A Clinical Guideline for Implementation of Kangaroo Care With Premature Infants of 30 or More Weeks' Postmenstrual Age

Effects of skin-to-skin contact in supported diagonal flexion positioning on movement quality in very preterm infants at term age

BACKGROUND

Preterm birth is associated with a high risk of long-term neuromotor disabilities such as coordination of movements, deficient antigravity limb movement, less adaptive postural control strategies, head deformities… AIMS: The aim of the present study was to examine the potential positive impact of a Supported Diagonal Flexion (SDF) skin-to-skin contact (SSC) positioning on the neuromotor development and movement quality of very preterm infants at term age.

STUDY DESIGN

Monocentric prospective matched-pair case-control study.

SUBJECTS

Thirty very preterm infants and their mother were proposed either SDF SSC positioning (n = 15) or Vertical SSC positioning (n = 15).

OUTCOME MEASURES

Amiel-Tison Neurological Assessment at Term (ATNAT) and observation of the spontaneous motor activity were assessed at term corrected age.

RESULTS

Infants in the SDF group had less dolichocephaly (adj. p = .014) and arms in candlestick position (adj. p = .048). Only 3 in the SDF group against 11 in the vertical group showed nonoptimal spontaneous motor activity. Infants in the SDF group had more positive signs such as foot-to-foot contact (adj. p = .047) or arms movements toward midline (adj. p = .046 and 0.011).

CONCLUSIONS

The present study shows that nonoptimal spontaneous motor activity was increased and dolichocephaly was more common in the vertical group. Consistently with current guidelines, it is critical to consider preterm infants' postures during SSC or while in incubators or cradles.

The Impact of Structured Kangaroo Care Education on Premature Infants' Weight Gain, Breastfeeding and Length of Hospitalization in Malaysia

Purpose

Kangaroo care is a complementary humanistic intervention based on a family-centered care model. This study investigated the effects of a locally contextualized, structured kangaroo care education program on weight gain, breastfeeding rate and length of hospitalization for premature infants.

Patients and Methods

This longitudinal quasi-experimental study with pre- and post-intervention design involved 96 infants born between 28 and 37 weeks of gestation for three months, and was carried out at a neonatal intensive care unit in Malaysia. The experimental group received a structured education program and careful monitoring of their kangaroo care practices, while the control group received routine care without a structured education program. The institutional review board approved the study design and registered at ClinicalTrials.gov (NCT04926402).

Results

The kangaroo care hours performed by mothers at baseline in the experimental and control group was 4.12 and 0.55 hours per week, respectively. At three months post-discharge, the experimental group had significantly higher weight gain, higher breastfeeding rates and shorter lengths of hospitalization than the control group.

Conclusion

A locally contextualized and structured kangaroo care education program is effective in the performance of kangaroo care. One hour per day of kangaroo care is positively associated with an extended period of breastfeeding, improved weight gain and shorter hospitalization of premature infants.

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.

Clinical practice guideline for kangaroo mother care in preterm and low birth weight infants

Kangaroo mother care has reduced mortality and morbidity in preterm and low birth weight infants and has many benefits, such as promoting breastfeeding. Based on the current evidence in China and international, we developed a clinical practice guideline for kangaroo mother care in preterm and low birth weight infants using the Grading of Recommendations, Assessment, Development and Evaluation and proposed 34 recommendations for 20 key questions. Our goal is to promote the appropriate implementation of kangaroo mother care in clinical practice.

Skin-to-skin SDF positioning: The key to intersubjective intimacy between mother and very preterm newborn-A pilot matched-pair case-control study

Background

Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits, for both the baby and the parent. However, very few studies have investigated SSC' benefits for communication, in particular in the very-preterm newborn immediately after birth.

Aims

To investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother-very-preterm newborn communication and to examine the coordination of the timing of communicative behaviors, just a few days after birth.

Subjects and study design

Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA, mean age at birth: 30 weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control positioning (n = 17) or the SDF Intervention positioning (n = 17). Mother and newborn were filmed during the first 5 min of their first SSC.

Outcome measures

Infants' states of consciousness according to the Assessment of Preterm Infants' Behavior scale (APIB). Onset and duration of newborns' and mothers' vocalizations and their temporal proximity within a 1-s time-window.

Results

In comparison with the Vertical group, very preterm newborns in the SDF Intervention Group spent less time in a drowsy state and more in deep sleep. At 3.5 days of life, newborns' vocal production in SSC did not differ significantly between the two groups. Mothers offered a denser vocal envelope in the SDF group than in the Vertical group and their vocalizations were on average significantly longer. Moreover, in a one-second time-frame, temporal proximity of mother-very preterm newborn behaviors was greater in the SDF Intervention Group.

Conclusion

Although conducted on a limited number of dyads, our study shows that SDF positioning fosters mother-very preterm newborn intimate encounter during the very first skin to skin contact after delivery. Our pioneer data sheds light on the way a mother and her very preterm vocally meet, and constitutes a pilot step in the exploration of innate intersubjectivity in the context of very preterm birth.

The impact of the COVID-19 pandemic on nursing care and nurses' work in a neonatal intensive care unit

PURPOSE

This study was conducted to determine the effects of the COVID-19 pandemic process on nursing care and nurses' work in neonatal intensive care units.

