Жаңа туған нәрестелерге күтім: «Ана құшағы» әдісі

Technique of newborn care

Kangaroo mother care (KMC), which involves skin to skin contact (SSC), is an intervention to care for premature or low birth weight (LBW) infants. The technique and intervention is the recommended evidence based care for LBW infants by the World Health Organization (WHO) since 2003. In the 2003 WHO Kangaroo Mother Care practical guide, Today, the WHO recommends "Kangaroo mother care (KMC) for preterm or low birth weight infants should be started as soon as possible after birth" Cardiopulmonary monitoring, oximetry, supplemental oxygen or nasal ventilation (continuous positive airway pressure), intravenous infusions, and monitor leads do not prevent KMC. In fact, babies who are in KMC tend to be less prone to apnea and bradycardia and have stabilization of oxygen needs. KMC has been shown to provide many benefits to the infant, as well as to the family directly involved in the infant's care. Large reviews of the thousands of scientific articles that present the body of evidence have been published, that serve as the bases for practical guides for practitioners. After initial reviews of scientific evidence in the mid 1990s highlighted research ongoing in both developed and developing countries, research into KMC grew exponentially. Systematic reviews of hundreds of scientific articles have documented the impact of KMC on mortality, morbidity, and quality of survival LBW infants. A randomized controlled trial published in 2016 reported that babies born between became physiologically stable in SSC starting from birth, compared to similar babies in incubators. A descriptive study of case series in a hospital without any technical resources evaluated two of the components of the KMC: the inpatient kangaroo position and kangaroo feeding and was published published in 1994. This paper supports the hypothesis that, in cases of absence of technical resources, inpatient kangaroo position and nutrition is an acceptable alternative. In 2016, a Cochrane review, "Kangaroo mother care to reduce morbidity and mortality in low birthweight infants", was published bringing together data from 21 studies including 3,042 LBW babies (less than at birth). This review showed that babies receiving kangaroo care had a reduced risk of death, hospital acquired infection, and low body temperature (hypothermia); was also associated with increased weight gain, growth in length, and rates of breastfeeding. increased weight gain, and fewer hospital acquired infections. Kangaroo care also helps to improve sleep patterns of infants and may be a good intervention for colic. Earlier discharge from hospital is also a possible outcome Evidence from a recent systematic review supports the use of kangaroo mother care as a substitute for conventional neonatal care in settings where resources are limited. A 2017 study found that the psychological benefits of kangaroo care for parents of preterm infants are fairly extensive. Research shows that the use of kangaroo care is linked to lower parental anxiety levels. It was shown to decrease anxiety scores in both mothers and fathers, unrelated to parents' marital status. Kangaroo care has also been shown to lead to greater confidence in parenting skills. Parents who used kangaroo care displayed higher confidence in their ability to care for their child. It has been shown to positively impact breastfeeding as well, with mothers producing larger amounts of milk for longer periods of time.

Both preterm and full term infants benefit from SSC for the first few weeks of life with the baby's father as well. The new baby is familiar with the father's voice, and it is believed that contact with the father helps the infant to stabilize and promotes father to infant bonding. If the infant's mother had a caesarean birth, the father can hold their baby in SSC while the mother recovers from the anesthetic. Looking at the review, researchers found that SSC was of benefit to fathers as well. Their findings included:

A Colombian study focused on India found that fathers who provided SSC to preterm infants exhibited more caring behaviours and developed a more sensitive approach to their infants. It is known that, during the hours of labor before a vaginal birth, a woman's body begins to produce oxytocin which aids in the bonding process, and the authors believe that SSC can be of special importance following a C section birth. Indeed, women reported that they felt that SSC had helped them to feel close to and bond with their infant. The review reported comments made by mothers such as "My baby calms down right away when I put him to my chest. I don't know if it's related to holding him skin‐to‐skin during the cesarean—but I think it is." Newborns were also found to cry less and relax quicker when they had SSC with their father as well. There is evidence that women who give birth by C section are less likely to breastfeed and those that do have increased difficulties in establishing breastfeeding. The review, however, found that immediate or early SSC increased the likelihood of successful breastfeeding. For mothers with low milk supply, increasing SSC is recommended, as it promotes more frequent feeding and stimulates the milk ejection reflex, prompting the body to produce more milk.

SSC is effective in reducing pain in infants during painful procedures. There appears to be no difference between mothers and others who provide SSC during medical treatments.

