1
|
Pallás-Alonso C, Montealegre A, Hernández-Aguilar MT, Muñoz-Amat B, Collados-Gómez L, Jiménez-Fernández L, García-Lara N, Cabrera-Lafuente M, Moral-Pumarega MT, López-Maestro M, Charpak N. XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support. Acta Paediatr 2023; 112:2478-2485. [PMID: 37667990 DOI: 10.1111/apa.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- Carmen Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Adriana Montealegre
- Fundación Canguro Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Bárbara Muñoz-Amat
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Laura Collados-Gómez
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
- Nursing and Nutrition Department, Faculty of Biomedicine, Universidad Europea, Madrid, Spain
| | | | - Nadia García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Marta Cabrera-Lafuente
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Spanish Neonatal BFHI Coordinator, Madrid, Spain
| | - María Teresa Moral-Pumarega
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - María López-Maestro
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | | |
Collapse
|
2
|
Charpak N, Montealegre-Pomar A. Follow-up of Kangaroo Mother Care programmes in the last 28 years: results from a cohort of 57 154 low-birth-weight infants in Colombia. BMJ Glob Health 2023; 8:bmjgh-2022-011192. [PMID: 37208122 DOI: 10.1136/bmjgh-2022-011192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is an evidence-based intervention focused on premature and low-birth-weight (LBW) infants. In different healthcare systems, outpatient KMC programmes (KMCPs) have been pioneers in the follow-up of these high-risk newborns.Here, we describe an overview analysis performed in an unprecedented data set comprising Colombian infants and spanning 28 years. METHODS Cohort study of 57 154 infants discharged home in kangaroo position (KP) for follow-up in four KMCPs between 1993 and 2021. RESULTS At birth and at hospital discharge to a KMCP, median gestational age and weight were 34.5 and 36 weeks, 2000 g and 2200 g, respectively. Chronological age at admission was 8 days. Over time, anthropometric measures at birth and somatic growth during follow-up improved; on the other hand, percentages of mechanical ventilation, intraventricular haemorrhage and need for intensive care decreased as neuropsychomotor, sensory disorders and bronchopulmonary dysplasia incidence at 40 weeks. Risk of cerebral palsy and teenage mothers' frequency was higher in the poorest population. Early home discharge in KP in less than 72 hours was possible in 19% of the cohort. During the COVID-19 pandemic, we observed a more than twofold increase in exclusive breast feeding at 6 months and a reduction in readmission rates. CONCLUSION This study provides a general overview of KMCPs follow-up during the last 28 years within the Colombian healthcare system. These descriptive analyses have allowed us to structure KMC as an evidence-based method. KMCPs allow close monitoring with regular feedback about preterm or LBW infants' perinatal care, quality of care over time and health status during their first year of life. Monitoring these outcomes is challenging but guarantees access to high-risk infants' care with equity.
Collapse
Affiliation(s)
| | - Adriana Montealegre-Pomar
- Research Group, Kangaroo Foundation, Bogota DC, Colombia
- Facultad de Medicina, Departamento de Pediatría, Pontificia Universidad Javeriana, Bogota, Colombia
- Neonatal Unit, Hospital Universitario San Ignacio, Bogota, Colombia
| |
Collapse
|
3
|
Garzón-Esguerra C, Charpak N, Muñoz-Avendaño FM, Floriano-Parra M, Girón-Giron M. [Impact of a few monthly-delivered groceries on preterm or low-birth-weight infants' nutrition]. Rev Salud Publica (Bogota) 2023; 22:498-505. [PMID: 36753217 DOI: 10.15446/rsap.v22n5.87207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/30/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To both evaluate the nutritional impact of a high-nutritional- valued, monthly-delivered groceries, combined with educational talks addressed to families of premature and/or low birth weight infant (LBW), followed by Kangaroo Mother Care Program (KMCP) in Bogota and Cundinamarca; and identify the risk factors that predispose the onset of malnutrition. METHODS Observational, descriptive, and prospective study of a cohort of 392 children enrolled in 10 KMCP who present in their follow-up a nutritional risk or a malnutrition (Weight <-2 SD [Standard Deviation]); from families with incomes <2 current legal minimum wages and who receive a high-nutritional-valued, monthly-delivered groceries with educational talks after 3 months of corrected age. RESULTS According to the health insurance system, there were no differences in nutritional outcomes. The monthly groceries delivery had no impact on nutrition but on adherence to KMCP. At 40 weeks, 19,2% had a weight of <-2SD, of which 20% had Intrauterine Growth Retardation. At 3 and 12 months of corrected age, 24,5% and 36,5% had a weight of <-2SD, the remaining were at malnutrition risk. Two risk factors were significant: the age of the mother and the level of malnutrition at admission. CONCLUSION A longer follow-up with faster intervention in the KMCP is necessary, to recover and monitor these children at dietary risk or with confirmed malnutrition, aware of the future impact it may have on neurological and cognitive development.
Collapse
Affiliation(s)
- Carolina Garzón-Esguerra
- CG: Enf. Esp. Gerencia de la Salud Pública. M. Sc. Antropología Aplicada: Salud y Desarrollo Comunitario, Fundación Canguro. Bogotá, Colombia.
| | | | - Flor M Muñoz-Avendaño
- FM: Nutricionista. Esp. Gerencia de Proyectos. Secretaria Distrital de Integración Social. Bogotá, Colombia.
| | | | | |
Collapse
|
4
|
Cortés D, Maldonado D, Gallego J, Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Pico J. Comparing long-term educational effects of two early childhood health interventions. J Health Econ 2022; 86:102693. [PMID: 36323186 DOI: 10.1016/j.jhealeco.2022.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/20/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.
Collapse
Affiliation(s)
- Darwin Cortés
- School of Economics, Universidad del Rosario, Colombia.
| | | | - Juan Gallego
- School of Economics, Universidad del Rosario, Colombia
| | | | | | - Juan Gabriel Ruiz
- Department of Medical and Population Health Sciences Research, Herber Wertheim, Florida International University, United States of America
| | | | - Felipe Uriza
- Hospital San Ignacio, Universidad Javeriana, Colombia
| | - Julieth Pico
- School of Economics, Universidad del Rosario, Colombia
| |
Collapse
|
5
|
Cristo Borrero M, Goretty Trujillo T, Sanchez C, Salazar A, Cárdenas MP, Charpak N. Bayley-III and Griffiths-II scales performance in a cohort of premature infants followed in Colombia. Early Hum Dev 2022; 173:105660. [PMID: 36058138 DOI: 10.1016/j.earlhumdev.2022.105660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
|
6
|
Charpak N, Tessier R, Ruiz JG, Uriza F, Hernandez JT, Cortes D, Montealegre‐Pomar A. Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm. Acta Paediatr 2022; 111:1004-1014. [PMID: 35067976 PMCID: PMC9303677 DOI: 10.1111/apa.16265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Aim The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. Method Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20‐year‐old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. Results The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. Conclusion Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.