DESIGN AND METHODS

The study was conducted using a qualitative method. The data were collected by voice recording with a one-on-one in-depth interview technique, and a semi-structured question form was used in the interviews. The data obtained from voice recordings were evaluated using the qualitative content analysis method.

RESULTS

The main themes and subthemes of the study were as follows: (1) decrease in physical contact with newborns due to fear of transmitting Covid-19 (decrease in physical contact between neonatal nurses and newborns, decrease in physical contact between mothers and newborns, decrease in physical contact between fathers and newborns), (2) communication problems between healthcare professionals and parents (3) changes in the working conditions for neonatal nurses (increase in the frequency and duration of work intense working speed, exhaustion and decreased motivation due to use of protective equipment).

CONCLUSION

The COVID-19 pandemic process led to a decrease in nurses' and parents' touching newborns, nurses' experiencing problems with parents due to measures taken, heavier working conditions and a decrease in motivation for nurses.

PRACTICE IMPLICATIONS

This study will inform future research to be directed to nursing care and the work of nursing who work on the front line in the COVID-19 pandemic process.

Effect of Music Therapy Interventions on Heart Rate Variability in Premature Infants

Premature infants are at risk of developing serious complications after birth. Communicative interventions performed in neonatal intensive care units (NICUs), such as music therapy interventions, can reduce the stress experienced by these infants and promote the development of their autonomic nervous system. In this study we investigated the effects of music therapy interventions, consisting of singing, humming, talking or rhythmic reading, on premature infants by investigating the effects on their heart rate variability (HRV). A total of 27 communicative intervention from 18 patients were included in this study. The NN-intervals were extracted from the ECG and the mean ± SEM values for the 6 different features (HR, SDNN, RMSSD, pNN50, pDec and SDDec) was investigated. Median feature values for the pre- and communicative intervention were compared using the Wilcoxon signed-rank test. An increase in values for the SDNN, RMSSD and pNN50 was found in the 20 minutes preceding the communicative intervention, when caregiving activities were performed, and was followed by an immediate decrease at the start of the intervention. Features' variability during the intervention appeared to be smaller than in the pre-communicative intervention, indicating improved autonomic regulation. This difference was, however, not statistically significant possibly due to different types of activities applied during the communicative intervention per patient.

Daily mother-infant skin-to-skin contact and maternal mental health and postpartum healing: a randomized controlled trial

This randomized controlled trial examined the effects of a daily hour of mother-infant skin-to-skin contact (SSC) during the first five postnatal weeks, compared to care-as-usual, on maternal depressive (primary outcome), anxiety, stress, fatigue, pain, and delivery-related post-traumatic stress symptoms (PTSS). Prenatal symptom severity and touch discomfort were examined as moderators. Mothers and full-term infants were randomly allocated to SSC or care-as-usual conditions and followed during the first postnatal year. For the total group (intention-to-treat analyses), care-as-usual mothers showed an increase of anxiety symptoms from week 2 to 12, while SSC mothers displayed a stability of anxiety symptoms. Also, care-as-usual mothers showed an initial decrease in fatigue followed by an increase, while SSC mothers showed a decrease from week 2 to 12. In per-protocol analyses, including only the SSC dyads who adhered to SSC guidelines, findings on anxiety, but not fatigue, were replicated. No SSC effects were found for depressive, stress, and pain symptoms. No moderator, dose-response, or 52-week follow-up effects were found. PTSS were low with little variation; consequently, analyses were discontinued. Daily SSC in healthy mother-infant dyads may reduce anxiety and fatigue symptoms, but not depressive, stress, and pain symptoms, during the early postpartum period. Replication studies are recommended.

What Do Neonatal Intensive Care Unit Policies Tell Us About Kangaroo Care implementation? A Realist Review

BACKGROUND

Kangaroo care (KC) is recommended for infants during their stay in the neonatal intensive care unit (NICU) due to the benefits to infant growth, stabilized vital signs, and parental bonding; however, literature primarily explores the physiologic benefits, barriers, and facilitators to KC practice. Little is known about the context and mechanisms of KC implementation.

PURPOSE

This realist review is to explore what NICU policies tell us about practices to implement KC in the NICU.

METHODS

Policies were obtained via email, database, and search engines. Criteria were established to review each policy. Data were entered into a database then exported for frequency counts of identified characteristics.

RESULTS

Fifty-one policies were reviewed, which revealed inconsistencies in the implementation of KC practices. Inconsistencies include variability in infant postmenstrual ages and weight criteria, infant medical equipment in place during participation, duration and frequency of KC, KC documentation, and ongoing monitoring requirements.

IMPLICATIONS FOR PRACTICE

KC implementation varies widely across NICUs, even with similar infant populations. Exclusion of some infants from receiving KC may decrease the potential beneficial outcomes known to result from KC.

IMPLICATIONS FOR RESEARCH

More research to understand KC best practice recommendations and implementation in the NICU is needed. Studies are needed to evaluate the duration and frequency of KC, as well as the benefits to infants and families to optimize KC in the NICU setting.

