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Bergman NJ. New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care. Front Psychol 2024; 15:1385320. [PMID: 39049943 PMCID: PMC11267429 DOI: 10.3389/fpsyg.2024.1385320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Background In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days. New perspectives The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC. Actionable recommendations This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units. Discussion The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.
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Affiliation(s)
- Nils J. Bergman
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Klemming S, Lilliesköld S, Arwehed S, Jonas W, Lehtonen L, Westrup B. Mother-newborn couplet care: Nordic country experiences of organization, models and practice. J Perinatol 2023; 43:17-25. [PMID: 38086962 PMCID: PMC10716037 DOI: 10.1038/s41372-023-01812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023]
Abstract
Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.
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Affiliation(s)
- Stina Klemming
- Lund-Malmö NIDCAP Training and Research Center, Department of Neonatology, Skåne University Hospital, Lund, Sweden.
| | - Siri Lilliesköld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Uppsala University Hospital, Uppsala, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescence Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Björn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Shuman CJ, Morgan M, Vance A. Integrating Neonatal Intensive Care Into a Family Birth Center: Describing the Integrated NICU (I-NIC). J Perinat Neonatal Nurs 2023:00005237-990000000-00019. [PMID: 37773333 DOI: 10.1097/jpn.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Parent-infant separation resulting from admission to a neonatal intensive care unit (NICU) is often reported as the most challenging and distressing experience for parents. Aiming to mitigate the stress of parent-infant separation, a new neonatal care model was designed to integrate NIC with delivery and postpartum care. Yet, little is known about the model and its implementation. METHODS Using a qualitative descriptive design with field observations, we describe the characteristics of an integrated-neonatal intensive care (I-NIC) model and examined perceptions of clinical staff (n = 8) and parents (n = 3). RESULTS The physical layout of the I-NIC rooms required additional oxygen and suction columns and new signage to specify them as NICU-equipped. Other NICU-related equipment was mobile, thus moved into rooms when necessary. Nurses were cross-trained in labor/delivery, postpartum, neonatal care; however, nurses primarily worked within their specific area of expertise. Clinician and parent perceptions of the model were notably positive, reporting decreased anxiety related to separation, increased ability for chest feeding and skin-to-skin care, and improved interdisciplinary care. CONCLUSION Future work is needed to understand implementation of the model in other settings, with specific attention to unit architecture, level of NICU care services, patient census, and staff and patient outcomes.
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Affiliation(s)
- Clayton J Shuman
- Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor (Dr Shuman and Ms Morgan); and Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
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Arya S, Chhabra S, Singhal R, Kumari A, Wadhwa N, Anand P, Naburi H, Kawaza K, Newton S, Adejuyigbe E, Westrup B, Bergman N, Rettedal S, Linner A, Chauhan R, Rani N, Minckas N, Yoshida S, Rao S, Chellani H. Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial. EClinicalMedicine 2023; 60:102006. [PMID: 37251633 PMCID: PMC10209186 DOI: 10.1016/j.eclinm.2023.102006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate caregiver and neonate needed to be together continuously, which led to the concept of the Mother-Newborn Care Unit (MNCU). Health-care providers and administrators were concerned of the potential increase in infections caused by the continuous presence of mothers or surrogates in the MNCU. We aimed to assess the incidence of neonatal sepsis in sub-groups and the bacterial profile among intervention and control neonates in the study population. Methods This is a post-hoc analysis of the previous iKMC trial, which was conducted in five level 2 Newborn Intensive Care Units (NICUs) one each in Ghana, India, Malawi, Nigeria, and Tanzania, in neonates with birth weight 1 to <1.8 kg. The intervention was KMC initiated immediately after birth and continued until discharge and compared to conventional care with KMC initiated after meeting stability criteria. The primary outcomes of this report were the incidence of neonatal sepsis in sub-groups, sepsis-related mortality and bacterial profile of isolates during hospital stay. The original trial is registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12618001880235) and the Clinical Trials Registry-India (CTRI/2018/08/01536). Findings Between November 30, 2017, and January 20, 2020, 1609 newborns in the intervention group and in the control group 1602 newborns were enrolled in iKMC study. 1575 newborns in the intervention group and 1561 in the control group were clinically evaluated for sepsis. Suspected sepsis was 14% lower in intervention group in sub-group of neonates with birth weight 1.0-<1.5 kg; RR 0.86 (CI 0.75, 0.99). Among neonates with birth weight 1.5-<1.8 kg, suspected sepsis was reduced by 24%; RR 0.76 (CI 0.62, 0.93). Suspected sepsis rates were lower in intervention group than in the control group across all sites. Sepsis related mortality was 37% less in intervention group than the control group; RR 0.63 (CI 0.47-0.85) which was statistically significant. The intervention group had fewer cases of Gram-negative isolates (n = 9) than Gram positive isolates (n = 16). The control group had more cases of Gram-negative isolates (n = 18) than Gram positive (n = 12). Interpretation Immediate Kangaroo Mother care is an effective intervention to prevent neonatal sepsis and sepsis related mortality. Funding The original trial was funded by the Bill and Melinda Gates Foundation through a grant to the World Health Organization (grant No. OPP1151718).
