequent and sudden exposure to temperature variation at the time of nappy changes may harm the preterm neonate, which is less in incubators where it is possible to maintain uniform temperature in the controlled environment during nappy changes. This has to be considered as the major hindrance in skin-to-skin contact care and require research to answer: How this could be prevented? Further Study of HR, RR, SaO2 and temperature during transfer into and out of KC, and during KC, and rest periods with ventilated preterm infants. 5. Breast milk secretion of the mother and suckling capacity of the infant, particularly in the case of premature babies, in the initial stages may be less. Then, how breast feeding, best source for nutrition, immunity, and growth, could be achieved in such situation. Research on maternal milk production, breast milk saturation, breast engorgement, and breast feeding status require further study. 6. Another question is: If cow milk or any other animal milk derivatives is unsuitable to preterm neonate, what is the substitute for human milk? Note: A detailed bibliography on KC research is available from: Bibliography Charts by Dr. Susan Ludington cited from Works Cited Albright, Lisa. Kangaroo Mother Care: Restoring the Original Paradigm for Infant Care and Breastfeeding. LEAVEN, Vol. 37; No. 5. P.106-107. Texas. 2001. 15 Dec. 2007 . Bergman, Nils. What is Kangaroo Mother Care: Understanding definition? 2005.15 Dec 2007. . Collard, Krisanne. Kangaroo Care: For Our Little Miracles. 15 Dec 2007. . Gale Roller, Cyndi. Getting to Know You: Mothers Experiences of Kangaroo Care. Journal of Obstetric, Gynecologic, & Neonatal Nursing. Volume 34 (2). Pp.210-217. 2005. 15 Dec 2007. . Read More