The Impact of Kangaroo Care on Premature Infant Weight Gain

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022

Background

Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia.

Methods

A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation.

Results

The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits.

Conclusion

Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.

Kangaroo Mother Care in Term and Late Preterm Neonates: A Systematic Review

This systematic review aims to investigate the efficacy of kangaroo mother care (KMC) in term and late-preterm babies. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, seven studies were analyzed, which covered a wide range of outcomes, from the post-vaccination serum bilirubin level and pain during the vaccination to the prevention of hypothermia and long-term neurodevelopmental outcomes. Results point out that KMC might come with some advantages such as the reduction of neonatal bilirubin levels, a painless and quicker vaccination process, and better prevention of hypothermia. Moreover, initial and lengthy KMC also plays a possible role in the better long-term brain development of low-birth-weight neonates. Furthermore, the limitation of smaller numbers of studies and variability in results remains to be solved. The next step is working to build stronger evidence and creating proper conditions for the implementation of KMC in future healthcare.

Randomized Controlled Trial Protocol on the Effects of a Sensory Motor Intervention Associated with Kangaroo Skin-to-Skin Contact in Preterm Newborns

There is still very limited evidence on the effects of neonatal interventions on infant neurodevelopmental outcomes, including general movements (GMs). This research will primarily assess the effects of a sensory motor physical therapy intervention combined with kangaroo skin-to-skin contact on the GMs of hospitalized preterm newborns. Secondary outcomes include body weight, posture and muscle tone, behavioral state, length of hospital stay, and breastfeeding. This study protocol details a two-arm parallel clinical trial methodology, involving participants with a postmenstrual age of 34-35 weeks admitted to a Neonatal Intermediate Care Unit (NInCU) with poor repertoire GMs. Thirty-four participants will be randomly assigned to either the experimental group, receiving a 10-day sensory motor physical therapy associated with kangaroo skin-to-skin contact, or the control group, which will only receive kangaroo skin-to-skin contact. The study will measure GMs (primary outcome), and body weight, posture and muscle tone, behavioral state, length of hospital stay, and breastfeeding (secondary outcomes). Data collection occurs in the NInCU before and after the intervention, with follow-up measurements post discharge at 2-4 weeks and 12-15 weeks post-term. SPSS will be used for data analyses. The results will provide novel information on how sensory motor experiences may affect early neurodevelopment and clinical variables in preterm newborns.

Effects of human milk odor stimulation on feeding in premature infants: a systematic review and meta-analysis

Previous studies suggested odor stimulation may influence feeding of premature neonates. Therefore, this systematic review and meta-analysis of randomized controlled trials was conducted to assess the effect of human milk odor stimulation on feeding of premature infants. All randomized controlled trials related to human milk odor stimulation on feeding in premature infants published in PubMed, Cochrane, Library, Medline, Embase, Web of science databases and Chinese biomedical literature databases, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP) and Wanfang Chinese databases were searched, and The Cochrane Handbook 5.1.0 was used to evaluate the quality and authenticity of the literature. Relevant information of the included studies was extracted and summarized, and the evaluation indexes were analyzed using ReviewManager5.3. The retrieval time was from the establishment of the database to July 28, 2022.12 articles were assessed for eligibility, and six randomized controlled studies were eventually included in the meta-analysis (PRISMA). A total of 6 randomized controlled studies with 763 patients were finally included in the study, and the quality evaluation of literatures were all grade B. Human milk odor stimulation reduced the transition time to oral feeding in premature infants [SMD = - 0.48, 95% CI (- 0.69, - 0.27), Z = 4.54, P < 0.00001] and shortened the duration of parenteral nutrition [MD = - 1.01, 95% CI (- 1.70, - 0.32), Z = 2.88, P = 0.004]. However, it did not change the length of hospitalization for premature infants [MD = - 0.03, 95% CI (- 0.41, 0.35), Z = 0.17, P = 0.86]. The implementation of human milk odor stimulation can reduce the transition time to oral feeding and the duration of parenteral nutrition in premature infants, but further studies are needed to determine whether it can reduce the length of hospital stay in premature infants. More high-quality, large-sample studies are needed to investigate the effect of human milk odor stimulation on the feeding process and other outcomes in premature infants.

Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study

Introduction Kangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methods  We conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant.  Results  One hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. Conclusion Sets of intervention packages based on needs analysis using the PDSA cycle were able to improve the rate and duration of KMC in the hospital and at home.

Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience

Background: Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals. Aims: To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals. Design: Prospective observational monocentric study. Methods: Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis. Results: In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23–33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25–34 weeks), 10 days (range 1–20 days), and 1131 g (range 631–2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported. Conclusions: These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.

Family care reduces the incidence of neonatal sepsis: A systematic review and meta-analysis

Purpose

Family-involved care in the neonatal intensive care unit (NICU) helps to alleviate neonatal anxiety and promotes breastmilk intake, body growth and neurological development, but its effect on reducing the incidence of neonatal sepsis is not known. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate whether neonates receiving family care have a lower incidence of neonatal sepsis compared to neonates receiving standard NICU care.

Methods

MEDLINE, Embase, Web of Science, and CENTRAL were searched for RCTs that compared preterm neonates receiving family care vs. standard NICU care. From 126 articles that were identified and screened, 34 full-text articles were assessed for eligibility, and 5 RCTs were included. The primary outcome was the development of sepsis. The RevMan 5.4 software was used to conduct the Meta-analysis.

Results

The metanalysis, based on 5 RCTs demonstrated that neonates receiving family-involved care had significantly lower incidence of sepsis (12.0% vs. 16.3%), increased body weight, and reduced length of hospital stay compared to those receiving standard NICU care.

Conclusion

This study suggests that family-involved care in NICU can (i) reduce the incidence of neonatal sepsis, (ii) improve growth, and (iii) reduce the length of hospital stay. This study highlights the need for evaluating whether family-involved care improves other neonatal outcomes.

The effects of multisensory stimulation on the length of hospital stay and weight gain in hospitalized preterm infants: A systematic review with meta-analysis

BACKGROUND

Multisensory interventions, such as auditory-tactile-visual-vestibular intervention (ATVV), tactile-kinesthesic stimulation (TKS), and the kangaroo mother care (KMC), have been commonly applied in hospitalized preterm infants.

OBJECTIVE

To investigate the effectiveness of the ATVV, the TKS, and the KMC combined to standard care compared to standard care in the length of hospital stay and weight gain of hospitalized preterm infants.

METHODS

PubMed, Scopus, Web of Science, Embase, SciELO Citation Index, CINAHL, Cochrane, and LILACS databases were searched from the inception to May 06, 2022 without language restrictions. We included randomized controlled trials. Two independent reviewers selected studies and extracted information about participants, interventions, outcomes, and the risk of bias. The body of evidence was synthesized through GRADE. Data were pooled using a random-effects model.

RESULTS

Sixty-three randomized clinical trials included a range of 20-488 preterm infants (gestational age=25 to <37 weeks). Evidence was low to very low due to risk of bias, inconsistency, and imprecision. Most studies presented some concerns about methodological quality. The ATVV and the KMC increased weight gain. The TKS reduced the number of days at the hospital and increased the daily weight gain and the total weight gain.

CONCLUSIONS

Adding ATVV, TKS, or KMC to standard care was more effective than standard care alone to improve weight gain. Only the TKS combined with standard care was more effective than standard care alone to reduce the length of hospital stay.

The efficacy of Kangaroo-Mother care to the clinical outcomes of LBW and premature infants in the first 28 days: A meta-analysis of randomized clinical trials

Objective

The objective of this study was to systematically determine the benefits of Kangaroo-Mother Care (KMC) on the clinical outcomes of low birthweight (LBW) and preterm infants.

Methods

For this study, the following databases were retrieved for articles published until November 2021: PubMed, Web of Science, EBSCO, and the Cochrane library. The primary clinical outcome was mortality between enrollment and 28 days. The secondary clinical outcomes were the mean duration of hospital stay, hypothermia, sepsis, exclusive breastfeeding at the end of the neonatal period, and exclusive breastfeeding at discharge.