An Infant Carrier Intervention and Breastfeeding Duration: A Randomized Controlled Trial

OBJECTIVES

Parent-infant skin-to-skin contact immediately after birth increases initiation and duration of bodyfeeding. We hypothesized that providing ergonomic carriers to parents during pregnancy would increase the likelihood of breastfeeding and expressed human milk feeding through the first 6 months of life.

METHODS

A randomized two-arm, parallel-group trial was conducted between February 2018 and June 2019 in collaboration with a home-visiting program in a low-income community. At 30 weeks' gestation, 50 parents were randomly assigned to receive an ergonomic infant carrier and instruction on proper use to facilitate increased physical contact with infants (intervention group), and 50 parents were assigned to a waitlist control group. Feeding outcomes were assessed with online surveys at 6 weeks, 3 months, and 6 months postpartum.

RESULTS

Parents in the intervention group were more likely to be breastfeeding or feeding expressed human milk at 6 months (68%) than control group parents (40%; P = .02). No significant differences were detected in feeding outcomes at 6 weeks (intervention: 78% versus control: 81%, P = .76) or 3 months (intervention: 66% versus control: 57%, P = .34). Exclusive human milk feeding did not differ between groups (intervention versus control at 6 weeks: 66% vs 49%, P = .20; 3 months: 45% vs 40%, P = .59; 6 months: 49% vs 26%, P = .06).

CONCLUSIONS

Infant carriers increased rates of breastfeeding and expressed human milk feeding at 6 months postpartum. Large-scale studies are warranted to further examine the efficacy and cost-effectiveness of providing carriers as an intervention to increase access to human milk.

[Impact of the kangaroo method of breastfeeding of preterm newborn infants in Brazil: an integrative review]

The scope of this integrative review of the literature was to assess if the Kangaroo-Mother Care Method as implemented in Brazil, from the first stage to outpatient follow-up, has an influence on breastfeeding. Brazilian research published in national and international journals in Portuguese, English or Spanish in the leading research databases between the years 2000 to 2017 was included, with full articles available and theme related to the scope of this study. A total of 1328 articles were located and articles not conducted in Brazil, literature review articles and themes not related to the Kangaroo-Mother Care Method were excluded, with 21 studies eventually being selected. The research results indicated a positive influence of the Kangaroo-Mother Care Method on breastfeeding and establishing a mother-child bond. However, the third stage or outpatient follow-up proved not to be effective in maintaining breastfeeding. Greater participation of primary care in home care provided to preterm newborns is necessary, with a view to promoting exclusive breastfeeding up to six months of age and extended up to two years of age.

Prevalence and Components of Newborn Assessment Policies Related to Sudden Unexpected Postnatal Collapse

OBJECTIVE

To describe, in a convenience sample, different hospitals' nursing care policies related to normal newborn assessment, to summarize common components of those policies related to sudden unexpected postnatal collapse (SUPC) of the newborn, and to correlate characteristics of the hospitals with the presence or absence of a normal newborn assessment policy.

DESIGN

Descriptive evaluative design.

SETTING

Hospital representatives were contacted to complete a questionnaire and provide a copy of their policies regarding normal newborn assessment.

PARTICIPANTS

Representatives from 39 hospitals that provide maternal/newborn services within the United States completed the questionnaire and/or provided the investigator with a written nursing care policy for normal newborn assessment.

INTERVENTION/MEASUREMENTS

Components of the hospitals' normal newborn assessment policies were evaluated according to the framework of recommended components outlined by the American Academy of Pediatrics in Feldman-Winter et al. (2016).

RESULTS

The four components most often included in the policies submitted by 26 hospitals were maternal/newborn dyad assessments (n = 25, 96%), sequence of events postpartum (n = 15, 58%), monitoring (n = 9, 35%), and skin-to-skin contact procedures (n = 8, 30%). Differences were noted based on the size of the hospital as defined by the number of births and number of beds and also by the type of unit.

CONCLUSION

Few policies in this study aligned with the recommended suggestions from the American Academy of Pediatrics outlined in Feldman-Winter et al. (2016). It is also important to note that these recommended suggestions relate to safe skin-to-skin contact and rooming-in practices, which may in turn affect the incidence of SUPC. There is much work to be done in terms of disseminating evidence and developing and implementing newborn assessment policies related to SUPC.

Longer duration of kangaroo care improves neurobehavioral performance and feeding in preterm infants: a randomized controlled trial

AIM

To investigate the effect of kangaroo care (KC) and its duration on neurobehavioral performance, stress response, breastfeeding success, and vital signs in premature infants.

METHODS

One hundred and twenty premature infants were randomized to receive either KC for 60 min daily, KC for 120 min daily or conventional care (controls) for at least 7 days. Salivary cortisol was measured before and after the first KC session and then after 7 days. Temperature, respiration rate, heart rate, and oxygen saturation were recorded, before and after KC. Neonates were evaluated by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS).

RESULTS

Both KC groups demonstrated higher scores for attention, arousal, regulation, nonoptimal reflexes, and quality of movements and lower scores for handling, excitability, and lethargy, compared to controls (p < 0.05). Both KC groups had higher infant breastfeeding assessment tool score and reached full enteral feeds faster than controls (p < 0.05). After the first KC session, improvement in O₂ saturation and temperature was observed in KC 120-min group compared with the KC 60-min group (p < 0.05). Salivary cortisol decreased in both KC groups compared with controls after 7 days (p < 0.05).