The Kangaroo Foundation research team in partnership with Colombian and Canadian university teams were able to locate and engage almost 200 adults that represent 70% of the randomized cohort of infants that received KMC 20 years earlier. The team performed a cross sectional evaluation of neurophysiology and neuroimaging with the application of a neuropsychological test battery. Results already published show that KMC should be considered a neuroprotective drug for the immature brain of the premature child. KMC allows a multisensory stimulation (olfactory, auditory, tactile, sensitive, and proprioceptive) that allows this immature brain to grow and connect in the best available condition.

Kangaroo care often results in reduced hospital stays, reduced need for expensive healthcare technology, increased parental involvement and teaching opportunities, and better use of healthcare dollars.

There are a number of early studies on the impact of SSC on the health of all newly born humans, In another randomized controlled trial conducted in Ethiopia, survival improved when SSC was started before six hours of age. In the 1990s, studies began to note a series of innate behaviors in full term infants when placed in SSC with their mothers. One 2011 study described a sequence of nine innate behaviors as:
the birth cry, relaxation, awakening and opening the eyes, activity (looking at the mother and breast, rooting, hand to mouth movements, soliciting sounds), a second resting phase, crawling towards the nipple, touching and licking the nipple, suckling at the breast and finally falling asleep. It is believed that

blockquote|this 'sensitive period' predisposes or primes mothers and infants to develop a synchronous reciprocal interaction pattern, provided they are together and in intimate contact. Infants who are allowed uninterrupted SSC immediately after birth and who self attach to the mother's nipple may continue to nurse more effectively. While this model of infant care is substantially different from the typical Western neonatal intensive care unit procedures, the two are not mutually exclusive, and it is estimated that more than 200 neonatal intensive care units practice kangaroo care. One survey found that 82% of neonatal intensive care units use kangaroo care in the US. In kangaroo care, the baby wears only a small diaper and a hat and is placed in a flexed (fetal position) with maximum SSC on parent's chest. The baby is secured with a wrap that goes around the naked torso of the adult, providing the baby with proper support and positioning (maintain flexion), constant containment without pressure points or creases, and protecting from air drafts (thermoregulation). If it is cold, the parent may wear a shirt or hospital gown with an opening to the front and a blanket over the wrap for the baby. The tight bundling is enough to stimulate the baby: vestibular stimulation from the parent's breathing and chest movement, auditory stimulation from the parent's voice and natural sounds of breathing and the heartbeat, touch by the skin of the parent, the wrap, and the natural tendency to hold the baby. All this stimulation is important for the baby's development. "Birth Kangaroo Care" places the baby in kangaroo care with the mother within one minute after birth and up to the first feeding. The American Academy of Pediatrics recommends this practice, with minimal disruption for babies that do not require life support. The baby's head must be dried immediately after birth and then the baby is placed with a hat on the mother's chest. Measurements etc. are performed after the first feeding. According to the US Institute of Kangaroo Care, healthy babies should maintain SSC method for about three months so that both baby and mother are established in breastfeeding and have achieved physiological recovery from the birth process. For premature babies, this method can be used continuously around the clock or for sessions of no less than one hour in duration (the length of one full sleep cycle). It can be started as soon as the baby is stabilized, so it may be at birth or within hours, days, or weeks after birth. Kangaroo care is different from the practice of babywearing. In kangaroo care, the adult and the baby are skin to skin and chest to chest, securing the position of the baby with a stretchy wrap, and it is practiced to provide developmental care to premature babies for six months and full term newborns for thee months. In babywearing, the adult and the child are fully clothed, the child may be in the front or back of the adult, it can be done with many different types of carriers and slings, and it is commonly practiced with infants and toddlers.

In primates, early SSC is part of a universal reproductive behavior, and early separation is used as a research modality to test the harmful effects on early development. Research suggests that, for all mammals, the maternal environment (or place of care) is the primary requirement for regulation of all physiological needs (homeostasis), maternal absence leads to dysregulation and adaptation to adversity. In mainstream clinical medicine, KMC is used as an adjunct to advanced technology that requires maternal infant separation. However, SSC may have a better scientific rationale than the incubator. All other supportive technology can be provided as part of care to extremely LBW babies during SSC and appears to produce a better effect. Based on the scientific rationale, it has been suggested that SSC should be initiated immediately, to avoid the harmful effects of separation (Bergman Curationis). In terms of classification and proper defining for research purposes, the following aspects that categorize and define SSC have been proposed:

Initiation time, (minutes, hours from birth), ideal is zero separation. Dose of SSC, (hours per day, or as percentage of day), ideal >90%. Duration, (measured in days or weeks from birth), ideally until infant refuses. Safe technique should ensure that obstructive apnea cannot occur. Since the mother must be able to sleep to provide adequate dose, this requires keeping the airway safely open, and close containment to mother's bare chest using a garment, various of these are described in the WHO guidelines. The defining feature of this is however for skin to skin contact (SSC, or sometimes STS). This is used synonymously with "skin to skin care". Nils Bergman, one of the founders of the Kangaroo Mother Care Movement, argues that, since SSC is a place of care, not a kind of care in itself, SSC should be the preferred term. KMC is a broader package of care defined by the WHO. KMC originally referred only to care of LMW and preterm infants and is defined as a care strategy including three main components: kangaroo position, nutrition, and discharge. Kangaroo position means direct SSC between mother and baby but can include father, other family member, or surrogate. The infant should be upright on the chest, and the airway secured with safe technique. (The term KMC is commonly used to mean SSC, despite its definition from the WHO as including a broader strategy). Kangaroo nutrition implies exclusive breastfeeding, with additional support as required but with the aim of achieving ultimately exclusive breastfeeding. Kangaroo discharge requires that the infant is sent home early, meaning as soon as the mother is breastfeeding and able to provide all basic care herself. In Colombia in 1985, this took place at weights around , with oxygen cylinders for home use; the reason was that overcrowding in their hospital meant that three babies in an incubator would result in potentially lethal cross infections. An essential part of this is close followup and access to daily visits.

An early example of skin to skin infant care is the traditional Inuit woman's garment, the amauti, had a large pouch at the back where the baby would sit against the mother's bare back. This skin to skin approach is also present in many other cultures around the world. Peter de Chateau in Sweden first described studies of "early contact" with mother and baby at birth in 1976, but the articles do not describe specifically that this was SSC. Klaus and Kennell did very similar work in the US, more well known in the context of early maternal infant bonding. The first reported use of the term "skin to skin contact" is by Thomson in 1979 and quotes the work of de Chateau in its rationale. The inception of Kangaroo Mother Care happens in Bogota, Colombia,

Rey Sanabria and Martinez Gomez published their results in 1981 in Spanish decided to adopt the original term “Kangaroo Mother Care" created by Rey Sanabria in 1978, in Colombia. An International Network of Kangaroo Mother Care (INK) was convened at the Trieste meeting and has overseen workshops and conferences every two years. After Trieste, meetings were held all over the world every two years, with major support from the Fundacion Canguro. These include: in Bogotá, Colombia, 1998; Yogyakarta, Indonesia, 2000; Cape Town, South Africa, 2002; Rio de Janeiro, Brazil, 2004; Cleveland, US, 2006; Uppsala, Sweden, 2008; Quebec, Canada, 2010; Ahmedabad, India, 2012; Kigali, Rwanda, 2014; Trieste 2016; Bogotá 2018; Manille 2020 (virtual); and Madrid, Spain, 2022. Papers have been published on the results of these workshop, the latest being in 2020. An informal steering committee coordinates these meetings: (alphabetically, current) Nils Bergman, Adriano Cattaneo, Nathalie Charpak, Juan Gabriel Ruiz, Kerstin Hedberg Nyqvist, Ochi Ibe, Susan Ludington, Socorro Mendoza, Mantoa Mokrachane, Carmen Pallas, Réjean Tessier, and Rekha Udani. Susan Ludington maintains a "KC BIB" (bibliography) on behalf of INK, endeavoring to be a complete inventory of any and all publications relevant to KMC. This is also broken down in an analysis of 120 charts, in which specific outcomes are collated. The International Kangaroo Care Awareness Day has been celebrated worldwide on 15 May since 2011. It is a day to increase awareness to enhance the practice of kangaroo care in NICUS, Post Partum, Labor and Delivery, and any hospital unit that has babies up to three months of age.

The International Kangaroo Care Awareness Day, sometimes referred to as World Kangaroo Care Day, or just Kangaroo Care Day, is celebrated on 15 May since 2011. It is a day to increase awareness, education, and celebration to enhance the practice of kangaroo care/SAC globally. Healthcare professionals, parents, and volunteers around the world show their support, in their own way, for improving kangaroo care practice to benefit babies, parents, and society at large. World Prematurity Day is observed on 17 November each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. It is also the day to speak about KMC and prematurity and family centered care