Results

We conducted a meta-analysis, which included 17 RCTs, involving overall 17,668 participants. The results of this meta-analysis showed that KMC could reduce the primary clinical outcome of mortality between enrollment and 28 days (RR: 0.80, 95% Cl: 0.71-0.91, p < 0.01). For the secondary clinical outcomes, KMC had a varying degree of benefits on the mean duration of hospital stay (SMD: -0.96, 95% Cl: -1.02-0.90, p < 0.001), hypothermia (RR: 0.45, 95% Cl: 0.27-0.75, p < 0.01), and sepsis (RR: 0.79, 95% Cl: 0.70-0.89, p < 0.001). The exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge of KMC had benefits, which was not statistically different though (OR: 2.16, 95% Cl: 0.55-8.41, p = 0.27; OR: 1.16, 95% Cl: 0.82-1.64, p = 0.39, respectively).

Conclusions

KMC was decreased mortality in LBW and premature infants between enrollment and 28 days. In addition, KMC also had a favorable effectiveness on the secondary clinical outcomes, such as mean duration of hospital stay, hypothermia, sepsis. Moreover, KMC also had a slight effectiveness on exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge.

Effect of the Kangaroo Mother Method after Preterm Delivery on Maternal Stress and Anxiety in the Context of the COVID-19 Pandemic-A Cohort Study

BACKGROUND

The kangaroo mother method (KMM) may benefit infants and mothers in many ways. However, few studies focused on its efficacy on maternal anxiety and stress, especially in the context of the COVID-19 pandemic.

OBJECTIVE

To examine the effect of the kangaroo mother method (KMM) on postnatal stress and anxiety in mothers of preterm infants in neonatal intensive care, in the context of the COVID-19 pandemic.

METHODS

A cohort study of two groups of 56 mother-infant dyads recruited from a neonatal intensive care unit was conducted. Two groups were compared in terms of the mean duration of KMM during the twelve days of the study: the intervention group (mean duration of more than ninety minutes per day) and the control group (less than ninety minutes). Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale and STAI E/R questionnaire before and after intervention (KMM). Demographic and other maternal covariates were extracted from medical records. Daily NICU records were used to track the frequency and duration of KMM sessions.

RESULTS

Mothers of the intervention group scored lower on the PSS: NICU and STAI E/R, although no statistically significant differences were found (p > 0.05).

CONCLUSIONS

Contrary to research based on biological and physiological parameters in newborns or performed before the COVID-19 pandemic, the differences found in applying subjective scales in mothers in the context of the COVID-19 pandemic were not significant. Therefore, mothers' perception of physical contact with their preterm infants may not have been as positive due to their fear of transmitting COVID.

Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care

It is well documented that the stress of separation of mother and baby can lead to short-term physiological instability as well as neurological, sociological or psychological consequences that may last a lifetime. Objective: The goal was to estimate the effect of kangaroo mother care (KMC) on physiological and biochemical parameters of preterm infant stress and maternal stress in neonatal intensive care. Methods: The investigation involved 112 preterm infants. Two groups were compared according to the mean duration of KMC during 12 days of study: the KMC group (mean duration more than 90 min daily) and the control group (less than 90 min). Results: Kangaroo mother care for more than 90 min on average per day in preterm infants is associated 12 days after the intervention with lower mean cortisol levels (p = 0.02), greater weight gain and less need for parenteral nutrition in preterm infants, as well as less postpartum depression (p = 0.02) and lower cortisol levels (p = 0.002) in the mothers of preterm infants. Conclusions: This study suggests that KMC can be used to improve the stress of preterm infants and their mothers, and that the greater weight gain observed in these preterm infants could contribute to a shorter average hospital stay and lower healthcare expenditure.

