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

Sudden Unexpected Postnatal Collapse: Review and Management

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.

Exploring factors influencing the uptake of kangaroo mother care: key informant interviews with parents

BACKGROUND

The updated World Health Organization (WHO) guideline recommends immediate kangaroo mother care (KMC) for all infants, particularly those born preterm. However, its uptake and sustainability have been unsatisfactory. Therefore, we aimed to gain deeper insight into factors influencing the uptake of KMC practice in our setting, and thereby identify possible solutions for the development of relevant interventions to improve its adoption and make KMC a routine practice for all infants.

METHODS

Using the Triandis model of social behaviour as our framework, we conducted key informant interviews with parents and healthcare providers. Trained interviewers conducted interviews with nine parents, recruited via purposive sampling. These parents were parents of preterm infants who had been introduced to KMC. Data was transcribed and analysed based on Triandis' Theory of Interpersonal Behaviour. This paper only reports the results of the parent interviews.

RESULTS

Major findings were how positive feelings like warmth and contentment, the sense of parenthood with KMC, the benefits of KMC for their infant and parents being enablers for KMC uptake. Conversely, the lack of KMC awareness, the initial negative feelings such as fear, uncertainty and embarrassment, the prioritization of time for milk expression, overcrowding in the ward, lack of space and privacy, limited visiting hours, lack of support and poor communication resulting in misapprehension about KMC were major barriers.

CONCLUSION

A deeper understanding of the factors influencing the uptake of KMC using the Triandis behavioural model provided a way forward to help improve its uptake and sustainability in our settings.

TRIAL REGISTRATION

This study was registered with the National Medical Research Registry (NMRR-17-2984-39191).

Study on the value of KMC combined with blue light irradiation in improving the therapeutic effect of neonatal jaundice

Neonatal jaundice is a common problem that affects newborns. We aim to investigate the effect of Kangaroo Mother Care (KMC) combined with blue-light irradiation on enhancing the therapeutic effect in the treatment of neonatal jaundice. From May 2020 to August 2022, 89 neonates with pathological jaundice and their mothers were selected as participants. All neonates received blue-light irradiation. The participants were divided into two groups: 46 neonates cared for by KMC as the research group (RG) and 43 neonates receiving routine nursing as the control group (CG). The first lactation time, first breastfeeding duration, and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after nursing were recorded and compared between the groups. Pre- and post-interventional total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL) levels of both groups of newborns were measured, and the time of jaundice resolution, first defecation, and meconium yellowing were recorded. Neonatal adverse reactions (ARs) during treatment were counted, and a nursing satisfaction survey was conducted at discharge. KMC group mothers had earlier lactation and longer first breastfeeding durations (P < 0.05). Both groups' SAS and SDS scores decreased post-nursing, with greater improvement in the KMC group (P < 0.05). KMC group newborns had lower bilirubin levels and faster resolution of jaundice and meconium yellowing, with fewer adverse reactions and higher nursing satisfaction (P < 0.05). KMC can effectively improve the efficacy of blue light irradiation in the treatment of neonatal jaundice, and promote the healthy development of newborns and the efficiency of maternal breastfeeding.

Factors associated with skin-to-skin contact less than 180 min/day in newborns weighing up to 1,800 g: multicenter study

This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

Exploring cultural determinants to be integrated into preterm infant care in the neonatal intensive care unit: an integrative literature review

BACKGROUND

Cultural practices are an integral part of childrearing and remain a significant aspect for healthcare professionals to ensure culturally sensitive care, particularly in the neonatal intensive care unit.

OBJECTIVE

To synthesise literature on the cultural determinants that can be integrated into care of preterm infants admitted into the neonatal intensive care unit.

METHODS

The current review followed the integrative literature review steps proposed by Lubbe and colleagues. The registration of the review protocol was in PROSPERO. There was a literature search conducted in the EBSCOhost, PubMed, ScienceDirect and Scopus databases using the search string developed in collaboration with the librarian. Three reviewers employed a three-step screening strategy to screen the articles published in English between 2011 and 2021 that focused on culturally sensitive care. The Johns Hopkins Nursing Evidence-Based Practice Evidence critical appraisal toolkit assessed the methodological quality of the articles included at the full-text screening level.

