KANGAROO MOTHER CARE IN THE NURSERY

44-14 WHICH INFANTS CAN BE GIVEN KANGAROO CARE IN THE NURSERY?

Most infants can be given KMC as long as they are stable with a normal skin temperature, heart rate and breathing rate. Even infants on ventilators can sometimes be given KMC provided that their condition allows this. Both infants in cots and incubators can be given KMC. KMC has the most benefit in low birth weight infants. All low birth weight infants should routinely be offered KMC once they are stable.

Where there are no incubators, every very small infant can be given KMC. In these circumstances, KMC can dramatically reduce the mortality of low birth weight infants.

Severely ill infants who are going to die can also be given KMC (compassionate KMC). Many parents want to hug or hold their dying infant.

44-15 WHEN SHOULD KANGAROO CARE BE GIVEN IN THE NURSERY?

KMC should be given every time the parents visit (intermittent KMC). The mother should be encouraged to give KMC throughout the visit. Even if the visit is short, the infant will benefit from KMC. Some mothers spend most of the day in the nursery and can give KMC for hours at a time. Usually KMC is given for a short period to start with and then the time of the KMC becomes longer as the mother becomes more confident.

44-16 WHO SHOULD TAKE THE INFANT OUT OF THE INCUBATOR FOR KANGAROO MOTHER CARE?

The mother needs to be shown how to remove the infant and how to put the infant back into the incubator safely. Once the mother is able to do this correctly, she can take the infant out and put it back by herself. It is important that the mother informs the nursing staff when she wants to give KMC. She must always wash her hands well before touching her infant.

44-17 HOW SHOULD THE INFANT BE TAKEN OUT OF THE INCUBATOR FOR KANGAROO MOTHER CARE?

It is important that the infant does not get cold. Before removing the infant, make sure that it is wearing a woollen cap and clean nappy. If the infant is receiving an intravenous infusion or has skin probes, be careful that they are not pulled loose.

44-18 SHOULD THE INFANT BE MONITORED DURING KANGAROO MOTHER CARE?

1. Infants that are not being monitored in the cot or incubator do not need to be monitored during KMC.
2. Infants who are not having apnoeic attacks, but are being routinely monitored with an apnoea monitor, can be disconnected from the monitor during KMC. Switch off the apnoea alarm when the infant is taken out of the incubator and placed in the KMC position. Do not forget to switch the apnoea monitor back on again when the infant is placed back in the incubator.
3. However, if the infant is being monitored for heart and respiratory rate or oxygen saturation, this should be continued while the infant is receiving KMC.
4. If the infant is having apnoea attacks, the infant is unstable and should either not receive KMC or be monitored during KMC.

*** If the infant is receiving positive airway pressure, be very careful that the tubing is not disconnected. With care the infant can be moved from the incubator into the KMC position without disturbing the ventilatory support. Switch the incubator to non-servocontrol mode when the infant is taken out for KMC or the incubator may overheat. Switch back to servocontrol mode when the infant is replaced into the incubator.

44-19 WHERE SHOULD THE MOTHER SIT TO GIVE KANGAROO MOTHER CARE?

It is best if the mother sits next to the cot or incubator in a comfortable chair. Once the infant is well and no longer needs ventilatory support, intravenous infusions (drips) and skin probes or electrodes, the mother may give KMC while walking about with the infant in the nursery.

44-20 WHAT SPECIAL FACILITIES ARE NEEDED IN THE NURSERY FOR KANGAROO MOTHER CARE?

No special facilities are needed. Comfortable chairs for the mother and partner are required. Simple plastic chairs are adequate. A refrigerator is helpful to store expressed breast milk. In a very crowded nursery, space must be created for parents to visit and give KMC.

44-21 SHOULD THE INFANT’S SKIN TEMPERATURE BE MONITORED DURING KANGAROO MOTHER CARE?

This is usually not necessary if the infant’s temperature has been stable in the incubator.

44-22 WHAT FEEDS SHOULD BE GIVEN IN THE NURSERY DURING KANGAROO MOTHER CARE?

As far as possible, give the infant its mother’s own milk. Exclusive breast feeding is by far the best for low birth weight infants. Some small infants will breastfeed while others will have to be fed expressed breast milk by nasogastric tube until they are mature enough to suck and swallow.

EXCLUSIVE BREAST FEEDING IS BY FAR THE BEST FOR LOW BIRTH WEIGHT INFANTS

44-23 HOW CAN A MOTHER ENCOURAGE A SMALL INFANT TO BREAST FEED DURING KANGAROO MOTHER CARE?

1. Hold the infant correctly to place the infant’s mouth over her areola (latch properly). Often the “foot ball” position is easiest. Infants can breastfeed while receiving KMC.
2. Express a little milk onto the nipple before latching the infant.
3. Place the nipple into the infant’s mouth even if the infant does not suckle well.
4. Put the infant to the nipple every time she gives KMC. It does not matter if the infant only suckles for a few minutes.

With encouragement, many small infants will take part or all of their feed from the breast. The mother should start to express her breasts from the day the infant is born. Until breastfeeding is established, the infant should be fed expressed breast milk by cup or nasogastric tube.

44-24 WHAT IS A LODGING WARD?

Often mothers have difficulty visiting their infants every day as they live far away and transport is expensive and infrequent. It is very helpful if these mothers can stay in or near the hospital on a 24 hour basis so that they can give intermittent KMC to their infants in the nursery.

This facility is often called a lodging ward. However, it is not a typical hospital ward as these mothers are well. It is one or more rooms where mothers can be given accommodation. Often the lodging ward is next to the nursery and KMC ward so that they can share facilities. The lodging ward needs to be supervised to ensure cleanliness and security but nursing is not required. Mothers in a lodging ward need a bed, somewhere to sit and relax, and a place to keep their clothes and belongings safely.

A LODGING WARD PROVIDES A MOTHER WITH A PLACE TO STAY SO THAT SHE CAN BE NEAR HER INFANT IN THE NURSERY AT ALL TIMES

It is not expensive to accommodate mothers in a lodging ward. By providing breast milk and giving KMC, they reduce the hospital cost of caring for small infants. Without a lodger ward, many mothers would be discharged home and would not be able to afford the transport to visit their infants regularly.