Association between early onset of skin-to-skin contact and mother-infant interaction at hospital discharge and six months of corrected age among preterm infants

OBJECTIVE

To compare mother-infant interaction between hospital discharge and at six months of corrected age of infants born ≤32 weeks and investigate the association between the onset of skin-to-skin contact and the difference in mother-infant interaction between discharge and six months of corrected age (CA) among preterm infants.

MATERIAL AND METHODS

Prospective observational study, in which 72 mother-infant dyads were evaluated. Preterm newborns (born with gestational age ≤ 32 weeks of gestational age) from two public maternity hospitals were assessed by means of video macro analysis of the mother-infant interaction according to the parameters adopted by the Mother-Baby Observation Protocol 0-6 (POIMB), at hospital discharge and at six months of corrected gestational age. Such variables as socioeconomic conditions, depression and maternal anxiety were controlled. Multivariate model was built.

RESULTS

Onset skin-to-skin contact within three days of life increased by 1.30 points for the best interactive infant behavior at discharge for the six months of CA. In addition, in relation to the tuning of the mother-infant dyad, the initiation of skin-to-skin contact at 20 days of life reduced 1.0 point significantly. Multiparous mothers or those exposed to cigarette smoke performed worse in the development of the dyad.

CONCLUSION

The preterm newborn should initiate skin-to-skin contact early and, whenever possible, by the third day of life to favor mother-infant interaction.

Treating Apnea of Prematurity

Premature babies often suffer apnea of prematurity as a physiological consequence of an immature respiratory system. Hypercapnia may develop, and neonates with apnea of prematurity are at an increased risk of morbidity and mortality. The long-term effects of apnea of prematurity or their treatments are less clear. While a number of treatment options exist for apnea of prematurity, there is no clear-cut "first-line" approach or gold standard of care. Effective treatments, such as caffeine citrate, carbon dioxide inhalation, nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and others, may be associated with safety concerns. More conservative treatments are available, such as kangaroo care, postural changes, and sensory stimulation, but they may not be effective. While apnea of prematurity resolves spontaneously as the respiratory system matures, it can complicate neonatal care and may have both short-term and long-term consequences. The role, if any, that apnea of prematurity may play in mortality of preterm neonates is not clear.

Kangaroo mother care and skin-to-skin care in preterm infants in the neonatal intensive care unit: A bibliometric analysis

BACKGROUND

The desire to understand and the growing interest in research on the effects of kangaroo mother care in preterm infants in the neonatal intensive care unit have led to a significant increase in the number of manuscripts published in this field over the past decade. It is therefore necessary to regularly review the state of knowledge on this phenomenon in order to identify progress and constraints, to stimulate reflection, and to encourage progress in future research.

PURPOSE

The aim of this study was to determine the current state of scientific production in relation to kangaroo mother care in preterm infants in the neonatal intensive care unit through bibliometric analysis.

DATA SOURCES

This study presents a review of 212 published papers from the Scopus database (1990-2019).

DATA EXTRACTION

Two processing software applications were used: VOSviewer and SciMAT. In addition, through a keyword analysis, this study established the hot spot research trends to be developed in future work. The study adhered to the PRISMA-ScR guidelines for quality improvement studies as part of the EQUATOR network.

RESULTS

Our results show that research in this field is going through a time of high productivity and we could sort this growing body of work into different periods, highlighting the most important topics.The analysis shows that most research in this field is focused on five motor topics. These are: prematurity, male, psychology, intensive care neonatal, and major clinical study. The analysis also allowed us to identify four basic and cross-disciplinary topics that need to be developed and that emerge as future research directions: preterm infants, child-parent relations, child development, and skin-to-skin contact.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The main contribution of this work is the creation of a knowledge map on the research in this field. This article provides information on how we can shape the future to provide optimal care for these infants and their parents.

GROWTH ANALYSIS OF PRETERM NEWBORNS WITH GASTROSCHISIS DURING HOSPITALIZATION IN A NEONATAL INTENSIVE CARE UNIT

BACKGROUND

Gastroschisis, especially complex type, prematurity and low birth weight are associated with a worse clinical outcome with higher mortality, higher incidence of sepsis and catheter-related infection, cholestasis, short bowel syndrome, greater number of days to achieve full diet, longer time of parenteral nutrition and longer hospitalization time.