RESULTS

There were 141 articles retrieved, and 20 included on the full-text screening level; the exclusion of one article was due to a low critical appraisal grade. Four topical themes emerged from 19 articles: spiritual care practices, intragenerational infant-rearing practices, infant physical care practices, and combining treatment practices.

CONCLUSION

Overall, the findings indicated that parental cultural beliefs and practices mostly influenced infant-rearing practices, emphasising the significance of integrating cultural practices when rendering healthcare services. The recommendation is that healthcare professionals understand various cultural determinants, mainly those specific to the community they serve, to provide culturally sensitive care.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

What influences the implementation of kangaroo mother care? An umbrella review

Background

Kangaroo mother care (KMC) is an evidence-based intervention that reduces morbidity and mortality in preterm infants. However, it has not yet been fully integrated into health systems around the world. The aim of this study is to provide a cogent summary of the evidence base of the key barriers and facilitators to implementing KMC.

Methods

An umbrella review of existing reviews on KMC was adopted to identify systematic and scoping reviews that analysed data from primary studies. Electronic English databases, including PubMed, Embase, CINAHL and Cochrane Library, and three Chinese databases were searched from inception to 1 July 2022. Studies were included if they performed a review of barriers and facilitators to KMC. Quality assessment of the retrieved reviews was performed by at least two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal checklist and risk of bias was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. This umbrella review protocol was documented in the PROSPERO registry (CRD42022327994).

Results

We generated 531 studies, and after the removal of duplicates and ineligible studies, six eligible reviews were included in the analysis. The five themes identified were environmental factors, professional factors, parent/family factors, access factors, and cultural factors, and the factors under each theme were divided into barriers or facilitators depending on the specific features of a given scenario.

Conclusions

Support from facility management and leadership and well-trained medical staff are of great significance to the successful integration of KMC into daily medical practice, while the parents of preterm infants and other family members should be educated and encouraged in KMC practice. Further research is needed to propose strategies and develop models for implementing KMC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05163-3.

Maintaining normal temperature immediately after birth in late preterm and term infants: A systematic review and meta-analysis

AIM

Prevention of hypothermia after birth is a global problem in late preterm and term neonates. The aim of this systematic review and meta-analysis was to evaluate delivery room strategies to maintain normothermia and improve survival in late preterm and term neonates (≥34 weeks' gestation).

METHODS

Medline, Embase, CINAHL, CENTRAL and international clinical trial registries were searched. Randomized controlled trials (RCTs), quasi-RCTs and observational studies were eligible for inclusion. Risk of bias for each study and GRADE certainty of evidence for each outcome were assessed.

RESULTS

25 RCTs and 10 non-RCTs were included. Room temperature of 23 °C compared to 20 °C improved normothermia [Risk Ratio (RR), 95% Confidence Interval (CI): 1.26, 1.11-1.42)] and body temperature [Mean Difference (MD), 95% CI: 0.30 °C, 0.23-0.37 °C), and decreased moderate hypothermia (RR, 95% CI: 0.26, 0.16-0.42). Skin to skin care (SSC) compared to no SSC increased body temperature (MD, 95% CI: 0.32, 0.10-0.52), reduced hypoglycemia (RR, 95% CI: 0.16, 0.05-0.53) and hospital admission (RR, 95% CI: 0.34, 0.14-0.83). Though plastic bag or wrap (PBW) alone or when combined with SSC compared to SSC alone improved temperatures, the risk-benefit balance is uncertain. Clinical benefit or harm could not be excluded for the primary outcome of survival for any of the interventions. Certainty of evidence was low to very low for all outcomes.

CONCLUSIONS

Room temperature of 23 °C and SSC soon after birth may prevent hypothermia in late preterm and term neonates. Though PBW may be an effective adjunct intervention, the risk-benefit balance needs further investigation.

Healthcare-Associated Infection Prevention Interventions for Neonates in Resource-Limited Settings

Healthcare-associated infections (HAIs) and antimicrobial-resistant (AMR) infections are leading causes of neonatal morbidity and mortality, contributing to an extended hospital stay and increased healthcare costs. Although the burden and impact of HAI/AMR in resource-limited neonatal units are substantial, there are few HAI/AMR prevention studies in these settings. We reviewed the mechanism of action and evidence supporting HAI/AMR prevention interventions, including care bundles, for hospitalized neonates in low- and middle-income countries (LMIC).