Collapse
Affiliation(s)
| | | | - Juan Gabriel Ruiz
- Department of Medical and Population Health Sciences Research Herber Wertheim Florida International University Miami Florida USA
| | - Felipe Uriza
- Hospital San Ignacio Universidad Javeriana Bogota Colombia
| | | | - Darwin Cortes
- Economics Department Universidad del Rosario Bogota Colombia
| | - Adriana Montealegre‐Pomar
- Fundación Canguro/Kangaroo Foundation Bogota Colombia
- Hospital San Ignacio Universidad Javeriana Bogota Colombia
| |
Collapse
|
7
|
Montealegre‐Pomar A, Charpak N. Individual factors determine how long infants born preterm or with a low birth weight need to be kept in the Kangaroo position. Acta Paediatr 2022; 111:305-306. [PMID: 34713499 DOI: 10.1111/apa.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Adriana Montealegre‐Pomar
- Newborn Unit Kangaroo Foundation Hospital Universitario San Ignacio Pontificia Universidad Javeriana Bogotá Colombia
| | - Nathalie Charpak
- Kangaroo Foundation Scientific Coordination of the Kangaroo Mother Care Program Hospital Universitario San Ignacio Bogotá Colombia
| |
Collapse
|
8
|
Montealegre-Pomar ADP, Charpak N. Randomized Clinical Trial of Metoclopramide as Prophylaxis of Gastroesophageal Reflux Disease in Preterm Infants. Paediatr Drugs 2021; 23:591-599. [PMID: 34693501 DOI: 10.1007/s40272-021-00475-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gastroesophageal reflux (GER) is more frequent in premature infants. Metoclopramide was introduced routinely in premature babies followed in ambulatory care by the Colombian Kangaroo Mother Care program (KMCP), based on a 2004 Cochrane review. AIM Because of the recent controversy on the use of metoclopramide in children, this study was conducted to evaluate the effectiveness and safety of metoclopramide given as GER disease (GERD) prophylaxis. METHODS A randomized clinical trial was conducted between April 2017 and January 2019 in 466 premature infants discharged home and followed at a KMCP. Double-blind allocation to metoclopramide versus placebo was performed, 0.2 mg/kg three times daily, administered 15 min before feeding, up to term. Exclusion criteria were oxygen dependency, any perinatal neurological problem or parent's participation refusal. The incidence of GERD symptoms and adverse events that could be associated with the use of metoclopramide were recorded by parents weekly (e.g., emesis, cyanosis or apnea, post-prandial crying episodes, extrapyramidal symptoms, tremor, and drowsiness). RESULTS A total of 466 subjects were recruited, most of them late preterm. The groups' baseline characteristics were similar. Median duration of the intervention was approximately 3 weeks, at which time most patients were at term. In the longitudinal mixed effects analysis, we did not find clinically significant differences in GERD-related symptoms between groups, either in minor or severe side effects. CONCLUSION Results show absence of effectiveness in the systematic use of metoclopramide as prophylaxis of GERD symptoms in premature infants. Additionally, no adverse effects attributable to the drug were found. ClinicalTrials.gov: NCT02907632; September 20, 2016. Retrospectively registered.
Collapse
Affiliation(s)
- Adriana Del Pilar Montealegre-Pomar
- Pediatrics Department, Pontificia Universidad Javeriana, Carrera 7 No 40-62, Bogotá, Colombia.
- Hospital Universitario San Ignacio, Bogotá, Colombia.
| | | |
Collapse
|
9
|
Montealegre-Pomar ADP, Charpak N. Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants. Pediatr Pulmonol 2021; 56:1601-1608. [PMID: 33524247 DOI: 10.1002/ppul.25288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS A prospective cohort study. Descriptive and multivariate analysis. RESULTS Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.
Collapse
Affiliation(s)
- Adriana Del Pilar Montealegre-Pomar
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Nathalie Charpak
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
10
|
Charpak N, Montealegre‐Pomar A, Bohorquez A. Systematic review and meta-analysis suggest that the duration of Kangaroo mother care has a direct impact on neonatal growth. Acta Paediatr 2021; 110:45-59. [PMID: 32683720 DOI: 10.1111/apa.15489] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
AIM A 2016 Cochrane review showed that Kangaroo mother care (KMC) had a moderate impact on preterm growth, with high heterogeneity among studies. This systematic review and meta-analysis considered new evidence on KMC, particularly the duration. METHOD Databases were searched for papers published in English, French, Spanish and Portuguese up to 2017. Randomised controlled trials (RCT) of preterm or low birth weight infants were included if they compared growth between KMC and conventional care. Anthropometric measures were related to duration. RESULTS We identified 1368 papers, and 13 RCTs covering 743 KMC infants and 718 controls met the selection criteria. Infants held in KMC for at least 6 h/d gained more weight than the controls, with a mean difference of 8.99 g/d (95% confidence interval 8.14-9.84, I2 = 0%). This difference persisted between 2 and 6 h/d and disappeared with 2 hours or less. When we used g/kg/d, the weight gain was higher when the duration was at least 8 h/d. Only babies who received 6 h/d gained more length and head circumference. CONCLUSIONS The effect of the KMC on growth was directly related to the duration.
Collapse
Affiliation(s)
- Nathalie Charpak
- Kangaroo Foundation Bogotá Colombia
- Department of Pediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| | - Adriana Montealegre‐Pomar
- Kangaroo Foundation Bogotá Colombia
- Department of Pediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| | - Adriana Bohorquez
- Department of Psychiatry and Mental Health Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| |
Collapse
|
11
|
Charpak N, Angel MI, Banker D, Bergh A, María Bertolotto A, De Leon‐Mendoza S, Godoy N, Lincetto O, Lozano JM, Ludington‐Hoe S, Mazia G, Mokhachane M, Montealegre A, Ramirez E, Sirivansanti N, Solano JM, Day LT, Uy ME. Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale. Acta Paediatr 2020; 109:2278-2286. [PMID: 32027398 PMCID: PMC7687100 DOI: 10.1111/apa.15214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.
Collapse
Affiliation(s)
| | | | - Deepa Banker
- SMT NHL Municipal Medical College Ahmedabad India
| | - Anne‐Marie Bergh
- SAMRC Unit for Maternal and Infant Health Care Strategies University of Pretoria Pretoria South Africa
| | | | | | | | - Ornella Lincetto
- Maternal Newborn Child and Adolescent Health Department World Health Organization Geneva Switzerland
| | - Juan M. Lozano
- Department of Medical and Population Health Sciences Research Herbert Wertheim College of Medicine Florida International University Miami FL USA
| | - Susan Ludington‐Hoe
- FP Bolton School of Nursing Case Western Reserve University Cleveland OH USA
| | - Goldy Mazia
- Global Health Department Save the Children Washington D.C. USA
| | - Mantoa Mokhachane
- Unit of Undergraduate Medical Education (UUME) Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Adriana Montealegre
- Fundación Canguro Bogotá Colombia
- Department of Pediatrics Pontificia Universidad Javeriana Bogotá Colombia
| | - Erika Ramirez
- Department of Sexuality Sexual Rights and Reproductive Rights Ministry of Health Bogotá Colombia
| | - Nicole Sirivansanti
- Department of Maternal, Newborn and Child Health Bill and Melinda Gates Foundation Seattle WA USA
| | | | - Louise-Tina Day
- MARCH Centre for Maternal, Adolescent Reproductive & Child Health London School of Hygiene & Tropical Medicine London UK
| | - Maria Esterlita Uy
- Institute of Child Health and Human Development National Institutes of Health University of the Philippines Manila Manila Philippines
| |
Collapse
|
12
|
Montealegre‐Pomar A, Bohorquez A, Charpak N. Systematic review and meta-analysis suggest that Kangaroo position protects against apnoea of prematurity. Acta Paediatr 2020; 109:1310-1316. [PMID: 31916621 DOI: 10.1111/apa.15161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/26/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine whether the Kangaroo position decreased apnoea events in preterm newborns compared with conventional care in incubator. METHODS We conducted a systematic review of clinical trials published in English, French, Spanish and Portuguese. A comprehensive literature search was realised until 2017. The main outcome was apnoea events. Data were extracted and combined in a fixed-effects model. The quality of the evidence was assessed according to the GRADE framework (grading the quality of evidence and the strength of recommendations). RESULTS Four original clinical trials were selected. These trials were conducted in India and Nepal, between 2005 and 2016. The systematic review comprised 416 preterm newborns. Three studies were randomised controlled trials and one was quasi-experimental. Meta-analysis showed a statistically significant reduction in apnoea episodes (relative risk [RR] 0.41; 95% confidence interval [CI] 0.22, 0.78). The result remained significant when only the three clinical trials were analysed (RR 0.43; 95% CI 0.23, 0.83). Quality analysis indicated moderate quality because of lack of an appropriate method of randomisation in one study. CONCLUSION The Kangaroo position could have protective effect against apnoea events in preterm infants, decreasing the associated risk of death or long-term disability.
