Maternal-fetal and neonatal characteristics associated with Kangaroo-Mother Care Method adherence

OBJECTIVE

To describe the association of maternal and neonatal characteristics with the adherence status to the in-hospital stages of the Kangaroo-Mother Care Method - KMC (full, partial, and no-adherence).

METHODS

Retrospective cohort study including infants < 2500 g admitted to a reference maternity hospital for the KMC in Rio de Janeiro from January to December 2018. Maternal and neonatal characteristics were distributed according to the adherence status to the KMC in-hospital stages. In the first stage, KMC is performed in Neonatal Intensive Care Unit and Conventional Neonatal Intermediate Care Unit. The second stage is completed in Kangaroo Neonatal Intermediate Care Unit. Multinomial multiple regression was performed with KMC adherence as a three-category dependent variable and maternal and neonatal characteristics as independent variables.

RESULTS

Of 166 dyads, 102 (61.5%) participated in two stages. Those who did not participate in any stage (n = 52; 31.3%) had a lower level of education, a higher frequency of adverse conditions, and were more often single mothers; mothers who participated only in the first stage (n = 12; 7,2%) had more premature and sick infants. Conditions associated with adherence to the two stages compared to no adherence were: high school education (OR = 2.34; 95% CI = 1.08-5.07), presence of a partner (OR = 3.82; 95% CI = 1.7-8.61), no adverse conditions (OR = 3.54; 95% CI = 1.59-7.89) and no neonatal resuscitation (OR = 2.73; 95% CI = 1.22-6.1).

CONCLUSIONS

The study identified maternal and neonatal conditions associated with adherence status to the KMC. The results suggest opportunities to improve adherence.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding

OBJECTIVE

Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding.

METHOD

Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%.

RESULTS

The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator.

CONCLUSION

The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

Skin-to-skin contact and deaths in newborns weighing up to 1800 grams: a cohort study

OBJECTIVE

To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g.

METHOD

Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis.

RESULTS

The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC.

CONCLUSIONS

The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection.

Association between early onset of skin-to-skin contact and mother-infant interaction at hospital discharge and six months of corrected age among preterm infants

OBJECTIVE

To compare mother-infant interaction between hospital discharge and at six months of corrected age of infants born ≤32 weeks and investigate the association between the onset of skin-to-skin contact and the difference in mother-infant interaction between discharge and six months of corrected age (CA) among preterm infants.

MATERIAL AND METHODS

Prospective observational study, in which 72 mother-infant dyads were evaluated. Preterm newborns (born with gestational age ≤ 32 weeks of gestational age) from two public maternity hospitals were assessed by means of video macro analysis of the mother-infant interaction according to the parameters adopted by the Mother-Baby Observation Protocol 0-6 (POIMB), at hospital discharge and at six months of corrected gestational age. Such variables as socioeconomic conditions, depression and maternal anxiety were controlled. Multivariate model was built.

RESULTS

Onset skin-to-skin contact within three days of life increased by 1.30 points for the best interactive infant behavior at discharge for the six months of CA. In addition, in relation to the tuning of the mother-infant dyad, the initiation of skin-to-skin contact at 20 days of life reduced 1.0 point significantly. Multiparous mothers or those exposed to cigarette smoke performed worse in the development of the dyad.

CONCLUSION

The preterm newborn should initiate skin-to-skin contact early and, whenever possible, by the third day of life to favor mother-infant interaction.

Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia

Purpose

Kangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital.

Methods

Data collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted.

Results

This study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC.

Conclusion

Efforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.

Comparing the effect of kangaroo mother care and field massage on serum bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward

Background:

Several factors contribute to the effectiveness of phototherapy. The aim of this study was to compare the effect of kangaroo mother care (KMC) and field massage on bilirubin level of term neonates with hyperbilirubinemia under phototherapy in the neonatal ward.

Methods:

This double-blind clinical trial was performed on 90 term neonates aged 48 hours with hyperbilirubinemia, hospitalized in Fereydunkenar Hospital during 2018-2019. The infants were randomly divided into 3 groups of massage with phototherapy, KMC with phototherapy and control (received conventional phototherapy without KMC and massage). The massage group used field technique for three 15-minutes in 3 days and the KMC group received KMC for five 30 minutes in 3 days as well. In three groups, the serum bilirubin levels were compared at baseline, 24, 48, 72 hours after the onset and at the end of phototherapy. Moreover, the mean duration of phototherapy and hospitalization was compared during the treatment.

Results:

Serum bilirubin levels at baseline in the control, field massage and KMC groups were (17±1.38, 17.01±1.46 and 16.97±1.27mg/dl) and at the end of phototherapy were (6.97±0.47, 5.56±0.48 and 5.91±0.52 mg/dl) respectively. There was a significant difference between the intervention and control groups (p<0.001). The mean duration of phototherapy and hospitalization had no significant difference between two intervention groups (p>0.001), but it was significantly higher in control group than intervention groups (p<0.001).

Conclusion:

The use of massage or KMC with phototherapy, compared to the phototherapy alone, can reduce the bilirubin level, phototherapy duration and hospital stay.

Weight-Gain Velocity in Newborn Infants Managed with the Kangaroo Method and Associated Variables

Objectives The Kangaroo method helps promote maternal breastfeeding and adequate growth of low birthweight preterm infants. The objective of this study was to analyze the association between weight-gain velocity during use of the Kangaroo method and maternal and infant variables. Methods A nested cross-sectional study in a cohort of newborn infants managed using the Kangaroo method was carried out at a reference center for the method in Brazil. Data on low birthweight and preterm infants managed using the Kangaroo Method (n = 78) and on their respective mothers (n = 70) was collected between January and July 2014. Maternal and infant variables were associated and correlated with weight-gain velocity (g/kg/day) at each phase of the method (p < 0.05). Results Mean weight-gain velocity increased from 0.12 ± 11.11 g/kg/day in the first phase to 13.47 ± 4.84 g/kg/day in the third phase (p < 0.001), and percentage of adequate weight increased at phase 3 (p < 0.001). Birthweight was inversely correlated with weight-gain velocity at phases 1 and 2 of the Kangaroo method. Birthweight of under 1500 g was associated with a lower likelihood of inadequate weight-gain velocity of the newborn at phase 1 (OR = 0.1; 95 % CI 0.01-0.78; p = 0.012). In phase 3, maternal age was directly correlated with weight-gain velocity. Conclusions Weight-gain velocity was associated with maternal (age) and infant (gestational age at birth, birthweight, weight for gestational age at birth, length of hospital stay and five-minute Apgar score) variables. Knowledge of the factors influencing weight-gain velocity and its behavior at each phase of the method can help guide conduct toward potentializing factors that promote adequate weight-gain.