CONCLUSION

Preterm neonates who receive KC for long durations reach full enteral feeds faster, have better breastfeeding success, neurobehavioral performance, thermal control, and tissue oxygenation.

Fostering mother-very preterm infant communication during skin-to-skin contact through a modified positioning

BACKGROUND

Skin-to-skin contact (SSC) has been widely studied in NICU and several meta-analyses have looked at its benefits both for the baby and the parent. Very few studies however have investigated benefit for communication.

AIMS

Investigate the immediate benefits of Supported Diagonal Flexion (SDF) positioning during SSC on the quality of mother - very-preterm infant communication and to gain insight into how mothers' and very-preterm infants' communicative behaviours are coordinated in time just a few days after birth.

SUBJECTS AND STUDY DESIGN

Monocentric prospective matched-pair case-control study. Thirty-four mothers and their very preterm infants (27 to 31 + 6 weeks GA; mean age at birth 30: weeks GA) were assigned to one of the two SSC positioning, either the Vertical Control (n = 17) or the SDF Intervention positioning (n = 17). Mother and infant were filmed during the first 5 min of SSC, 15 days after the very first SSC (i.e. 18 days after very premature birth, i.e. on average 32.4 weeks GA).

OUTCOME MEASURES

Infants' state of consciousness according to the Assessment of Preterm Infants' Behavior scale. Onset and duration of infants' and mothers' smiles, gazes and vocalizations, and their temporal proximity inside a 1-sec time-window.

RESULTS

In the SDF Intervention Group, very preterm infants vocalized three times more and mothers vocalized, gazed at their baby's face, and smiled more than in the Vertical Control Group. Moreover, in a one-second time-frame, temporal proximity of mother-infant behaviours was greater in the SDF Intervention Group.

CONCLUSIONS

Our study shows that SDF positioning creates more opportunities for mother-infant communication during SSC. SDF positioning fosters a greater multimodal temporal proximity thus supporting a more qualitative mother-infant communication.

Assessment of skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia

OBJECTIVE

The study aimed at assessing skin-to-skin contact (SSC) during the postpartum stay and its determinant factors among mothers at public health institutions in Ethiopia.

RESULT

A total of 384 mothers-indexed newborns admitted in postnatal wards were interviewed. The prevalence of mothers' SSC practice to their newborns with in the first 1 h during the postpartum stay was 28.1%. Mothers education (AOR = 18.23 [95% CI 5.26, 63.52]), and number of ANC visits (AOR = 8.55 [95% CI 1.05, 69.54]) were independently associated with SSC practice of mothers to their infants.

Mother⁻Infant Physical Contact Predicts Responsive Feeding among U.S. Breastfeeding Mothers

Responsive feeding—initiating feeding in response to early hunger cues—supports the physiology of lactation and the development of infant feeding abilities, yet there is a dearth of research examining what predicts responsive feeding. In non-Western proximal care cultures, there is an association between responsive feeding and mother–infant physical contact, but this has not been investigated within Western populations. In two studies, we tested whether mother–infant physical contact predicted feeding in response to early hunger cues versus feeding on a schedule or after signs of distress among U.S. breastfeeding mothers. With an online questionnaire in Study 1 (n = 626), physical contact with infants (via co-sleeping and babywearing) predicted increased likelihood of self-reported responsive feeding. Mothers who reported responsive feeding were more likely to exclusively breastfeed for the first six months, breastfeed more frequently throughout the day, and had a longer planned breastfeeding duration than mothers who reported feeding on a schedule or after signs of infant distress. In Study 2 (n = 96), a three-day feeding log showed that mother–infant physical contact predicted feeding in response to early hunger cues but mother–infant proximity (without physical contact) did not. In sum, our results demonstrate that physical contact with infants may shape breastfeeding behavior among U.S. mothers, highlighting a connection between social interaction and infant nutrition that warrants further investigation.

Effectiveness of skin-to-skin contact versus care-as-usual in mothers and their full-term infants: study protocol for a parallel-group randomized controlled trial

BACKGROUND

Twenty-to-forty percent of women experience postpartum depressive symptoms, which can affect both the mother and infant. In preterm infants, daily skin-to-skin contact (SSC) between the mother and her infant has been shown to decrease maternal postpartum depressive symptoms. In full-term infants, only two studies investigated SSC effects on maternal depressive symptoms and found similar results. Research in preterm infants also showed that SSC improves other mental and physical health outcomes of the mother and the infant, and improves the quality of mother-infant relationship. This randomized controlled trial will investigate the effects of a SSC intervention on maternal postpartum depressive symptoms and additional outcomes in mothers and their full-term infants. Moreover, two potential underlying mechanisms for the relation between SSC and the maternal and infant outcomes will be examined, namely maternal oxytocin concentrations and infant intestinal microbiota.

METHODS/DESIGN

Design: A parallel-group randomized controlled trial.

PARTICIPANTS

116 mothers and their full-term infants.