Collapse
Affiliation(s)
- Adriana Montealegre‐Pomar
- Department of Paediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
- Kangaroo Foundation Bogotá Colombia
| | - Adriana Bohorquez
- Department of Clinical Epidemiology Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
| | - Nathalie Charpak
- Department of Paediatrics Faculty of Medicine Pontificia Universidad Javeriana Bogotá Colombia
- Kangaroo Foundation Bogotá Colombia
| |
Collapse
|
13
|
Charpak N, Ruiz-Pelaez JG. Improving survival of infants with low birthweight cared for outside hospitals. Lancet 2019; 394:1688-1690. [PMID: 31590990 DOI: 10.1016/s0140-6736(19)32257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nathalie Charpak
- San Ignacio Teaching Hospital, Javeriana University, Bogota 110231, Colombia; Kangaroo Foundation of Bogota, Bogota, Colombia.
| | - Juan G Ruiz-Pelaez
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| |
Collapse
|
14
|
Aldana Acosta AC, Tessier R, Charpak N, Tarabulsy G. Randomised controlled trial on the impact of kinesthetic stimulation on early somatic growth of preterm infants in Kangaroo position. Acta Paediatr 2019; 108:1230-1236. [PMID: 30506594 DOI: 10.1111/apa.14675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022]
Abstract
AIM Evaluation of early growth in preterm infants receiving kinesthetic stimulation with massage in Kangaroo position or in incubator. METHODS A cohort of 66 infants between 30 and 33 weeks of gestational age (GA), born at a university hospital in 2013 in Bogota, were randomised when eligible to intervention. We measured weight gain (g/kg/day) at five days and 15 days postrandomisation and weight at 40 weeks, according to chronological age at randomisation. RESULTS Daily weight gain was significantly higher (p = 0.02) with kinesthetic stimulation in Kangaroo position with a growth at five days of 11.0 g/kg/day (95% CI 5.7;16.3) and at 15 days of 12.1 g/kg/day (95% CI 10.4;13.7) versus 2.1 g/kg/day (95% CI -3.1;7.4) at five days and 9.4 g/kg/day (95% CI 7.7;11.1) at 15 days in incubator. Weight at 40 weeks was higher (p = 0.05) in Kangaroo position group (2.904 g) than in incubator group (2.722 g) (95% CI 2.784;3.007). Daily weight gain according to chronological age at randomisation was higher when kinesthetic stimulation initiates before five days of life in Kangaroo position with 1.53 g/kg/day (95% CI 5.9;9.0) versus -11.9 g/kg/day (95% CI -19.0;-4.8) in incubator. CONCLUSION Early kinesthetic stimulation in Kangaroo position reduces the initial weight loss in infants between 30-33 weeks born without major health problems.
Collapse
Affiliation(s)
| | - Rejean Tessier
- Department of Psychology Laval University Quebec City QC Canada
| | | | - George Tarabulsy
- Department of Psychology Laval University Quebec City QC Canada
- CRUJeF Laval University Quebec City QC Canada
| |
Collapse
|
15
|
Montealegre A, Charpak N, Parra A, Devia C, Coca I, Bertolotto AM. [Effectiveness and safety of two phototherapy devices for the humanised management of neonatal jaundice]. An Pediatr (Barc) 2019; 92:79-87. [PMID: 30979682 DOI: 10.1016/j.anpedi.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Neonatal jaundice is common, especially in premature infants. Compliance with treatment protocols and standard serum bilirubin curves forces the clinician to separate the child from the mother after birth for short phototherapy. The objective of this study is to evaluate the effectiveness and safety of two innovative devices for phototherapy including a LED light mesh: one sleeping bag and one blanket compared to conventional hospital or ambulatory phototherapy. METHODS Two randomised clinical trials were conducted: one with newborns >2,000g at birth in the Neonatal Care Unit and the other with premature infants followed-up in an outpatient clinic (PMC). The gold standard for bilirubin measurement was serum bilirubin, and ambulatory controls were performed with the Bilicheck®. Parents and health personnel completed a questionnaire on comfort and perceptions. RESULTS In the study using the bag, a linear regression was performed for the decrease in bilirubin in mg/dL/h, controlling by early jaundice (<36h) and the device type. The results were similar between the 2 devices. For the blanket trial in the PMC, the decrease in bilirubin levels with the new device was significantly greater with no differences in temperatures, duration of phototherapy, re-admission, mortality, or side effects for both trials. Parents and staff satisfaction with the two devices was identical for the 2 trials. CONCLUSION These 2 small studies add a 'grain of sand' to humanisation of newborn care, avoiding the mother-and-child separation for both the intra-hospital high-risk hyperbilirubinaemia, as well as for the lower-risk hyperbilirubinaemia in an outpatient clinic.
Collapse
Affiliation(s)
- Adriana Montealegre
- Hospital Universitario San Ignacio, Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Colombia; Fundación Canguro, Bogotá, Colombia.
| | - Nathalie Charpak
- Pontificia Universidad Javeriana, Bogotá, Colombia; Fundación Canguro, Bogotá, Colombia; Programa Madre Canguro Integral, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Adriana Parra
- Programa Madre Canguro Integral, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Claudia Devia
- Hospital Universitario San Ignacio, Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Isabel Coca
- Hospital Universitario San Ignacio, Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana María Bertolotto
- Hospital Universitario San Ignacio, Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
16
|
Cattaneo A, Amani A, Charpak N, De Leon-Mendoza S, Moxon S, Nimbalkar S, Tamburlini G, Villegas J, Bergh AM. Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future. BMC Pregnancy Childbirth 2018; 18:170. [PMID: 29769056 PMCID: PMC5956892 DOI: 10.1186/s12884-018-1819-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 05/02/2018] [Indexed: 01/05/2023] Open
Abstract
Background Globally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries. Findings Barriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants. Conclusion It is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.
Collapse
Affiliation(s)
- Adriano Cattaneo
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Adidja Amani
- Child and Newborn Health, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Sarah Moxon
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Anne-Marie Bergh
- SAMRC Research Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa.
| |
Collapse
|
17
|
Ropars S, Tessier R, Charpak N, Uriza LF. The long-term effects of the Kangaroo Mother Care intervention on cognitive functioning: Results from a longitudinal study. Dev Neuropsychol 2018; 43:82-91. [DOI: 10.1080/87565641.2017.1422507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stéphanie Ropars
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Réjean Tessier
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | | | - Luis Felipe Uriza
- Department of Radiology, Pontifica Universidad Javeriana, Bogota, Colombia
| |
Collapse
|
18
|
Montealegre A, Charpak N, Grosso Z, Vargas Y, Villegas J. Concordance between serum and transcutaneous bilirubin levels with the Bilispect®. IJBET 2018. [DOI: 10.1504/ijbet.2018.095990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Montealegre Pomar ADP, Sierra Andrade AP, Charpak N. El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro. Rev Salud Publica (Bogota) 2018; 20:10-16. [DOI: 10.15446/rsap.v20n1.67974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivo En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015.Materiales y Métodos Estudio de cohorte prospectiva.Resultados Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%.Conclusiones Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.