OBJECTIVE

To evaluate the growth of preterm newborns with gastroschisis during their hospitalization in the neonatal intensive care unit.

METHODS

Descriptive study, based on a retrospective cohort (January 2012 to December 2018), including preterm newborns (gestational age less than 37 weeks) with simple and complex gastroschisis admitted in a tertiary neonatal intensive care unit. The following parameters were analyzed: maternal age, parity, type of delivery, birth weight, gender, gestational age, nutritional adequacy, type of gastroschisis, fasting time, parenteral nutrition time, time until achieving full enteral nutrition, hospitalization time, weight gain and outcome. The results were expressed in percentage, average, and median.

RESULTS

A total of 101 newborns with gastroschisis were admitted, of which 59.4% were premature (80.7% of late preterm infants). From the maternal data, the mean age was 21.2 years and 68.3% were primiparous. Regarding childbirth: 80% were cesarean sections. From newborns: the average birth weight was 2137 g, 56.6% were female, the average gestational age was 34.8 weeks, the average weight gain was 20.8 g/day during hospitalization and 83.3% were discharged from the hospital.

CONCLUSION

The growth analysis by weight gain (grams/day) during hospitalization in the intensive care unit showed that more than 90% of the sample presented acceptable or adequate weight gain.

Kangaroo Mother Care Reduces Noninvasive Ventilation and Total Oxygen Support Duration in Extremely Low Birth Weight Infants

OBJECTIVE

Evidence on the safety and influence of kangaroo mother care (KMC) in extremely low birth weight infants (ELBWIs) on ventilation is lacking.

STUDY DESIGN

This is a retrospective cohort study performed in 145 ELBWIs on noninvasive mechanical ventilation from a tertiary center.

RESULTS

The duration of nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (CPAP) ventilation was significantly shorter in infants with KMC compared with infants without (21 vs. 13.5 days, p = 0.001 and 29.5 days vs. 20.5 days, p = 0.001, respectively). The frequency of apnea during hospital stay was fewer in KMC infants, compared with no KMC (23 vs. 20 times, p = 0.002). Multiple linear regression analysis showed that KMC was an independent protective factor for shortening nIPPV/CPAP duration (β = -9.90, 95% confidence interval [CI] [-13.20, -6.60], p < 0.001), total supplemental oxygen support (β = -10.52, 95% CI [-16.73, -4.30], p = 0.001), and reducing times of apneas (β = -5.88, 95% CI [-8.56, -3.21], p < 0.001).

CONCLUSION

KMC benefits ELBWIs by shortening nIPPV/CPAP ventilation duration and total supplemental oxygen support, and reducing the frequency of apneas.

Effect of SOCS3 on apoptosis of human trophoblasts via adjustment of the JAK2/STAT3 signaling pathway in preterm birth

BACKGROUND

The expression of suppressor of cytokine signaling 3 (SOCS3) was induced by interleukin-6 (IL-6) in preterm placental tissues. However, its role in IL-6 induced apoptosis of trophoblast cells derived from preterm placental tissues remains to be elucidated.

METHODS

Primary cytotrophoblasts from human preterm placental tissues were used to stably knock down and overexpress the level of SOCS3 by corresponding lentiviral vectors and the expression of SOCS3 was validated by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blot. The effect of SOCS3 overexpression or knockdown on the proliferation and apoptosis of IL-6 treated human cytotrophoblasts were determined by Cell Counting Kit-8 (CCK8) assay and Annexin-V/Propidium Iodide (PI) double-staining assay, respectively. Based on it, we detected the proteins associated with the Janus Tyrosine Kinase (JAK)/Signal Transducer and Activator of Transcription (STAT) pathway and apoptosis, such as JAK2, p-JAK2, STAT3, p-STAT3, B-cell lymphoma-2 (Bcl-2) and BCL2-associated X (Bax) by Western blot.

