Kangaroo Mother Care

Shubham Adhikari
Intern
2017
CONTENTS
 Introduction

 Components of KMC

 Benefits of KMC

 Criteria for eligibility of KMC

 Initiation of KMC

 KMC Procedure
Introduction
Kangaroo mother care (KMC) is a method of care of preterm or low birth
weight (LBW) neonates by placing them in skin-to-skin contact with mother
or other caregiver in order to ensure their optimum growth and
development.

The term Kangaroo care is derived from it’s practical similarities to

marsupial caregiving, i.e. infant is kept in the maternal pouch and close to
the breasts for unlimited feeding.
In 1978, due to increasing morbidity and mortality rates in the Instituto
Materno Infantil NICU in Bogota, Colombia, Dr Edgar Rey, Professor of
neonatology at Department of Pediatry National University of Colombia,
introduced a method to alleviate the shortage of caregivers and lack of
resources with mothers to have continuous Skin-to-skin contact with
their premature or LBW babies to keep them warm and to give exclusive
breastfeeding as needed in the form of KMC.

Alternative to technology-based care, KMC is now considered as the

standard of care for LBW neonates in all settings.
 Components of KMC
1. Kangaroo position
The kangaroo position consists of skin-to-skin contact between the mother and
the neonate in vertical position, between the mother’s breasts and under her
clothes.

Provider must be in semi-reclining position to avoid the gastric reflux in the

neonates.

Kangaroo position is maintained until the neonate no longer tolerates it (at least
1-2hr/sitting) – as indicated by sweating or refusing to stay in KMC position.
2. Kangaroo nutrition
Kangaroo nutrition is the delivery of nutrition to “kangarooed” neonates as
soon as oral feeding is possible.

Goal is to provide exclusive or nearly exclusive breastfeeding.

3. Kangaroo discharge and follow up

Early home discharge in the kangaroo position from neonatal unit is one of the
key components of KMC. Mothers at home require adequate support and
follow-up program and access to emergency services must be ensured.
Benefits of KMC
 Is as good as incubator care in terms of safety and thermal protection.
 Reduction in the risk of mortality.
 Reduction in nosocomial infection/sepsis.
 Reduction in hypothermia.
 Reduction in length of hospital stay.
 Improves breast feeding rate.
 Better bonding between child and the mother.
 Can safely be considered a modern method of care in any settings, even
where expensive technology and adequate care is available.
Criteria for eligibility of KMC
• Neonates

All stable LBW neonates are eligible for KMC. However, sick and very
small neonates (<1200g) needing special care need to be cared under
radiant warmer initially and KMC should be started once the baby is
hemodynamically stable. KMC can be provided while baby is being fed
via orogastric tube or on oxygen therapy.
Timing of KMC initiation for different birth weight categories
• Mother/relatives
All mothers can provide KMC, irrespective of age, parity, education, culture
and religion.
The following points must be taken into consideration when counselling on
KMC.
1. Willingness: The mother must be willing to provide KMC. Healthcare
providers should counsel and motivate her.
2. General health and nutrition: The mother should be free from serious
illness to be able to provide KMC. She should receive adequate diet and
supplements recommended by her physician.
3. Hygiene: The mother should maintain good hygiene; daily bath/sponge,
change of clothes, hand washing, short and clean finger nails.
Initiation of KMC
1) Counseling

When baby is ready for KMC, arrange a time that is convenient to the
mother and her baby. Demonstrate her the KMC procedure in a caring,
gentle manner and with patience. Encourage her to bring her mother/
mother-in-law, husband or any other member of the family. This helps in
building positive attitude of family and ensuring family support to the
mother.
2) Mother’s clothing

Mother can wear any front-open dresses as per local culture. This may
include sari, a blouse, front open gown, a suit, or a simple shirt.

KMC can be done with special apparel (such as AIIMS KMC jacket) design to
suit the needs of mothers.

3) Baby’s clothing

Baby is dressed with cap, socks, nappy, and a front-open sleeveless shirt.
 KMC procedure
1. Kangaroo positioning
- The neonate should be placed between the mother’s breasts in an upright position.

- The head should be turned to one side and kept in a slightly extended position.

- The hips should be flexed and abducted in a frog position. The arms should also be

flexed. Baby’s abdomen should be at the level of the mother’s epigastrium.

- Mother’s breathing stimulates the baby, thus reducing the occurrence of apnea.

- Support the baby’s bottom with a sling or binder.

2. Monitoring
- Neonate receiving KMC should be monitored carefully.

- Nursing staff should make sure that neonate’s neck position is neither too
flexed nor too extended, airway is clear, breathing is regular, colour is pink
and neonate is maintaining temperature.

- Mother should be involved in observing neonate during KMC so that she

herself can continue monitoring at home.
3. Feeding
- The mother should be explained how to breastfeed while the baby is in
KMC position.

- Holding the baby near the breast stimulates milk production and may
express milk while the baby is still in KMC position.

- Baby could be fed with paladai, spoon or tube depending on condition of

the baby.
4. Duration
- Skin-to-skin contact should start gradually in the nursery, with a
smooth transition from conventional care to continuous KMC.
- Sessions that last less than one hour should be avoided because
frequent handling may be stressful for the baby.
- Length of skin-to-skin contacts should be gradually increased up to 24
hours a day, interrupted only for changing diapers.
- When neonate doesn't require intensive care, baby can be transferred
to postnatal ward where KMC should be continued.
Can the mother continue KMC during sleep and resting?

The mother can sleep with her baby in kangaroo position in reclined or
semi recumbent position about 30 degrees from horizontal. This can be
done with a adjustable bed or with pillows on an ordinary bed or on
KMC chair.
Discharge criteria
• Baby’s general health is good.

• Gaining weight (at least 15-20g/kg/day for three consecutive days)

• Maintaining body temperature satisfactorily for at least three consecutive

days in room temperature.

• Feeding well and receiving exclusively or predominantly breast milk.

• The mother and family members are confident to take care of the baby.
When to discontinue KMC?
KMC is continued for as long as possible at the health facility and then
at home. Often this is desirable until the gestation reaches term or the
weight is around 2500gm. The time when the infant starts wriggling to
show that she is uncomfortable, pulls her limbs out, cries and fusses
every time the mother tries to put her back skin-to-skin is the time to
wean her from KMC.
Post-discharge follow-up
Close follow up is a fundamental pre-requisite of KMC. The infant is
followed once or twice a week till 37-40 weeks of gestation or till
he/she reaches 2.5 to 3kg of weight. Thereafter, a follow up once in 2-4
weeks may be enough till 3 months of post-conception age. The baby
should gain adequate weight (15-20 gm/kg/day up to 40 weeks of post-
conception age and 10gm/kg/day subsequently).
Barriers and enablers of KMC
Stress associated with birth of a preterm neonate along with
lack of knowledge about KMC among parents, families and
health-care workers. Barriers??
These barriers can be overcome by clear articulation of benefits of

Enablers??
KMC for mothers, newborns, caregivers and health-care workers.
Engagement of fathers in childcare can help overcome these
barriers.
Reference
• GHAI ESSENTIAL PEDIATRICS – NINTH EDITION
• AIIMS Protocols in Neonatology – Volume II
THANK YOU