Collapse
|
20
|
Vargas Y, Grosso Z, Villegas J, Montealegre A, Charpak N. Concordance between serum and transcutaneous bilirubin levels with the Bilispect®. IJBET 2018. [DOI: 10.1504/ijbet.2018.10017208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
21
|
Suffren S, Angulo D, Ding Y, Reyes P, Marin J, Hernandez JT, Charpak N, Lodygensky GA. Long-term attention deficits combined with subcortical and cortical structural central nervous system alterations in young adults born small for gestational age. Early Hum Dev 2017; 110:44-49. [PMID: 28544954 DOI: 10.1016/j.earlhumdev.2017.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Being born small for gestational age has been associated with neurodevelopmental disabilities and smaller gray matter volumes in childhood. However, it is not known if these changes persist in adults and whether SGA has any impact on attention memory and IQ. AIMS The goal of this study was to evaluate the association between birth weight and gray matter anatomy in adults born small for gestational age at term, in relation to IQ, attention and memory. MATERIALS AND METHODS This prospective follow-up study at age 20 included 39 adults born small for gestational age at term and 37 adults born appropriate for gestational age at term. Detailed neurocognitive skills were assessed (IQ, attention and memory). Anatomical images were analyzed using Voxel-Based-Morphometry and FreeSurfer. RESULTS Adults born small for gestational age at term had lower performances in subtests assessing attention and executive functions. They also showed smaller total intracranial volume; smaller volumes and surface areas in the frontal lobe, inferior/middle parietal and temporal gyrus; smaller cerebellum, thalamus and basal ganglia volumes. Interestingly, all these structures correlated with attention subtests. CONCLUSION These results highlight the persistent effects of being born small for gestational age on attention and associated brain structures.
Collapse
Affiliation(s)
- Sabrina Suffren
- Research Center, Sainte-Justine University Hospital, 3175, Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T1C5, Canada
| | - Diego Angulo
- ImExHS, Imex-Research, Calle 93 # 16 - 46, Of 502, Edificio Zen Office, Bogotá, Colombia; Kangaroo Foundation, Bogotá, Colombia; IMAGINE, Systems and Computing Engineering, Universidad de los Andes, Bogotá, Colombia
| | - Yang Ding
- Research Center, Sainte-Justine University Hospital, 3175, Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T1C5, Canada
| | - Pablo Reyes
- Kangaroo Foundation, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Jorge Marin
- Fundación Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Jose T Hernandez
- IMAGINE, Systems and Computing Engineering, Universidad de los Andes, Bogotá, Colombia
| | | | - Gregory A Lodygensky
- Research Center, Sainte-Justine University Hospital, 3175, Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T1C5, Canada; Department of Pediatrics and Pharmacology, University of Montreal, C.P.6128, succursale Centre-ville, Montreal, Quebec H3C3J7, Canada.
| |
Collapse
|
22
|
Charpak N, Ruiz JG. Latin American Clinical Epidemiology Network Series – Paper 9: The Kangaroo Mother Care Method: from scientific evidence generated in Colombia to worldwide practice. J Clin Epidemiol 2017; 86:125-128. [PMID: 27765653 DOI: 10.1016/j.jclinepi.2016.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Nathalie Charpak
- Fundación Canguro/Kangaroo Foundation, Calle 44 b, #53-50, La Esmeralda, Bogotá, Colombia.
| | - Juan Gabriel Ruiz
- Fundación Canguro/Kangaroo Foundation, Calle 44 b, #53-50, La Esmeralda, Bogotá, Colombia; Department of Epidemiology, Pontificia Universidad Javeriana, Carrera 7, #40-62, Bogotá, Colombia; Department of Biostatistics, Hospital Universitario San Ignacio, Carrera 7, #40-62, Bogotá, Colombia
| |
Collapse
|
23
|
Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, Nadeau L, Mercier C, Maheu F, Marin J, Cortes D, Gallego JM, Maldonado D. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 2017; 139:peds.2016-2063. [PMID: 27965377 DOI: 10.1542/peds.2016-2063] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother-infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood. METHODS From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests. RESULTS The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group. CONCLUSIONS This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.
Collapse
Affiliation(s)
| | | | - Juan G Ruiz
- Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Felipe Uriza
- Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Line Nadeau
- Université Laval, Québec City, Québec, Canada
| | | | | | - Jorge Marin
- Hospital Universitario Infantil San José, Bogotá, Colombia; and
| | | | | | | |
Collapse
|
24
|
Angulo DA, Schneider C, Oliver JH, Charpak N, Hernandez JT. A Multi-facetted Visual Analytics Tool for Exploratory Analysis of Human Brain and Function Datasets. Front Neuroinform 2016; 10:36. [PMID: 27601990 PMCID: PMC4993811 DOI: 10.3389/fninf.2016.00036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/13/2022] Open
Abstract
Brain research typically requires large amounts of data from different sources, and often of different nature. The use of different software tools adapted to the nature of each data source can make research work cumbersome and time consuming. It follows that data is not often used to its fullest potential thus limiting exploratory analysis. This paper presents an ancillary software tool called BRAVIZ that integrates interactive visualization with real-time statistical analyses, facilitating access to multi-facetted neuroscience data and automating many cumbersome and error-prone tasks required to explore such data. Rather than relying on abstract numerical indicators, BRAVIZ emphasizes brain images as the main object of the analysis process of individuals or groups. BRAVIZ facilitates exploration of trends or relationships to gain an integrated view of the phenomena studied, thus motivating discovery of new hypotheses. A case study is presented that incorporates brain structure and function outcomes together with different types of clinical data.
Collapse
Affiliation(s)
- Diego A Angulo
- IMAGINE, Systems and Computing Engineering, Universidad de los Andes Bogota, Colombia
| | | | | | | | - Jose T Hernandez
- IMAGINE, Systems and Computing Engineering, Universidad de los Andes Bogota, Colombia
| |
Collapse
|
25
|
Charpak N, de la Hoz AM, Villegas J, Gil F. Discriminant ability of the Infant Neurological International Battery (INFANIB) as a screening tool for the neurological follow-up of high-risk infants in Colombia. Acta Paediatr 2016; 105:e195-9. [PMID: 26913581 DOI: 10.1111/apa.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 01/03/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to assess the discriminative ability of the Infant Neurological International Battery (INFANIB), applied at 3, 6 and 9 months of corrected age (CA), on neurological outcomes at 1 year of CA. METHOD An observational analytic study was conducted on a cohort of 5857 infants, followed up to 1 year of CA in a Kangaroo Mother Care programme from 1993 to 2010 in Bogotá, Colombia. Infants were included if they had two complete INFANIB results at 3 or 6 or 9 months of CA and at 12 months of CA, including the Griffiths Scale. The outcome was defined as the presence of a neurological abnormality, as evidenced by the results of both the INFANIB and Griffiths Scale. RESULTS The sensitivity of the INFANIB at 3 months was 62.2%, and specificity was 76.1%, with a receiver operating characteristic (ROC) area of 0.69. At 6 months, the results were 77.5% for sensitivity and 74.4% for specificity (ROC 0.76), and at 9 months, they were 77.2% for sensitivity and 91.1% for specificity (ROC 0.84). CONCLUSION The INFANIB was an appropriate neurological screening test with regard to determining which Colombian infants would benefit from a timely intervention for neuromotor disorders.
