Utility of kangaroo mother care in preterm and low birthweight infants

Maternal factors and child health conditions at birth associated with preterm deaths in a tertiary health facility in Ghana: A retrospective analysis

Background

Preterm birth continues to be a leading cause of death for children under the age of 5 globally. This issue carries significant economic, psychological, and social costs for the families affected. Therefore, it is important to utilize available data to further research and understand the risk factors for preterm death.

Objective

The objective of this study was to determine maternal and infant complications that influence preterm deaths in a tertiary health facility in Ghana.

Methods

A retrospective analysis of data on preterm newborns was conducted at the neonatal intensive care unit of Korle Bu Teaching Hospital (KBTH NICU) in Ghana, covering the period January 2017 to May 2019. Pearson's Chi-square test of association was used to identify factors that were significantly associated with preterm death after admission at the NICU. The Poisson regression model was used to determine the risk factors of preterm death before discharge after admission to the NICU.

Results

Of the 1,203 preterm newborns admitted to the NICU in about two and half years, 355 (29.5%) died before discharge, 7.0% (n = 84) had normal birth weight (>2.5 kg), 3.3% (n = 40) had congenital anomalies and 30.5% (n = 367) were born between 34 and 37 gestational week. All 29 preterm newborns between the 18-25 gestational week died. None of the maternal conditions were significant risk factors of preterm death in the multivariable analysis. The risk of death at discharge was higher among preterm newborns with complications including hemorrhagic/hematological disorders of fetus (aRRR: 4.20, 95% CI: [1.70-10.35], p = 0.002), fetus/newborn infections (aRRR: 3.04, 95% CI: [1.02-9.04], p = 0.046), respiratory disorders (aRRR: 13.08, 95% CI: [5.50-31.10], p < 0.001), fetal growth disorders/restrictons (aRRR: 8.62, 95% CI: [3.64-20.43], p < 0.001) and other complications (aRRR: 14.57, 95% CI: [5.93-35.77], p < 0.001).

Conclusion

This study demonstrate that maternal factors are not significant risk factors of preterm deaths. Gestational age, birth weight, presence of complications and congenital anomalies at birth are significantly associated with preterm deaths. Interventions should focus more on child health conditions at birth to reduce the death of preterm newborns.

Does Kangaroo Care Have an Effect on Transition Time from Gavage Feeding to Full Oral Feeding in Premature Babies?

OBJECTIVES

Kangaroo care is a safe and effective alternative method to conventional neonatal care for newborn babies. The aim of this study was to evaluate the effect of kangaroo care on the transition time to full oral feeding in preterm infants fed by gavage.

METHODS

This is a randomized controlled trial. This study was conducted in a level III neonatal intensive care unit of a university hospital in eastern Turkey 50 premature babies with a birth weight of≥1000 g and a gestational age of 27-36 weeks, and their mothers were included in the study. The cases were randomly divided into two groups: kangaroo care, which would be applied up to five days a week, and standard care. Records of cases were kept regularly from their hospitalization until they reached full oral feeding.

RESULTS

Premature babies in the kangaroo care group reached full oral feeding at 29.20±8.06 days after birth, while babies in the standard care group reached full oral feeding at 44.60±21.90 days. The transition period from gavage feeding to reaching full oral feeding was 13.60±6.83 days in the kangaroo care group, and 22.10±7.38 days in the standard care group. The difference was statistically significant (p=0.007).

CONCLUSION

Kangaroo care is an effective method to reduce the transition time from gavage feeding to full oral feeding for premature babies.

The practice of early mother-newborn skin-to-skin contact after delivery of healthy term neonate and associated factors among health care professionals at health facilities of Southwestern Oromia, Ethiopia: A cross-sectional study

INTRODUCTION

Skin-to-skin contact between a mother and her new-born baby after birth is beneficial for both the mother and her baby. Although mother-newborn skin-to-skin contact after birth is an essential practice, it is limited to a small proportion of premature babies in low-income countries including Ethiopia. The aim of this study was to assess the practice of early mother-new-born skin-to-skin contact after the delivery of healthy term neonates and associated factors among health care professionals in Southwestern Oromia, Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted to assess the practice of 286 health care practitioners towards early mother-new-born skin-to-skin contact after delivery. Data was collected using a pre-tested observational checklist and a self-administered questionnaire from March to April 2017. Epi Info 3.5 was used for data entry, while SPSS version 20 was used for cleaning and analyzing the data. To determine the association between outcome variable and independent variables, bivariate and multivariable logistic regressions were used with a 95% confidence interval and P <0.05. Frequency tables and charts were used to present the findings.