INTERVENTION

Mothers in the SSC condition will be requested to provide daily at least one continuous hour of SSC to their infant. The intervention starts immediately after birth and lasts for 5 weeks. Mothers in the control condition will not be requested to provide SSC. Maternal and infant outcomes will be measured at 2 weeks, 5 weeks, 12 weeks and 1 year after birth.

PRIMARY OUTCOME

maternal postpartum depressive symptoms. Secondary maternal outcomes: mental health (anxiety, stress, traumatic stress following child birth, sleep quality), physical health (physical recovery from the delivery, health, breastfeeding, physiological stress), mother-infant relationship (mother-infant bond, quality of maternal caregiving behavior). Secondary infant outcomes: behavior (fussing and crying, sleep quality), physical health (growth and health, physiological stress), general development (regulation capacities, social-emotional capacities, language, cognitive and motor capacities). Secondary underlying mechanisms: maternal oxytocin concentrations, infant intestinal microbiota.

DISCUSSION

As a simple and cost-effective intervention, SSC may benefit both the mother and her full-term infant in the short-and long-term. Additionally, if SSC is shown to be effective in low-risk mother-infant dyads, then thought could be given to developing programs in high-risk samples and using SSC in a preventive manner.

TRIAL REGISTRATION

NTR5697 ; Registered on March 13, 2016.

Influence of maternal factors on the successful outcome of kangaroo mother care in low birth-weight infants: A randomized controlled trial

BACKGROUND

Kangaroo mother care (KMC) is associated with positive neonatal outcomes. Studies demonstrated significant influence of maternal factors on the success of applying KMC.

AIM

To determine maternal factors that influence on anthropometric parameters in low birth weight babies that received kangaroo mother care.

METHODS

This is a randomized controlled study that involved low birth weight newborns. We randomly assigned newborns into two groups; a group who received KMC and a group who received conventional care. Maternal factors were recorded. We followed weight, length, and head circumferences of newborns for thirty days.

RESULTS

A total of 40 newborns were included. Weight parameters were significantly higher in the KMC group than the conventional group. From maternal characteristics, only gestational age was found to influence increased head circumference in KMC group (p = 0.035); however, it did not affect the increase in weight or length. Maternal age, parity, education, mode of delivery, fetal sex, and initial Apgar score did not influence growth parameters in either groups.

CONCLUSION

KMC was associated with increased weight gain in LBW infants. Gestational age influences head growth in infants who received KMC.

Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants

OBJECTIVE

To determine whether heart rate variability (HRV) can serve as a surrogate measure to track regulatory changes during kangaroo care, a period of parental coregulation distinct from regulation within the incubator.

STUDY DESIGN

Nurses annotated the starting and ending times of kangaroo care for 3 months. The pre-kangaroo care, during-kangaroo care, and post-kangaroo care data were retrieved in infants with at least 10 accurately annotated kangaroo care sessions. Eight HRV features (5 in the time domain and 3 in the frequency domain) were used to visually and statistically compare the pre-kangaroo care and during-kangaroo care periods. Two of these features, capturing the percentage of heart rate decelerations and the extent of heart rate decelerations, were newly developed for preterm infants.

RESULTS

A total of 191 kangaroo care sessions were investigated in 11 preterm infants. Despite clinically irrelevant changes in vital signs, 6 of the 8 HRV features (SD of normal-to-normal intervals, root mean square of the SD, percentage of consecutive normal-to-normal intervals that differ by >50 ms, SD of heart rate decelerations, high-frequency power, and low-frequency/high-frequency ratio) showed a visible and statistically significant difference (P <.01) between stable periods of kangaroo care and pre-kangaroo care. HRV was reduced during kangaroo care owing to a decrease in the extent of transient heart rate decelerations.

CONCLUSION

HRV-based features may be clinically useful for capturing the dynamic changes in autonomic regulation in response to kangaroo care and other changes in environment and state.

Kangaroo Mother Care 1: Alleviation of Physiological Problems in Premature Infants

Kangaroo mother care (KMC) involves placing the newborn infant into prolonged and continuous skin-to-skin contact with the mother as soon as possible after birth, exclusive breastfeeding, early discharge from the health facility, and supportive follow-up at home. Claimed benefits of KMC as an aid to the clinical mitigation of some detrimental features of prematurity need to be evidence based. This article, the first of two, provides an overview of the impact of prematurity on those features of neonates to which KMC may be directed. Specifically, the mitigation of some cardiorespiratory, neurophysiological, sensory, gastrointestinal, musculoskeletal, renal, metabolic, and immunological impacts are outlined. Relevant neurobehavioral, psychosocial, sociocultural, and economic perspectives are briefly reviewed in the companion article. These two articles provide scientific support for a wider upscaling of KMC education and its cautious use in physiologically stable preterm infants.

Noninvasive Ventilation in Premature Neonates

BACKGROUND

The use of noninvasive ventilation is a constantly evolving treatment option for respiratory disease in the premature infant. The goals of these noninvasive ventilation techniques are to improve gas exchange in the premature infant's lungs and to minimize the need for intubation and invasive mechanical ventilation.