Collapse
Affiliation(s)
| | - Ana María de la Hoz
- Pontificia Universidad Javeriana; Bogotá Colombia
- Hospital Universitario San Ignacio; Bogotá Colombia
| | | | - Fabián Gil
- Pontificia Universidad Javeriana; Bogotá Colombia
- Hospital Universitario San Ignacio; Bogotá Colombia
| |
Collapse
|
26
|
Charpak N, Montealegre-Pomar A. Calidad del seguimiento clínico y neurológico en una cohorte de recién nacidos muy prematuros, 2002-2012. Rev Salud Publica (Bogota) 2015; 17:500-513. [DOI: 10.15446/rsap.v17n4.53273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/09/2015] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Objetivo </strong>Explorar el curso clínico de una cohorte de recién-nacidos <1000gr o <29 semanas de edad gestacional al nacer, luego del alta del Programa Madre Canguro (PMC).</p><p><strong>Método</strong> Encuesta telefónica a padres de una cohorte retrospectiva de 569 prematuros manejados en tres PMC entre 2002 y 2012.</p><p><strong>Resultados</strong> Se contactó 65,4 % de la cohorte a una mediana de edad de 4 años. 34 pacientes (6 %) fallecieron, 65 % en los primeros 6 meses de vida. Se rehospitalizaron 63 %. 32 % presentaban antecedente de hemorragia intraventricular, 30 % tenían enfermedad Pulmonar Crónica, 5,2 % parálisis cerebral o retardo mental y 2,7 % convulsiones. 72 % se controlaron por Pediatra, 65 % necesitaron terapia física y 39 % terapia del lenguaje. 7 % repitieron años escolares y 9 % de los mayores de 4 años no había iniciado escritura. 4 % de los que ya escribían, presentaba dificultades. 81 % de los mayores de 6 años presentaba dificultad para vestirse, 55 % no practicaba ningún deporte.</p><p><strong>Discusión </strong>Los prematuros extremamente inmaduros o de bajo peso tienen una tasa elevada de secuelas respiratorias y neurológicas que impactan su calidad de vida y la de su familia. Es importante continuar con un seguimiento estricto después de 12 meses para detectar y manejar a tiempo las alteraciones del desarrollo neuro-psicomotor. </p>
Collapse
|
27
|
Ruiz-Peláez JG, Charpak N. [Bronchopulmonary dysplasia epidemic: incidence and associated factors in a cohort of premature infants in Bogotá, Colombia]. Biomedica 2014; 34:29-39. [PMID: 24967857 DOI: 10.1590/s0120-41572014000100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 07/19/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION There is a perception that bronchopulmonary dysplasia incidence has increased in Bogotá since 2000. This study estimates its incidence, compares it with historical data and describes associated factors. MATERIALS AND METHODS We carried out a prospective analytical cohort of preterm newborns =34 weeks of gestational age without major malformations from 12 health facilities from Bogotá in 2004. The main outcomes were incidence and severity of bronchopulmonary dysplasia, which were compared with an historical cohort (1994-1999). RESULTS Neonatal mortality was 80/496, and the bronchopulmonary dysplasia incidence was 54.3% (95% CI, 49.4-59.1). When controlling for type of institution (low and high mortality) it appeared that being born in an institution with low mortality decreased the risk for death (OR=0.308; 95% CI, 0.129-0.736) but increased the odds for moderate-severe bronchopulmonary dysplasia (OR=1.797; 95% CI, 1.046-3.088). The risk for bronchopulmonary dysplasia was higher than for the historical control cohort (RR=1.924; 95% CI, 1.686-2.196). Weight and gestational age at birth, mechanical ventilation, intrauterine growth restriction and type of institution (low vs. intermediate-high mortality) were independently associated with bronchopulmonary dysplasia of increasing severity or even death. CONCLUSIONS The frequency of bronchopulmonary dysplasia in Bogotá has increased markedly, and this cannot be explained solely by better survival of more fragile infants. Survivors-irrespective from gestational age-- have more frequent and more severe respiratory sequels. Probably suboptimal aggressive respiratory care practices associated with a recent transition from restricted to almost universal access to mechanical ventilation in neonatal intensive care units in Bogota might be compromising the quality of neonatal respiratory care.
Collapse
Affiliation(s)
- Juan G Ruiz-Peláez
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
| | | |
Collapse
|
28
|
Charpak N, Ruiz JG, Motta S. [The clinical course and one year forcast for a cohort of premature infants who were discharged with home oxygen in Bogota, Colombia]. Rev Salud Publica (Bogota) 2012; 14:102-15. [PMID: 23250319 DOI: 10.1590/s0124-00642012000100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 02/25/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Documenting the clinical course and forecast for a concurrent cohort of discharged preterm infants who received home oxygen in Bogota, Colombia. METHODS This was a prospective study of a concurrent cohort of 194 newborn infants having 34 weeks gestational age (GA) or less at birth who were born in 12 institutions and followed up for one year of corrected age to assess mortality, morbidity, growth and development. RESULTS Oxygen dependency was mild in 49 infants (25.3 %) and moderate-severe in 145 of them (74.7 %). There were 3 deaths; vital status was known in 169 infants at 40 weeks GA (87.1 %) and 103 (53%) at 1 year. Breast feeding at term was successful in 147 (75.8 %) infants. Growth indices at one year were appropriate (8,991 g weight, 73 cm height and 46.2 cm head circumference) 74.1 % of the cohort were still receiving home oxygen at 40 weeks and and 22.7 % at 3 months and oxygen was discontinued on average on postnatal day 109. 56.8 % of the cohort were readmitted to hospital at least once, 47% of them because of respiratory conditions. Only 71 % had ophthalmological screening and retinopathy of prematurity (ROP) was detected in 38 % of cases (4 severe cases: 3 laser surgery and 1 blind infant). Neuro-psychomotor and sensorial screening tests were only performed on 19 % of the infanys. CONCLUSION More than 60 % of newborn infants discharged with home oxygen lacked structured follow-up. Oxygen-dependancy in infants is complex; our data suggested that there is plenty of room for improvement in Bogotá in that respect.
Collapse
|
29
|
Schneider C, Charpak N, Ruiz-Peláez JG, Tessier R. Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects. Acta Paediatr 2012; 101:1045-53. [PMID: 22734793 DOI: 10.1111/j.1651-2227.2012.02770.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Given that prematurity has deleterious effects on brain networking development beyond childhood, the study explored whether an early intervention such as Kangaroo Mother Care (KMC) in very preterm preemies could have influenced brain motor function up to adolescence. METHODS Transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (M1) of 39 adolescents born very prematurely (<33 weeks' gestational age, 21 having received KMC after birth, 18 Controls with no KMC) and nine adolescents born at term (>37 weeks' gestational age, >2500 g) to assess the functional integrity of motor circuits in each hemisphere (motor planning) and between hemispheres (callosal function). RESULTS All TMS outcomes were similar between KMC and term adolescents, with typical values as in healthy adults, and better than in Controls. KMC adolescents presented faster conduction times revealing more efficient M1 cell synchronization (p < 0.05) and interhemispheric transfer time (p < 0.0001), more frequent inhibitory processes with a better control between hemispheres (p < 0.0001). CONCLUSION The enhanced synchronization, conduction times and connectivity of cerebral motor pathways in the KMC group suggests that the Kangaroo Mother Care positively influenced the premature brain networks and synaptic efficacy up to adolescence.