RESULTS

Only 128 (44.8%) of the study participants practiced mother-newborn skin-to-skin contact within the first hour of life after birth. Mother newborn skin-to-skin contact after birth was found to be significantly associated with health professional's knowledge (AOR = 4, 95% CI = 1.7, 10), training (AOR = 7, 95% CI = 2.2, 21), complicated delivery (AOR = 0.12, 95% CI = 0.04, 0.4), and maternal chronic illness (AOR = 0.13, 95% CI = 0.03, 0.6).

CONCLUSION

In general, the practice of health care providers on mother-newborn skin-to-skin contact in the first one hour after birth was low. Knowledge, training, childbirth related maternal complication, and maternal chronic illness were significant factors associated with the practice of mother-newborn skin-to-skin contact immediately after birth. Policies should be revised and enforced, with monitoring and awareness building through training among health care workers, to improve the practice of skin-to-skin contact between mothers and newborns shortly after birth.

Knowledge, attitude and practice towards kangaroo mother care among postnatal women in Ethiopia: Systematic review and meta-analysis

BACKGROUND

Kangaroo mother care is a key procedure in reducing neonatal mortality and morbidity associated with preterm birth. In Ethiopia, neonatal death remains a serious problem, and this study aims to determine the prevalence of the knowledge, attitudes and practice of kangaroo mother care among Ethiopia women.

METHODS

PubMed, Web of Science, Google Scholar, EMBASE and the Ethiopian University online library were searched. Data were extracted using Microsoft Excel and analysed using STATA statistical software (v. 11). Publication bias was checked by forest plot, Begg's rank test and Egger's regression test. To look for heterogeneity, I2 were computed and an overall estimated analysis carried out. Subgroup analysis was done by region, study setting, publication, gestational age, birth weight and component of kangaroo care. The Joanna Briggs Institute risk of bias assessment tool was used. We carried out a leave one out sensitivity analysis.

RESULTS

Out of 273 articles retrieved, 16 studies met the eligibility criteria and are thus included in this study. Those 16 studies had a total of 12,345 respondents who reported kangaroo mother practice, with five (comprising 1,232 participants combined) reporting that both knowledge and attitude were used to determine the overall estimation. The pooled estimates of good knowledge, positive attitude and poor practice of kangaroo mother care were found to be 64.62% (95% CI: 47.15%-82.09%; I2 = 97.8%), 61.55% (49.73%-73.38%; I2 = 94.8%) and 45.7% (95% CI: 37.23%-54.09%; I2 = 98.5%), respectively. This study is limited to postnatal women and does not take account their domestic partners or health providers.

CONCLUSION

The findings revealed significant gaps in the knowledge, attitudes and practice of kangaroo mother care in Ethiopia when compared with other developing countries. Therefore, kangaroo mother care training to women, along with further studies on domestic partners and health providers.

Effects of mother-infant skin-to-skin contact on postpartum depression: A systematic review

PURPOSE

The aim of this systematic review was to evaluate the effects of the skin-to-skin contact (SSC) method on postpartum depression.

DESIGN AND METHODS

A systematic review of the literature was performed.

FINDINGS

This review was completed with three studies meeting the research criteria. Two studies were randomized controlled studies and one study had a quasi-experimental design.

PRACTICE IMPLICATIONS

SSC is such a low-cost intervention that it would be accessible, simple, and feasible for most mothers in the first postpartum weeks. By reducing mothers' depressive symptoms and physiological stress, SSC facilitates mothers' wellbeing and ultimately affects infants' development by enhancing the mother/infant relationship.

The Effect of Kangaroo Care on Breastfeeding and Development in Preterm Neonates

PURPOSE

This study investigated the effect of kangaroo care (KC) on breastfeeding rate and development in preterm neonates in the first six months of life.

DESIGN

The study was conducted using a quasi-experimental method with a pretest-posttest control group design. The sample consisted of preterm neonates in the NICU of two state hospitals of Turkey. The experimental group (n =30) was provided with KC by their mothers for 30 min once a day during a postnatal month. The control group (n = 30) received routine care. Feeding patterns and physical development parameters were determined during the transition to exclusive breastfeeding and at discharge, and in the first, third, and sixth postnatal months. Data were collected using a descriptive characteristics questionnaire, a nutrition and physical development follow-up form, and a home KC follow-up form. Percentage distribution, mean, chi-square test, and t-test were used for analysis.

RESULTS

The KC group had a significantly higher mean body weight than the control group in the third and sixth postnatal months (p < .05). The KC group had higher breast milk intake and breastfeeding rates than the control group during the transition to exclusive breastfeeding and at discharge, and in the first, third, and sixth postnatal months (p < .05).