PURPOSE

The goals of this article are to consider various uses of nasal interfaces, discuss skin care and developmental positioning concerns faced by the bedside nurse, and discuss the medical management aimed to reduce morbidity and mortality. This article explores the nursing role, the advances in medical strategies for noninvasive ventilation, and the team approach to noninvasive ventilation use in this population.

SEARCH STRATEGY

Search strategy included a literature review on medical databases, such as EBSCOhost, CINAHL, PubMed, and NeoReviews.

FINDINGS

Innovative products, nursing research on developmental positioning and skin care, and advanced medical management have led to better and safer outcomes for premature infants requiring noninvasive ventilation.

IMPLICATIONS FOR PRACTICE

The medical focus of avoiding long-term mechanical ventilation would not be possible without the technology to provide noninvasive ventilation to these premature infants and the watchful eye of the nurse in terms of careful positioning, preventing skin breakdown and facial scarring, and a proper seal to maximize ventilation accuracy.

IMPLICATIONS FOR RESEARCH

This article encourages nursing-based research to quantify some of the knowledge about skin care and positioning as well as research into most appropriate uses for noninvasive ventilation devices.

The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia

Background

Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries.

Methods

Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders.

Results

The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies.

Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs.

The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998–2006); the newborn-care phase (2007–2012); and lastly the current phase where small babies are also included in action plans.

Conclusions

This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.

Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial

PURPOSE

To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding.

DESIGN AND METHODS

This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest.

OUTCOME MEASURE

Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions.

RESULTS

The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score.

IMPLICATIONS FOR PRACTICE

Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship.

IMPLICATIONS FOR RESEARCH

The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions

BACKGROUND

Preterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up.

METHODS

The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC.

RESULTS

Marked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks.

CONCLUSIONS

There are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.

Interactional pattern analysis of mother–baby pairs: Kangaroo mother care versus incubator care

Within the field of neonatal care, two approaches have gained prominence – incubator care and kangaroo mother care. Each contributes to a baby’s physiological well-being. The aim of this study was to conduct an investigation into the effects of incubator care and kangaroo mother care from a psychological perspective – specifically an interactional approach – by undertaking interactional pattern analyses of mother–baby pairs receiving incubator care and kangaroo mother care, respectively. Person-centred interviews were conducted and audio recorded with 17 mothers whose babies were receiving either incubator care or kangaroo mother care at the Dr George Mukhari Academic Hospital in Ga-Rankuwa, South Africa. Each interview was studied by an independent clinical psychologist trained in observation and, in particular, the interactional pattern analysis and who then completed an adapted interactional pattern analysis questionnaire. The procedure yielded standardised interactional pattern analyses for the mother–baby pairs. Mann–Whitney U tests revealed that, in relation to their babies, the mothers in the kangaroo mother care group yielded significantly more effective interactional patterns than those in the incubator care group, highlighting that, in terms of the interactional approach, kangaroo mother care may be the preferred method of neonatal care.

Early maternal separation: a rodent model of depression and a prevailing human condition

The early life of most mammals is spent in close contact with the mother, and for the neonate, early maternal separation is a traumatic event that, depending on various conditions, may shape its behavioral and neurochemical phenotype in adulthood. Studies on rodents demonstrated that a very brief separation followed by increased maternal care may positively affect the development of the offspring but that prolonged separation causes significant amounts of stress. The consequences of this stress (particularly the hyperreactivity of the HPA (hypothalamic-pituitary-adrenal) axis are expressed in adulthood and persist for life. Maternal separation in rodents, particularly rats, was used as a model for various psychotic conditions, especially depression. The most popular separation procedure of a 3-h daily separation from the second to the 12th postpartum day yields a depression model of high construct and predictive validity. The results of studies on maternal separation in rats and monkeys prompt a discussion of the consequences of traditional procedures in the maternity wards of developed countries where attention is focused on the hygiene of the neonates and not on their psychological needs. This alternate focus results in a drastic limitation of mother-infant contact and prolonged periods of separation. It is tempting to speculate that differences in the course and severity of various mental disorders, which are usually less prevalent in underdeveloped countries than in developed countries (as noted by Kraepelin), may be related to different modes of infant care. Only recently has so-called kangaroo mother care (establishing mother-infant skin-to-skin contact immediately after birth) become popular in developed countries. In addition to its instant benefits for the neonates, this procedure may also be beneficial for the mental health of the offspring in adulthood.

NICU nurses' ambivalent attitudes in skin-to-skin care practice

This article illuminates the essence of Neonatal Intensive Care Unit (NICU) nurses' attitudes in skin-to-skin care (SSC) practice for preterm infants and their parents. Health care providers are in a unique position to influence the dynamic between infants and parents, and SSC affects both partners in the dyad. The design is descriptively phenomenological in terms of reflective lifeworld approach. Eighteen Swedish, Danish, and Norwegian nurses from NICUs offering varied possibilities and extents of SSC participated. NICU nurses' attitudes in SSC practice are ambivalent. The nurses consider the sensory, wellness, and mutuality experiences to be primary and vital and enact SSC as much as possible. But "as much as possible" is a broad and varied concept, and their attitudes are ambivalent in terms of not always facilitating what they consider to be the optimal caring conditions. The source of NICU nurses' ambivalent attitudes in SSC practice is a complex interplay of beliefs, norms, and evidence, which have a multidisciplinary basis. The ambivalent attitudes are, to a great extent, the result of the need to balance these multidisciplinary concerns. This needs to be acknowledged in considering SSC practice, as well as acknowledging that clinical judgments concerning optimal SSC depend on parents and infants unlimited access to each other, which NICU nurses can influence.

