XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support

AIM

This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC).

METHODS

The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation.

RESULTS

Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability.

CONCLUSION

Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

Quality of attachment in infants less than 1500g or less than 32weeks. Related factors

BACKGROUND

Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment.

OBJECTIVE

To assess the type of attachment in children under 32weeks' gestational age (GA) or below 1500g, in hospitals where development-centred care has been implemented and to study the association between various types of attachment and certain neonatal and family characteristics.

METHOD

Children <1500g or <32weeks GA who were born or admitted before 48h of life to one of two hospitals in Madrid between January and December 2012 were candidates for the study. The type of attachment was assessed through the strange situation procedure (SSP). Attachment was classified according to three types: secure (B), avoidant (A), or resistant/ambivalent (C). Insecure attachment was considered to be A+C. Children were assessed at a corrected age of 2years using the Bayley III Scales and SSP. Data on the characteristics of the parents and children were collected.

RESULTS

A total of 59% (117/199) of the children <1500g or <32weeks GA born in 2012 in the two study hospitals were able to be evaluated. Secure attachment was found in 64% (75/117), avoidant attachment in 12.8% (15/117), and resistant/ambivalent in 23.1% (27/117). The children with secure attachment had a score of 107.6±16 in the cognitive area of the Bayley's Scale versus 98.8±18.8 in those with insecure attachment (p 0.007). Frequency of secure attachment at ≤26weeks GA was 23% (3/13) versus 69% (72/104) in children >26weeks GA (p 0.003).

CONCLUSIONS

Nearly two-thirds of the children studied presented secure attachment, which was associated with better cognitive development. The frequency of secure attachment is lower in the children born more preterm.

Necessary resources and barriers perceived by professionals in the implementation of the NIDCAP

BACKGROUND

The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires a significant effort from all professionals involved.

AIM

To determine the necessary requirements and barriers perceived by health professionals in the implementation of the NIDCAP.

STUDY DESIGN

A questionnaire covering requirements and obstacles perceived in the implementation of the NIDCAP was developed and validated in two Spanish level III neonatal intensive care units. The questionnaire was answered by 305 health professionals (response rate of 85%).

RESULTS

The requirements identified in the questionnaire were considered by most respondents as necessary to implementing the NIDCAP, especially more time, education, and staff. Nurses, compared to doctors, thought that more staff was necessary (93% vs. 74%; p < .01). The main obstacle identified in the survey was lack of coordination among different professionals (77%), followed by noise level in the unit (35%). Doctors, in comparison to nurses, considered noise level (61% vs. 23%; p < .01) and nursing staff (56% vs. 29%; p = .05) the most relevant obstacles to NIDCAP implementation. The more experienced professionals perceived their own colleagues as an obstacle, particularly among nursing staff.

CONCLUSIONS

The implementation of the NIDCAP requires a series of conditions that confirm it is not a trivial process but rather a somewhat laborious one. The lack of coordination among different professionals is often considered the main obstacle.

Staff perceptions on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) during its implementation in two Spanish neonatal units

BACKGROUND

The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires great effort. Few studies evaluating staff perception of NIDCAP exist, especially in Southern Europe, and these few studies usually have a low representation of the medical staff.

AIMS

Exploration of staff perception (neonatologists, nurses and nursing assistants) of NIDCAP during its implementation and their attitude towards it and intention to put it into practice.

STUDY DESIGN

This study is a descriptive survey measuring staff perceptions of NIDCAP and its effects on their work in two Spanish neonatal level III intensive care units (NICUs). Validated questionnaires were distributed to neonatologists, nurses and nursing assistants of which 305 were completed (response rate: 85%).

RESULT

Virtually all the items which assess the infant's well being and the parents' role received a positive evaluation. However, three items got slightly negative evaluations: NIDCAP was more time consuming and nurses' working conditions and lighting in the unit were less optimal than in earlier practices. The professionals also had a positive attitude and a willingness to use the NIDCAP. Neonatologists perceived NIDCAP more positively than the nursing staff with statistically significant differences.

CONCLUSION

The neonatal unit staff in two Spanish NICUs perceived NIDCAP positively. This assessment is more positive for neonatologists than for nurses.