RESULTS

IL-6-treatment resulted in significant apoptosis of human cytotrophoblasts. Overexpressing SOCS3 in the cytotrophoblasts reduced cell apoptosis, while the knockdown of SCOS3 had the opposite effects. Further analyses showed that SOCS3 overexpression inhibited JAK2 and STAT3 phosphorylation, which was induced by IL-6 stimulation.

CONCLUSIONS

SOCS3 plays a protective role in human preterm placental tissue-derived cytotrophoblasts from IL-6 induced apoptosis by feedback inhibition of JAK2/STAT3 signaling.

Improving the uptake of Kangaroo Mother Care in neonatal units: A narrative review and conceptual framework

Kangaroo Mother Care is a beneficial intervention for high-risk infants; however, global uptake is lacking. Recent systematic reviews have collated the numerous studies that identify diverse barriers and enablers to the use of Kangaroo Mother Care. In this narrative review, we combine the findings of these systematic reviews with more recent studies to propose a conceptual framework, encompassing factors that may affect the initiation and maintenance of Kangaroo Mother Care in neonatal units. CONCLUSION: This conceptual framework includes parental, healthcare professional, and healthcare system factors, and highlights the potential interplay between them. In line with this, we suggest strategies to improve the uptake of Kangaroo Mother Care in neonatal units.

Feasibility of Kangaroo Mother Care (KMC) Implementation in Depok City, Indonesia

Background: The infant and neonatal mortality rate in Depok City is still high, with low birth weight (LBW) and premature births being one of the main causes. In 2018, 14 out of 41 cases of early neonatal death were due to LBW. Studies show that Kangaroo Mother Care (KMC) can prevent or reduce LBW deaths caused by hypothermia, but the implementation is still not evenly distributed. Objective: Describe KMC feasibility as a supporting material for a KMC policy umbrella at Depok City. Method: Qualitative research was conducted with a Rapid Assessment Procedure (RAP) design. A total of 56 informants were divided into 8 discussion groups, 7 in-depth interviews and 2 Focus Group Discussions (FGD). The types of informants were families and inter-sectoral officers. Thematic analysis was used to analyze the data. Results: KMC implementation feasibility in Depok City in terms of facilities and infrastructure was still limited and the quality was insufficient. The number of human resources was still limited, and the competency was still not evenly distributed. LBW family readiness can be maintained if provided with complete and accurate knowledge; therefore, a strong commitment may develop to continue KMC at home. The potential sources of KMC financing are found at health facilities and inter-sectoral; however, to use it, a legal umbrella at the city district level is necessary. Conclusions: The factors of potential financing sources need to be followed up into a priority. This is to overcome the constraints of KMC feasibility implementation.

Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants

Background and Objectives: Kangaroo mother care (KMC) benefits preterm infants' health through increasing breastfeeding, but the longitudinal effects of KMC remain unknown. This study investigates the impact of KMC on breastfeeding and health outcomes in Chinese preterm infants. Methods: A longitudinal randomized controlled study was conducted with 79 preterm infant-mother dyads. The KMC group (n = 36) was provided 2.5 hours/day KMC during the neonatal intensive care unit (NICU) hospitalization, while the control group (n = 43) received standard care. Infant's feeding regimens and physical growth were documented daily at NICU. Physical growth and Neonatal Behavioral Neurological Assessment were measured at 40 weeks, 3 months, and 6 months of corrected age (CA). Breastfeeding outcomes were documented at 6 months of CA. Results: Compared with the control group, KMC infants received higher mothers' milk proportion during hospitalization (B = 0.16, confidence interval [CI] = [0.11-0.21]) and less feeding intolerance at discharge (odds ratio [OR] = 0.11, CI = [0.02-0.43]); and higher exclusive breastfeeding proportion (OR = 14.6, CI = [3.5-60.9]) at 6 months CA. KMC infants also had significant increased body weight and body length at hospital discharge; and more increases of body weight, body length, and head circumference in follow-ups. The neurobehavioral score was also higher in the KMC group compared to the control group over time. Conclusions: Longitudinal KMC effects are significant in promoting preterm infants' breastfeeding outcomes, growth, and neurodevelopment. Early initiation of KMC practice is highly recommended to the parent-infant population in Chinese NICUs to promote breastfeeding and developmental outcomes.