CONCLUSION

The KC neonates were breastfed for a more extended period of time than controls. This result suggests that KC improves breast milk intake and breastfeeding rates. Therefore, mothers should be trained in KC in the postnatal period.

PRACTICE IMPLICATIONS

Healthcare professionals should encourage and follow mothers for kangaroo care.

Chest-to-Back Skin-to-Skin Contact to Regulate Body Temperature for Low Birth Weight and/or Premature Babies: A Crossover Randomized Controlled Clinical Trial

Skin-to-skin contact (SSC) is one of the critical components of kangaroo mother care (KMC), which is an intervention to enhance the survival of low birth weight (LBW) and/or premature infants in low-income settings. Chest-to-chest (CC) contact has been practiced widely; however, mothers face practical challenges to continuously provide CC-SSC. Hence, we assessed the efficacy of chest-to-back (CB) SSC as an alternative to CC-SSC in regulating body temperature for LBW and/or premature babies in Ethiopia. We applied a noninferiority clinical trial among LBW and/or premature infants admitted to a referral hospital neonatal intensive care unit (NICU) in Ethiopia. The study randomized the infants into two crossover arms; arm 1 applied first CB-SSC followed by CC-SSC, and arm 2 applied first CC-SSC followed by CB-SSC. The outcome measure was a change in skin temperature. We used a linear mixed-effect model for analysis. The result showed no statistically significant difference in the mean temperature between the comparison arms. In conclusion, we found that the CB-SSC was not inferior to the CC-SSC in regulating body temperature of the babies. Thus, CB-SSC can be further investigated as an alternative to CC-SSC in the kangaroo care model in low-income settings.

The Effect of Skin-to-Skin Contact on Maternal Anxiety, Heart Rate, and Oxygen Saturation during the Vaccination of One-Month-Old Infants

This study aimed to reduce maternal anxiety scores and heart rates, increase oxygen saturation linked to vaccination processes with Skin-to skin contact (SSC). The study is a prospective, multicenter, paired, randomized, controlled trial. This experimental study was conducted with a pretest-posttest control group. The study was carried out with 128 mothers of infants. A Sociodemographic Questionnaire, the State Anxiety Inventory and a pulse oximeter were used in the data collection. In the study, SSC began to be given to the infants in the intervention group five minutes before vaccination and the infant was left in SSC for an uninterrupted 15 minutes following the vaccination. The maternal anxiety scores were noted before and after the vaccination process. The mothers' heart rates and oxygen saturation were monitored a total of three times. The anxiety scores of the intervention group decreased while oxygen saturation increased after the vaccination as compared to the control group. The heart rate decreased in the intervention group but increased in the control group. The study revealed that SSC reduced scores of maternal anxiety and heart rates and increased oxygen saturation during the vaccination process.

The Effects of Kangaroo Care Applied by Turkish Mothers who Have Premature Babies and Cannot Breastfeed on Their Stress Levels and Amount of Milk Production

PURPOSE

This study aimed to examine the effects of kangaroo care applied by Turkish mothers who have premature babies and cannot breastfeed on their stress levels and amount of milk production.

DESIGN AND METHODS

This open-label, multicentre, randomised controlled trial included preterm infants not breastfed by their mothers and the mothers of the infants. The mothers were randomised at a 1:1 ratio into the kangaroo care group and the standard care group. The mothers in the kangaroo care group applied kangaroo care to their babies once a day for three weeks. The mothers in the standard care group saw their infants for 15-20 min once a day for five days a week for three weeks, which was standard care in the newborn intensive care unit. The mothers milked their breasts with breast milking machines or pumps every day for three weeks.

RESULTS

The mothers in the kangaroo care group had higher breast milk production averages than the standard care group in all measurements. The mothers who applied kangaroo care had lower Parental Stressor Scale, subdimensions and total scale average scores than the mothers in the standard care group.

CONCLUSIONS

Kangaroo care is effective at stimulating breast milk production and decreasing maternal stress levels.

PRACTICE IMPLICATIONS

Kangaroo care decreases mothers' stress levels and increases breast milk production by mothers who cannot breastfeed their premature infants.

Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice

Background

Providing high-quality kangaroo mother care (KMC) is a strategy proven to improve outcomes in premature babies. However, whether KMC is consistently and appropriately provided in Ethiopia is unclear. This study assesses the quality of KMC services in Ethiopia and the factors associated with its appropriate initiation among low birth weight neonates.