[Neonatal morbidity and mortality in a low-resource urban district hospital of Douala, Cameroon]

INTRODUCTION

In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals.

METHOD

This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously.

RESULTS

During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemic encephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection.

CONCLUSION

In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account.

Expanded care for women and families after preterm birth

Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent-newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin-to-skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family-centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.

Pain assessment and measurement in neonates: an updated review

Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.

Intermittent kangaroo mother care: a NICU protocol

The practice of kangaroo mother care (KMC) is steadily increasing in high-tech settings due to its proven benefits for both infants and parents. In spite of that, clear guidelines about how to implement this method of care are lacking, and as a consequence, some restrictions are applied in many neonatal intensive care units (NICUs), preventing its practice. Based on recommendations from the Expert Group of the International Network on Kangaroo Mother Care, we developed a hospital protocol in the neonatal unit of the Institute for Maternal and Child Health in Trieste, Italy, a level 3 unit, aimed to facilitate and promote KMC implementation in high-tech settings. Our guideline is therefore proposed, based both on current scientific literature and on practical considerations and experience. Future adjustments and improvements would be considered based on increasing clinical KMC use and further knowledge.

Effect of intermittent kangaroo mother care on weight gain of low birth weight neonates with delayed weight gain

OBJECTIVE

To evaluate intermittent Kangaroo Mother Care (KMC) with additional opportunities to breastfeed on weight gain of low birth weight (LBW) neonates with delayed weight gain.

METHODS

40 LBW neonates were followed to see whether KMC with additional opportunities to breastfeed improved weight gain.

RESULTS

In the KMC group, the mean age of regaining birth weight was significantly less (15.68 vs. 24.56 days) and the average daily weight gain was significantly higher (22.09 vs. 10.39 g, p < .001) than controls.

CONCLUSION

KMC with additional opportunities to breastfeed was found to be an effective intervention for LBWs with delayed weight gain and should be considered to be an effective strategy.

Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices

AIM

To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC.

METHODS

One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109).

RESULTS

The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits.

CONCLUSION

Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.

Translating research findings into practice--the implementation of kangaroo mother care in Ghana

BACKGROUND

Kangaroo mother care (KMC) is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival. Many countries find it difficult to take KMC to scale in healthcare facilities providing newborn care. KMC Ghana was an initiative to scale up KMC in four regions in Ghana. Research findings from two outreach trials in South Africa informed the design of the initiative. Two key points of departure were to equip healthcare facilities that conduct deliveries with the necessary skills for KMC practice and to single out KMC for special attention instead of embedding it in other newborn care initiatives. This paper describes the contextualisation and practical application of previous research findings and the results of monitoring the progress of the implementation of KMC in Ghana.

METHODS

A three-phase outreach intervention was adapted from previous research findings to suit the local setting. A more structured system of KMC regional steering committees was introduced to drive the process and take the initiative forward. During Phase I, health workers in regions and districts were oriented in KMC and received basic support for the management of the outreach. Phase II entailed the strengthening of the regional steering committees. Phase III comprised a more formal assessment, utilising a previously validated KMC progress-monitoring instrument.

RESULTS

Twenty-six out of 38 hospitals (68 %) scored over 10 out of 30 and had reached the level of 'evidence of practice' by the end of Phase III. Seven hospitals exceeded expected performance by scoring at the level of 'evidence of routine and institutionalised practice.' The collective mean score for all participating hospitals was 12.07. Hospitals that had attained baby-friendly status or had been re-accredited in the five years before the intervention scored significantly better than the rest, with a mean score of 14.64.

CONCLUSION

The KMC Ghana initiative demonstrated how research findings regarding successful outreach for the implementation of KMC could be transferred to a different context by making context-appropriate adaptations to the model.

Respostas fisiológicas de recém-nascidos pré-termo submetidos ao Metódo Mãe-Canguru e a posição prona

O Ministério da Saúde recomenda e incentiva a Atenção Humanizada ao recém-nascido de baixo peso utilizando-se o Método Mãe-Canguru (MMC) nas unidades integrantes do Sistema Único de Saúde (SUS). O objetivo deste estudo foi avaliar e comparar as respostas fisiológicas entre o MMC e a posição prona (PP), em recém-nascidos pré-termo (RNPT). Foi feito um estudo de intervenção, realizado entre setembro e outubro de 2009, composto por 20 RNPT, de ambos os sexos, com idade gestacional entre 24 a 36 semanas, estáveis hemodinamicamente, sendo classificados como grupo I (MMC) e grupo II (PP). Foram consideradas as variáveis: frequência cardíaca (FC), frequência respiratória (FR), saturação periférica de oxigênio (SatO2) e temperatura corporal (T). As mensurações foram realizadas por três dias consecutivos, antes e 60 min após a aplicação das técnicas. No grupo PP, a FR aferida antes foi significativamente maior do que a aferida após a intervenção, nos 1º e 3º dias (p<0,0001; p<0,006); enquanto que, no MMC, a FR apresentou diferença significativa somente no 3º dia (p<0,006). A FC apresentou redução entre os momentos no 3º dia, nos grupos PP (p<0,02) e no MMC (p<0,04). No grupo PP, a variável SatO2 apresentou significativo aumento nos 1º (p<0,02) e 3º dias (p<0,02), entre os momentos de coleta, e no 3º dia do MMC (p<0,04). Não foram observadas alterações na FR, FC, T e SatO2 com a aplicação do MMC e PP, não havendo melhor desempenho em relação aos grupos. Observamos diminuição da FR após a aplicação do MMC e PP em momentos isolados e aumento da SatO2 no 3º dia após o MMC.