Neonatal care practices in Buikwe District, Uganda: a qualitative study

Background

Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births.

Methods

The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis.

Results

The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care.

Conclusions

Continued focus on systemic strategies for further implementation of the UCG is recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03699-4.

Kangaroo mother care alters chromogranin A and perfusion index in preterm babies

BACKGROUND

While providing various benefits, concerns about the potential risks of kangaroo mother care, or skin-to-skin contact (SSC), between mother and her preterm infant hinder its widespread implementation in some resource- rich countries. In neonates, salivary chromogranin A (s-CgA) is elevated upon exposure to stress, whereas the perfusion index (PI) is associated with hemodynamics and peripheral perfusion. Here, we investigated the effects of SSC on s-CgA and the PI in preterm infants.

METHODS

Twelve infants were enrolled in the study. Factors associated with baseline s-CgA were analyzed. Baseline s-CgA and the level after SSC were compared. Secreted IgA in the saliva was compared as the control. The PI before, throughout, and after SSC were compared.

RESULTS

Baseline s-CgA was significantly lower in infants who were supplemented with baby formula milk in addition to breast milk before SSC (n = 2) compared with those fed with their mother's breast milk alone (n = 10, P = 0.03). SSC significantly decreased s-CgA in babies who were fed breast milk only before SSC (n = 10, P = 0.01) but not in those supplemented with formula milk before SSC (n = 2). Secreted IgA in saliva was not affected by SSC. The PI was significantly elevated during SSC (P = .01).

CONCLUSION

Our data indicate that SSC can reduce s-CgA levels when combined with mother's breast milk and increase the PI in preterm infants, thereby providing additional evidence of the benefit of SSC.

Blinded randomized crossover trial: Skin-to-skin care vs. sucrose for preterm neonatal pain

OBJECTIVE

To compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control.

METHODS

Preterm neonates (28-36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors.

RESULTS

A hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups.

CONCLUSION

Albeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.

Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care

BACKGROUND

Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown.

PURPOSE

The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.

METHODS

In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis.

RESULTS

Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving.

IMPLICATIONS FOR PRACTICE

Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance.

IMPLICATIONS FOR RESEARCH

Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.

Dealing with neonatal emergencies in low-resource settings

We describe the development and delivery of neonatal care including trends and impacts of major interventions on neonatal mortality particularly in low-resource settings. Low- and middle-income countries continue to be major contributors to neonatal mortality. Although there has been progress in reducing neonatal mortality, neonatal deaths are contributing an increasing percentage of childhood mortality. Several interventions targeting neonatal care such as neonatal resuscitation and essential newborn care have contributed to improved outcomes. However, there are still many neonatal deaths that are preventable with known effective interventions. This review addresses interventions proven effective in reducing neonatal mortality, challenges to implement them, and future directions of implementing these interventions in low- and middle-income countries.

Improving neurodevelopment in infants with complex congenital heart disease

Worldwide, more than 400,000 infants are born each year with complex congenital heart disease (CCHD) requiring surgical intervention within the first months of life. Although improvements in perioperative care have resulted in increased rates of survival, more than half of infants with CCHD have neurodevelopmental impairments affecting subsequent educational achievements, job opportunities, and mental health. Brain maturity and impaired outcomes in infants with CCHD are similar to those of prematurely born infants. Developmentally supportive care, including foundational application of kangaroo care (KC), improves neurodevelopment in premature infants. Provision of developmentally supportive care with KC during the early hospitalization of infants with CCHD has the potential to similarly improve neurodevelopment. The purposes of the article are to describe common congenital heart defects, describe developmentally supportive care with an emphasis on KC, and to offer specific recommendations for KC and research in infants with CCHD.