Methods

We used data from the 2016 national Emergency Obstetric and Newborn Care (EmONC) assessment which contains data on all health facilities providing delivery care services in Ethiopia (N = 3,804). We described the quality of KMC services provided to low-birth weight (LBW) babies in terms of infrastructure, processes and outcomes (survival status at discharge). We also explored the factors associated with appropriate KMC initiation using multivariable logistic regression models.

Results

The quality of KMC services in Ethiopia was poor. The facilities included scored only 59.0% on average on a basic index of service readiness. KMC was initiated for only 46.4% of all LBW babies included in the sample. Among those who received KMC, 66.7% survived, 13.3% died and 20.4% had no data on survival status at discharge. LBW babies born in health centers were twice more likely to receive KMC compared to those born in hospitals (AOR = 2.0, 95% CI: 1.3–3.0). Public facilities, those with a staff rotation policy in place for newborn care, and those with separate newborn corners were also more likely to initiate KMC for LBW babies.

Conclusions

We found low levels of appropriate KMC initiation, inadequate infrastructure and staffing, and poor survival among LBW babies in Ethiopia. Efforts must be made to improve the adoption of this life saving technique, particularly in hospitals and in the private sector where KMC remains underutilized. Facilities should also dedicate specific spaces for newborn care that enables mothers to provide KMC. In addition, improving record keeping and data quality for routine health data is a priority.

Prevalence and associated prenatal and perinatal risk factors for oropharyngeal dysphagia in high-risk neonates in a South African hospital

Background

The prevalence of neonatal oropharyngeal dysphagia (OPD) in high-risk infants in lower-middle-income countries is unknown.

Objectives

To determine the prevalence and associated risks for OPD in high-risk neonates in order to allow timely intervention for OPD, minimising negative outcomes.

Method

A prospective cross-sectional observational study was conducted in an urban hospital in South Africa. Clinical feeding assessments were conducted using the Neonatal Feeding Assessment Scale with all available neonates in neonatal care.

Results

The sample of 81 high-risk neonates (mean chronological age = 11.7 days; standard deviation = 15.6 days) had been feeding orally for 2 days and were approaching discharge. Fifty-two participants (64.2%) had OPD. Risks likely associated with OPD included breech presentation, septicaemia and other infections, spending more than 1 day on a warm table or incubator, neurological conditions, prenatal exposure to maternal smoking, siblings with mental or neurological disability, participants with congenital disorders, preterm birth (< 37 weeks), low birth weight (< 2500 g), or retinopathy of prematurity.

Conclusion

An unexpected high prevalence of OPD was found in neonates already deemed ready for oral feeding and approaching discharge. Timely early involvement of the Speech-Language Therapists (SLTs) in decision-making about feeding readiness may prevent serious complications of neonatal OPD. Findings may inform South African neonatal clinicians. The study provides motivation for early intervention from SLTs before the infant and mother are discharged from high care and dispersed to communities where intervention services may be scarce.

The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies

Background

Kangaroo mother care is a comprehensive intervention given for all newborns especially for premature and low birthweight infants. It is the most feasible and preferred intervention for decreasing neonatal morbidity and mortality. Even though time to initiating breastfeeding has been examined by randomized controlled trials, varying findings have been reported. Therefore, the main objective of this meta-analysis was to estimate the pooled mean time to initiate breastfeeding among preterm and low birthweight infants.

Methods

The authors searched for randomized controlled trial studies conducted on the effects of kangaroo mother care on the time to breastfeeding initiation among preterm and low birthweight infants. Published articles were identified through a computerized search of electronic databases that includes MEDLINE via PubMed, EMBASE, CINAHL and CENTRAL. The search terms were kangaroo mother care or (skin to skin), or conventional care, newborns, preterm infants, low birthweight infants and randomized controlled trial. A total of 467 eligible titles were identified and eight studies met the inclusion criteria. The extracted data were entered and analyzed using Cochrane Review Manager-5-3 software. Heterogeneity across studies was evaluated by Chi² test and inconsistency index (I²). Publication bias was assessed using a funnel plot. The random effect model was applied to estimate the pooled mean time to initiate breastfeeding with 95% confidence interval.

Results

In this meta-analysis, the overall pooled mean time to initiate breastfeeding was 2.6 days (95% CI 1.23, 3.96). Preterm and low birthweight infants receiving kangaroo mother care intervention initiated breastfeeding 2 days 14 h 24 min earlier than conventional care of radiant warmer/incubator method.

Conclusions

Kangaroo mother care promotes early initiation of breastfeeding as compared to conventional care method. Therefore, health facilities need to implement the kangaroo mother care for preterm and low birthweight infants.

Electronic supplementary material

The online version of this article (10.1186/s13006-019-0206-0) contains supplementary material, which is available to authorized users.