Collapse
Affiliation(s)
- Cyril Schneider
- Clinical neuroscience and neurostimulation laboratory, Centre de recherche du CHUQ, Québec, QC, Canada.
| | | | | | | |
Collapse
|
30
|
Charpak N, Gabriel Ruiz J. KMC, Concepts, Definitions and Praxis: What Elements are Applicable in What Settings in Which Local Circumstances? CWHR 2011. [DOI: 10.2174/157340411796355180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
31
|
Charpak N, Gabriel Ruiz J. Editorial from Guest Editor [Hot Topic:Kangaroo Mother Care: Past, Present and Future (Guest Editors: Nathalie Charpak and Juan Gabriel Ruiz)]. CWHR 2011. [DOI: 10.2174/157340411796355225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
32
|
Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, Ewald U, Ludington-Hoe S, Mendoza S, Pallás-Allonso C, Peláez JG, Sizun J, Wiström AM. State of the art and recommendations. Kangaroo mother care: application in a high-tech environment. Breastfeed Rev 2010; 18:21-28. [PMID: 21226419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low-income settings, the original KMC modelis implemented. This consists of continuous (24 h/day; 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding and, adequate follow up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC modelin all types of settings was discussed at the 7th International Workshop on KMC Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents'role, modification of the NICU environment, performance of care in KMC, and KMCin case of infant instability. CONCLUSION Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.
Collapse
Affiliation(s)
- K H Nyqvist
- Department of Women's and Children's Health, University Hospital, Uppsala, Sweden.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, Ewald U, Ibe O, Ludington-Hoe S, Mendoza S, Pallás-Allonso C, Ruiz Peláez JG, Sizun J, Widström AM. Towards universal Kangaroo Mother Care: recommendations and report from the First European conference and Seventh International Workshop on Kangaroo Mother Care. Acta Paediatr 2010; 99:820-6. [PMID: 20219044 DOI: 10.1111/j.1651-2227.2010.01787.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The hallmark of Kangaroo Mother Care (KMC) is the kangaroo position: the infant is cared for skin-to-skin vertically between the mother's breasts and below her clothes, 24 h/day, with father/substitute(s) participating as KMC providers. Intermittent KMC (for short periods once or a few times per day, for a variable number of days) is commonly employed in high-tech neonatal intensive care units. These two modalities should be regarded as a progressive adaptation of the mother-infant dyad, ideally towards continuous KMC, starting gradually and progressively with intermittent KMC. The other components in KMC are exclusive breastfeeding (ideally) and early discharge in kangaroo position with strict follow-up. Current evidence allows the following general statements about KMC in affluent and low-income settings: KMC enhances bonding and attachment; reduces maternal postpartum depression symptoms; enhances infant physiologic stability and reduces pain, increases parental sensitivity to infant cues; contributes to the establishment and longer duration of breastfeeding and has positive effects on infant development and infant/parent interaction. Therefore, intrapartum and postnatal care in all types of settings should adhere to a paradigm of nonseparation of infants and their mothers/families. Preterm/low-birth-weight infants should be regarded as extero-gestational foetuses needing skin-to-skin contact to promote maturation. CONCLUSION Kangaroo Mother Care should begin as soon as possible after birth, be applied as continuous skin-to-skin contact to the extent that this is possible and appropriate and continue for as long as appropriate.
Collapse
|
34
|
Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, Ewald U, Ludington-Hoe S, Mendoza S, Pallás-Allonso C, Peláez JG, Sizun J, Widström AM. State of the art and recommendations. Kangaroo mother care: application in a high-tech environment. Acta Paediatr 2010; 99:812-9. [PMID: 20219028 DOI: 10.1111/j.1651-2227.2010.01794.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Since Kangaroo Mother Care (KMC) was developed in Colombia in the 1970s, two trends in clinical application emerged. In low income settings, the original KMC model is implemented. This consists of continuous (24 h/day, 7 days/week) and prolonged mother/parent-infant skin-to-skin contact; early discharge with the infant in the kangaroo position; (ideally) exclusive breastfeeding; and, adequate follow-up. In affluent settings, intermittent KMC with sessions of one or a few hours skin-to-skin contact for a limited period is common. As a result of the increasing evidence of the benefits of KMC for both infants and families in all intensive care settings, KMC in a high-tech environment was chosen as the topic for the first European Conference on KMC, and the clinical implementation of the KMC model in all types of settings was discussed at the 7th International Workshop on KMC. Kangaroo Mother Care protocols in high-tech Neonatal Intensive Care Units (NICU) should specify criteria for initiation, kangaroo position, transfer to/from KMC, transport in kangaroo position, kangaroo nutrition, parents' role, modification of the NICU environment, performance of care in KMC, and KMC in case of infant instability. CONCLUSION Implementation of the original KMC method, with continuous skin-to-skin contact whenever possible, is recommended for application in high-tech environments, although scientific evaluation should continue.
Collapse
|
35
|
Tessier R, Charpak N, Giron M, Cristo M, de Calume ZF, Ruiz-Peláez JG. Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr 2009; 98:1444-50. [PMID: 19500083 DOI: 10.1111/j.1651-2227.2009.01370.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. SETTING The largest social security hospital in Colombia with a neonatal intensive care unit. SUBJECTS At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. INTERVENTIONS Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. OUTCOME MEASURES The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. RESULTS 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. CONCLUSION Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children.
Collapse
Affiliation(s)
- R Tessier
- School of Psychology, Laval University, Quebec, QC, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVES Describing preterm breast milk evolution and composition according to gestational age (GA) and postnatal age (PNA) in a cohort of mothers cared for in an ambulatory Kangaroo Mother Care Program (KMCP) in a developing country. METHODS A cohort involving 113 mothers who delivered 'healthy' preterms adequate for GA was assembled. Mothers received intensive breastfeeding support before discharge. Samples of both fore- and hind milk were obtained at entry into KMCP and weekly thereafter, until term. Composition was described according to PNA and postconceptional age (PCA). RESULTS Protein concentration varied inversely with both PCA and PNA. Fat concentration was consistently higher in hind milk than in fore milk samples of the same feed. Lactose increased steadily with PCA. Calcium/phosphorus ratios were stable, close to 2:1 and content of both was similar in samples of different PCA and PNA. CONCLUSION Minerals concentration could be inadequate for preterms. Protein concentration decreases steadily to mature milk levels by the third week of PNA, regardless of birth GA. Therefore, from the third week of PNA onwards, protein content could be insufficient to satisfy needs of preterms born at 32 weeks or less. Feeding hind milk could increase caloric density and fat intake to better meet preterms' nutritional needs.
Collapse
Affiliation(s)
- N Charpak
- Kangaroo Foundation, Bogota, Columbia.
| | | |
Collapse
|
37
|
Abstract
BACKGROUND Randomized clinical trials have shown that Kangaroo Mother Care (KMC) can decrease morbidity and mortality due to low birthweight. Between 1994 and 2004, 44 teams in 25 developing countries were trained in KMC in Bogotá, Colombia; however, not all the teams were successful in initiating their own programmes and, of those that started, not all replicated the validated model. AIM To identify factors involved in unsuccessful KMC implementation and find solutions. METHODS A study was conducted in which 17 open-ended questionnaires were sent by e-mail to the coordinators of functioning KMC programmes in 15 countries, and 15 site visits were made to institutes that reported problems in starting programmes. The information was classified according to the perceived obstacle and the KMC model component involved. RESULTS The early-discharge component (including ambulatory follow-up) was that found most difficult to implement. Resistance from health professionals, mothers and families was often related to local cultural practices. CONCLUSION Active surveillance for and appropriate identification of obstacles usually indicated the appropriate solution. Some of the obstacles were common to many second-generation KMC programmes, making this information valuable for the implementation of programmes.