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Affiliation(s)
- Sugandha Arya
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Suhail Chhabra
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Richa Singhal
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Archana Kumari
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Nitya Wadhwa
- Translational Health Science and Technology Institute, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Post Box #04, Faridabad, Haryana, 121001, India
| | - Pratima Anand
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Helga Naburi
- Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 255, Tanzania
| | - Kondwani Kawaza
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana
| | - Ebunoluwa Adejuyigbe
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Bjorn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Nils Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Siren Rettedal
- Department of Paediatrics, Stavanger University Hospital, Norway
| | - Agnes Linner
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Rahul Chauhan
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Nisha Rani
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
| | - Nicole Minckas
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Switzerland
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Switzerland
| | - Suman Rao
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Switzerland
- Department of Neonatology, St John's Medical College Hospital, Bengaluru, India
| | - Harish Chellani
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi, 110029, India
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Dargahiyan Z, Ghasemi F, Karami K, Valizadeh F, Mohammadi R. A comparative study of the effects of Kangaroo care by mothers and maternal grandmothers on the vital signs of hospitalized preterm newborns: a randomized controlled clinical trial study. Trials 2023; 24:275. [PMID: 37059994 PMCID: PMC10104429 DOI: 10.1186/s13063-023-07288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Kangaroo care (KC) is an effective technique to prevent injury in newborns due to prematurity and hospitalization. Mothers of preterm newborns experience their own set of physical and mental problems. Such circumstances call for another family member to take care of the newborn. This study compared the effect of KC by mothers and maternal grandmothers on the vital signs of preterm newborns. METHODS This parallel randomized controlled trial was done at the neonatal and NICU departments of the hospital in Kuhdasht in Iran. Eighty preterm neonates were selected through convenience sampling according to the eligibility criteria, then by stratified block randomization allocated to two groups. The control group received KC from the mother, and the intervention group received KC from the maternal grandmothers on the vital signs of preterm newborns. Vital signs were assessed 15 min before, during, and after the KC as the primary outcome. The data collection tools included a demographic questionnaire and a form to record the vital signs. Vital signs were measured by a pulse oximeter, an electronic thermometer, and observation. Data were analyzed by the chi-square test, the independent t-test, and the repeated measures ANOVA. RESULTS The vital signs of newborns in each group showed a significant difference before, during, and after receiving KC (P < 0.05). Nevertheless, the vital signs of the newborns did not differ significantly between the mother and the maternal grandmother KC groups (P > 0.05). CONCLUSION KC by maternal grandmother may stabilize the vital signs of preterm newborns as much as when this type of care is provided by the mother. We, therefore, recommend the provision of KC by the maternal grandmother, as a support and substitute for the mother whenever she is incapable of being at the hospital and to enable the mother to rest. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20211225053516N1, March 31, 2022.
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Affiliation(s)
- Zahra Dargahiyan
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Ghasemi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Kimia Karami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Valizadeh
- Department of Pediatrics Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramad, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Muacevic A, Adler JR. A Narrative Review of Kangaroo Mother Care (KMC) and Its Effects on and Benefits for Low Birth Weight (LBW) Babies. Cureus 2022; 14:e31948. [PMID: 36582577 PMCID: PMC9794926 DOI: 10.7759/cureus.31948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Kangaroo mother care (KMC) is a preventative, economical method for infants with low birth weight (LBW). KMC benefits LBW infants in a number of ways. This review standpoints the effect of KMC on the weight gain of LBW neonates. KMC also improves breastfeeding rates during the hospital stay as well as at home. KMC can be provided not only by mothers but also by fathers and other adults in the family. However, it is not routinely practiced in hospitals. Short-term and long-term KMC is beneficial for survival, neurodevelopment, breastfeeding, and mother-infant bonding. Preterm infants are more likely to experience neonatal mortality and morbidity due to acute breathing problems, gastrointestinal problems, autoimmune disorders, and neurological defects as compared to full-term and normal-weight infants. A thorough literature search was conducted using key databases like PubMed and Google Scholar, as well as Medical Subject Heading (MeSH) terms and related keywords. Clinical health experts also believed that implementing KMC would assist mothers in developing more solid emotional bonds with their newborns. As a result, both mothers and their newborns felt more secure, and the babies were more relaxed. KMC was also seen to support the infants' growth and development, which improved the mothers' sense of connection. It is crucial to remember that KMC works better for babies with very low birth weight (VLBW). The mother-child relationship enhances sucking-feeding, and KMC infants have higher means of growth parameters.
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