Kangaroo care for the preterm infant and family

Kangaroo care (KC) is the practice of skin-to-skin contact between infant and parent. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. KC is also beneficial for preterm infants in high-income countries. Cardiorespiratory and temperature stability, sleep organization and duration of quiet sleep, neurodevelopmental outcomes, breastfeeding and modulation of pain responses appear to be improved for preterm infants who have received KC during their hospital stay. No detrimental effects on physiological stability have been demonstrated for infants as young as 26 weeks' gestational age, including those on assisted ventilation. Mothers show enhanced attachment behaviours and describe an increased sense of their role as a mother. The practice of KC should be encouraged in nurseries that care for preterm infants. Information is available to assist in developing guidelines and protocols.

Kangaroo care (KC) is the practice of skin-to-skin contact between infant and parent. In developing countries, KC for low-birthweight infants has been shown to reduce mortality, severe illness, infection and length of hospital stay. KC is also beneficial for preterm infants in high-income countries. Cardiorespiratory and temperature stability, sleep organization and duration of quiet sleep, neurodevelopmental outcomes, breastfeeding and modulation of pain responses appear to be improved for preterm infants who have received KC during their hospital stay. No detrimental effects on physiological stability have been demonstrated for infants as young as 26 weeks’ gestational age, including those on assisted ventilation. Mothers show enhanced attachment behaviours and describe an increased sense of their role as a mother. The practice of KC should be encouraged in nurseries that care for preterm infants. Information is available to assist in developing guidelines and protocols.

Should neonates sleep alone?

BACKGROUND

Maternal-neonate separation (MNS) in mammals is a model for studying the effects of stress on the development and function of physiological systems. In contrast, for humans, MNS is a Western norm and standard medical practice. However, the physiological impact of this is unknown. The physiological stress-response is orchestrated by the autonomic nervous system and heart rate variability (HRV) is a means of quantifying autonomic nervous system activity. Heart rate variability is influenced by level of arousal, which can be accurately quantified during sleep. Sleep is also essential for optimal early brain development.

METHODS

To investigate the impact of MNS in humans, we measured HRV in 16 2-day-old full-term neonates sleeping in skin-to-skin contact with their mothers and sleeping alone, for 1 hour in each place, before discharge from hospital. Infant behavior was observed continuously and manually recorded according to a validated scale. Cardiac interbeat intervals and continuous electrocardiogram were recorded using two independent devices. Heart rate variability (taken only from sleep states to control for level of arousal) was analyzed in the frequency domain using a wavelet method.

RESULTS

Results show a 176% increase in autonomic activity and an 86% decrease in quiet sleep duration during MNS compared with skin-to-skin contact.

CONCLUSIONS

Maternal-neonate separation is associated with a dramatic increase in HRV power, possibly indicative of central anxious autonomic arousal. Maternal-neonate separation also had a profoundly negative impact on quiet sleep duration. Maternal separation may be a stressor the human neonate is not well-evolved to cope with and may not be benign.

Cuidado mãe canguru em recém-nascidos pré-termo sob suporte ventilatório: avaliação dos estados comportamentais

OBJETIVOS: descrever os estados comportamentais dos recém-nascidos com peso inferior a 1500 g, em ventilação mecânica, antes, durante e após o cuidado mãe canguru (CMC). MÉTODOS: estudo do tipo quase experimental em que os estados comportamentais definidos como sono profundo, ativo, sonolência, alerta inativo, alerta ativo e choro de acordo com a Escala Neonatal de Brazelton foram avaliados em três momentos: 15 minutos antes do CMC, 30 minutos após o início da exposição e 15 minutos após o CMC num total de uma hora de exposição. Quarenta e quatro recém-nascidos pré-termo (poder estatístico >0,9), com idade gestacional média de 29 semanas e peso médio de 1096 g, intubados e estáveis do ponto de vista hemo-dinâmico, foram selecionados por amostra de entrada contínua. RESULTADOS: evidenciou-se o favorecimento do sono, principalmente o sono profundo (52,3%), comparado aos períodos antes (6,8%) e após (13,6%) (p<0,001) o CMC. Além disso, os recém-nascidos apresentaram sinais de dor após o CMC com diferença significativa (p=0,002). CONCLUSÕES: o cuidado mãe canguru, nas condições deste estudo, pode ser considerado como uma estratégia favorecedora para o desenvolvimento neurocomportamental.