Collapse
Affiliation(s)
- Nathalie Charpak
- Kangaroo Foundation and Kangaroo Mother Care Program, Bogotá, Colombia.
| | | |
Collapse
|
38
|
Charpak N, Ruiz-Peláez JG, Figueroa Z. Influence of feeding patterns and other factors on early somatic growth of healthy, preterm infants in home-based kangaroo mother care: a cohort study. J Pediatr Gastroenterol Nutr 2005; 41:430-7. [PMID: 16205511 DOI: 10.1097/01.mpg.0000177310.86909.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Breast-milk fortifiers recommended for premature infants are seldom available in developing countries. We describe the characteristics of growth in preterm infants under ambulatory Kangaroo Mother Care (KMC) who eventually required supplemental formula because of failure to thrive with exclusive breast feeding. We evaluated the relationship between growth indices at term, nutritional status of the infant at birth, and feeding pattern. DESIGN Prospective cohort study conducted in the Neonatal Unit at Clínica San Pedro Claver and the KMC program, an ambulatory clinic from the Clínica del Niño tertiary care clinics in Bogotá, Colombia. Included were 115 mothers and their 129 healthy, preterm infants. One hundred twenty-six (98.4%) infants were available for evaluation at term. Infant weights were monitored daily until they achieved 15 g/kg per day for 2 days and then weekly until term. Formula was offered only to infants who did not gain 15 g per kg per day for 3 consecutive days. RESULTS Sixty (47.6%) infants gained weight adequately with exclusive breast feeding. In 14 of those who needed supplements, adequate weight gain was achieved before reaching term and supplements could be stopped. The more immature infants required supplementation more frequently. With or without supplementation, infants with lower weight for gestational age at birth were less likely to achieve adequate weight by term. CONCLUSIONS Growth indices at term in premature infants were close to those expected for term infants born in Bogotá (between percentile 10 to percentile 25). Decision on formula supplementation of breast milk should be made not only based on birth weight or gestational age but on a careful monitoring of weight gain while the mother is receiving continuous support to enhance and maintain successful breast-feeding. Small-for-date premature infants thrive less well than other infants even with supplementation.
Collapse
Affiliation(s)
- N Charpak
- Kangaroo Foundation, Bogota, Colombia.
| | | | | |
Collapse
|
39
|
Charpak N, Ruiz JG, Zupan J, Cattaneo A, Figueroa Z, Tessier R, Cristo M, Anderson G, Ludington S, Mendoza S, Mokhachane M, Worku B. Kangaroo Mother Care: 25 years after. Acta Paediatr 2005; 94:514-22. [PMID: 16188735 DOI: 10.1111/j.1651-2227.2005.tb01930.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infant's cognitive development. CONCLUSION Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.
Collapse
|
40
|
Abstract
Caring for low birthweight infants imposes a heavy burden on poor countries. An effective healthcare technique developed in 1978 may offer a solution to this problem and additionally be of use in wealthy countries too
Collapse
Affiliation(s)
- Juan Gabriel Ruiz-Peláez
- Clinical Epidemiology and Biostatistics Unit, School of Medicine, Javeriana University, Bogotá, Colombia
| | | | | |
Collapse
|
41
|
de Thé G, Buonaguro F, Charpak N, Franca Junior I, Hutton JL, Thorstensson R, Valdas E, Zetterström R. Ethical issues in research on control of the HIV/AIDS epidemic: report from a workshop of the world federation of scientists, Erice, Sicily, Italy, 22-24 August 2003. Acta Paediatr 2004; 93:1125-8. [PMID: 15456208 DOI: 10.1111/j.1651-2227.2004.tb02729.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In research on control of the HIV/AIDS epidemic there are many ethical issues to be considered. The problem of personal autonomy versus the interest of society to prevent the spread of the disease in various settings makes it difficult to follow the regulations of the Declaration of Helsinki in all respects. This is particularly clear in the evaluation of trials aimed at preventing mother-to-child transmission of HIV. The interest of the child does not always conform to the policy of avoiding stigmatization of the mother. Programmes for the implementation of antiretroviral therapy and vaccine trials may differ in countries with different mean incomes of the inhabitants, and are also influenced by local patterns. For this reason, the Declaration of Helsinki should be changed in such a way that it conforms with the ways in which it may be possible to combat such a disastrous epidemic as that caused by HIV.
Collapse
Affiliation(s)
- G de Thé
- Pasteur Institute, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Sack J, Goldstein A, Charpak N, Rozin A, Ruiz-Pelaez JG, Figueroa de Calume Z, Charpak Y, Weller A. Postpartum maternal hyperthyrotropinemia in an area in which iodine supplementation is required. Thyroid 2003; 13:959-64. [PMID: 14611705 DOI: 10.1089/105072503322511364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mild maternal hypothyroidism during pregnancy can adversely affect infant development. We studied thyrotropin (TSH) levels in mothers of premature and low-birth-weight infants in Colombia, where iodized salt supplements the diet to correct iodine deficiency. The additional impact of salt restriction in mothers with hypertensive disorders was examined. Blood was spotted on filter paper from 404 mothers and their infants. Using radioimmunoassay (RIA), TSH was measured in the mothers, and TSH and thyroxine in their infants at three postpartum times. Initially, mothers had high TSH levels (i.e., TSH > 10 mU/L in half the mothers at the first assessment). Fourteen days later, only 9.3%, and at calculated term 7.5% were greater than 10 mU/L. Maternal TSH levels correlated with infant birth weight and gestational age (r = 0.47, and r = 0.49, p < 0.01). Initial TSH values were higher in salt restricted (20.1 +/- 2 mU/L, n = 76) versus control mothers (14.6 +/- 0.85, n = 328, p < 0.01), dropping dramatically in both groups 14 days later (to 3.4 +/- 0.7 mU/L vs. 2.8 +/- 0.4 mU/L) and at calculated term (2.8 +/- 0.4 mU/L vs. 2.3 +/- 0.6 mU/L). Increased maternal TSH levels during pregnancy in an iodine-deficient area may be aggravated by salt restriction. Monitoring TSH and supplementing iodine or thyroxine are recommended in pregnancy, especially if dietary salt restriction is prescribed.
Collapse
Affiliation(s)
- Joseph Sack
- Department of Pediatrics, Sheba Medical Center & Sackler School of Medicine, Tel Hashomer, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
UNLABELLED It has been estimated that 95% of low-birthweight infants are born in developing countries. Nevertheless, most of the globally available resources are invested in developed countries, both for sophisticated, expensive technological care and for research focused on solving problems in scenarios in which access to expensive resources is available. Very little research on scientifically sound, economically accessible interventions reaches internationally recognized scientific journals. For instance, one accepted scientific dogma is that all premature infants must receive breast-milk fortifiers. Thus, healthcare workers consider that not offering fortification or supplementation to all preterm infants under 2000 g is unethical, as it denies them the proven benefits of this intervention. This approach oversimplifies the problem by assuming that infants under 2000 g are a homogeneous population, with similar needs and risks. The largest proportion of preterm survivors in developing countries comprises infants weighing > 1200 g, and their nutritional needs differ from those weighing < 1200 g, who represent a significantly smaller proportion. In developing countries, fortification of breast milk is seldom a feasible option. Even supplementing breast milk with formula implies an expense that cannot always be covered. In addition, many preterm infants (particularly those weighing > 1200 g) can grow properly on exclusive breastfeeding. In our experience, about 45% of infants under ambulatory Kangaroo Mother Care (KMC) thrive properly. The choice between giving and withholding supplementation for all preterm infants is not an ethical issue, because there is no choice. This was the justification for conducting the study reported here, which attempts to answer the question of how to identify, as early as possible, those premature infants who survive the early neonatal period and have no obvious risk factors for inadequate growth other than prematurity, but who are less likely to thrive with exclusive breastfeeding. CONCLUSION The answer to this question will allow us to use our meagre resources in the most reasonable way, as supplementing breast milk involves not only the direct cost of the formula but also that of training the mothers in techniques for feeding their infants without compromising breastfeeding or increasing the risk of infectious diseases.
Collapse
Affiliation(s)
- J G Ruiz
- Kangaroo Foundation, and Clinical Epidemiology Unit, Javeriana University (INCLEN), Bogotá, Colombia.
| | | | | |
Collapse
|
44
|
Weller A, Rozin A, Goldstein A, Charpak N, Ruiz-Pelaez JG, Figueroa de Calume Z, Charpak Y, Sack J. Longitudinal assessment of pituitary-thyroid axis and adrenal function in preterm infants raised by 'kangaroo mother care'. Horm Res Paediatr 2002; 57:22-6. [PMID: 12006715 DOI: 10.1159/000057942] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess whether complete kangaroo mother care (KMC), a skin-to-skin contact intervention, would affect longitudinal/developmental patterns of hormonal change. METHOD An open randomized controlled trial was conducted in a large tertiary care hospital, comparing KMC and traditional care for newborn infants weighing less than 2,001 g. Eighty-seven healthy preterm (<37 weeks gestational age) infants from this study provided three blood-spot samples on filter paper: at randomization (postnatal age 1-5 days), 2 weeks later, and at calculated term (41 weeks gestational age). They met a number of additional inclusion criteria including discharge from the hospital within the first postnatal week. The levels of 17alpha-hydroxy-progesterone (17-OHP), thyroxine-stimulating hormone (TSH) and thyroxine (T(4)) were assessed by radioimmunoassay. Birth weight (<1,800 or > or =1,800 g) and prenatal maternal corticosteroid treatment were taken into account in the analysis. INTERVENTIONS Complete KMC includes early discharge, positioning the infant on the parent's chest in an upright position, 24 h/day in skin-to-skin contact, and breast-feeding. In the traditional care group, infants were discharged according to routine hospital practice. RESULTS Levels of 17-OHP and TSH decreased significantly from eligibility to calculated term while T(4) levels did not change significantly over time. Most importantly, overall, treatment (KMC) did not interact with the pattern of physiological change. CONCLUSIONS Maturation of the pituitary-thyroid axis and adrenal function is apparently not compromised by KMC, at least in healthy preterm infants.
Collapse
Affiliation(s)
- Aron Weller
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Biberfeld G, Biberfeld P, Buonaguro F, Charpak N, de Thé erreira Rea M, Gray G, Huraux C, Lindberg A, Samuel NM, Scarlatti G, Tlou S, Van de Perre P, Yi Z, Zetterström R. Mother-to-Child transmission of HIV-1. Meeting of world Federation of Scientists in Erice, Italy, august 2001. Joint working group report of AIDS and infectious diseases PMP, and mother and child health PMP Plea for action with special emphasis on antiretroviral therapy: a scientific and community challenge. Acta Paediatr 2001; 90:1337-9. [PMID: 11808909 DOI: 10.1080/080352501317130425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- G Biberfeld
- Unit of Immunobiology of HIV, DIBIT, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE To assess the effectiveness and safety of Kangaroo Mother Care (KMC) for infants of low birth weight. METHODS An open, randomized, controlled trial of a Colombian social security referral hospital was conducted. A total of 1084 consecutive infants who were born at </=2000 g were followed, and 746 newborns were randomized when eligible for minimal care, with 382 to KMC and 364 to "traditional" care. Information on vital status was available for 693 infants (93%) at 12 months of corrected age. KMC consisted of skin-to-skin contact on the mother's chest 24 hours/day, nearly exclusive breastfeeding, and early discharge, with close ambulatory monitoring. Control infants remained in incubators until the usual discharge criteria were met. Both groups were followed at term and at 3, 6, 9, and 12 months of corrected age. The main outcomes measured were morbidity, mortality, growth, development, breastfeeding, hospital stay, and sequelae. RESULTS Baseline variables were evenly distributed, except for weight at recruitment (KMC: 1678 g; control participants: 1713 g). The risk for death was lower among infants who were given KMC, although the difference was not significant (KMC: 11 [3.1%] of 339; control participants: 19 [5.5%] of 324; relative risk: 0.57; 95% confidence interval: 0.17-1.18). The growth index of head circumference was statistically significantly greater in the group given KMC, but the developmental indices of the 2 groups were similar. Infants who weighed </=1500 g at birth and were given KMC spent less time in the hospital than those who were given standard care. The number of infections was similar in the 2 groups, but the severity was less among infants who received KMC. More of these infants were breastfed until 3 months of corrected age. CONCLUSION These results support earlier findings of the beneficial effects of KMC on mortality and growth. Use of this technique would humanize the practice of neonatology, promote breastfeeding, and shorten the neonatal hospital stay without compromising survival, growth, or development.
Collapse
Affiliation(s)
- N Charpak
- Fundación Canguro, Santa Fe de Bogotá, Colombia.
| | | | | | | |
Collapse
|
47
|
Affiliation(s)
- N Charpak
- Kangaroo Foundation, Santa Fé de Bogotá, Colombia.
| | | | | |
Collapse
|
48
|
Dovie Akue JP, Babaki P, Barré-Sinoussi F, Charpak N, de Thé G, Ferreira Rea M, Huraux C, Ndiaye B, Pratomo H, Samuel NM, Wilfert C, Zetterström R. Further views by the Erice working group on mother-to-child transmission of HIV type 1. Acta Paediatr 2001; 90:102-3. [PMID: 11227325 DOI: 10.1080/080352501750064978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
49
|
Akue JP, Babaki P, Barre-Sinoussi F, Charpak N, de Thé G, Rea MF, Huraux C, Ndiaye B, Pratomo H, Samuel NM, Wilfert C, Zetterström R. Human immunodeficiency virus type-1: mother-to-child transmission. Meeting of World Federation of Scientists in Erice, Italy, August 2000. Joint report of AIDS/Infectious Diseases PMP and Mother and Child PMP. Acta Paediatr 2000; 89:1385-6. [PMID: 11106055 DOI: 10.1080/080352500300002624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
50
|
Charpak N, de Calume ZF, Ruiz JG. "The Bogotá Declaration on Kangaroo Mother Care": conclusions at the second international workshop on the method. Second International Workshop of Kangaroo Mother Care. Acta Paediatr 2000; 89:1137-40. [PMID: 11071099 DOI: 10.1080/713794578] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N Charpak
- Fundación Canguro and Universidad Javeriana, Santa Fé de Bogotá, Colombia.
| | | | | |
Collapse
|