Kangaroo care is a technique of direct skin-to-skin contact between mothers (or fathers) and their premature infants. Kangaroo care appears to have physiologic as well as psychosocial benefits. Kangaroo care has been shown to:

• improve the mother’s psychological state,

• strengthen mother-infant bonding, and

• stimulate maternal lactation.

Studies also suggest that direct skin-to-skin contact between the infant and mother may

• stabilize the infant’s temperature in the thermal neutral range

• stabilize the infant’s vitals signs, respiratory pattern, and oxygenation, resulting in decreased apneic events

• encourage more homogenous sleep patterns

• potentially result in better weight gain.

The only negative aspect of kangaroo care reported in recent literature was a report of potential heat stress associated with increased bradycardia and desaturations. (Bornhorst et al. J Pediatr 2001; 138:193-7)

Who can kangaroo care?

All stable infants are eligible. Infants with umbilical lines or thoracostomy tubes can not kangaroo. In most instances, infants with endotracheal tubes should not kangaroo. Respiratory support in the form of oxygen supplementation or nasal CPAP is not a contraindication. In most instances, kangaroo holding should be limited to mothers and fathers. Parents with rashes or open skin lesions should abstain from skin-to-skin contact with their infant.

Preparation: Secure all of the infant’s lines and tubes. If possible, perform early any needed procedures that may later interrupt mother-infant interaction. Obtain a rocker/recliner and privacy screen. Dress the infant in diaper and hat; booties are also acceptable. The parent should wear a loose shirt/blouse that opens in the front. Ordinary daily hygiene is the only skin cleansing required for the parent. Parents should be discouraged from using skin lotions and wearing perfumes.

Transfer: is the most difficult part of the experience for the infant. Transfer the infant gently as a contained unit. Place the infant upright on the parent’s chest between the breasts or on either side. Attempt to maximize skin contact between the parent and child. Place a blanket or two over the infant to cover baby and parent. Protect the pair from side drafts, doors, and distraction as much as possible.

Positioning: The infant should be upright and inclined at approximately a 60-degree tilt on the parent’s chest. Care should be taken to position the head and neck of smaller infants to avoid airway obstruction. If possible, position the face of the infant so that the parent can see the infant’s facial expression.

Monitoring: Keep the infant on the cardiac monitor. Continue the pulse oximeter as ordered. Monitor temperature per NICU protocol and prn. Allow the infant 20 – 30 minutes after transfer to stabilize vital signs. Monitor and document any signs of distress.

Kangaroo care initially should be practiced for 30 minutes once a day and gradually increased to two to three hours. Remember that the transfer is stressful for the infant so give him/her enough time to derive benefit from kangaroo care after settling in. Parent-infant interaction should be disturbed as little as possible except for necessary nursing or medical care. Infants in deep sleep should be allowed to continue to sleep as long as possible. The infant may be fed during kangaroo care either PO or by gavage.

Maintain the incubator/warmer temperature during kangaroo care. Suggest to lactating mothers that after kangaroo care is a good time to pump their breasts.

Documentation: The bedside nurse should document vital signs, oxygen saturation, and temperature before, during, and after kangaroo care. Indicate "kangaroo care" on the nursing flow sheet (on the procedure line). Write a brief note indicating how the infant tolerated kangaroo care including significant positives and negatives and parents’ comments. Include the amount of time spent in kangaroo care and any teaching given.

Policy endorsed by Policy & Procedure Committee May 1993.

References:

Feldman R, et al. Comparison of skin-to-skin (Kangaroo) and traditional care: Parenting outcomes and preterm infant development. Pediatrics 2002; 110: 16-26.

Conde-Agudelo A, Diaz-Rossello JL,and Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Collaborative Review Group, 2000.

http://www.nichd.nih.gov/cochrane/conde-agudelo/review.htm

Fohe K, Kropf S, and Avenarius S. Skin-to-skin contact improves gas exchange in premature infants. J Perinatol 2000; 5: 311-5.

Ludington-Hoe SM, Thompson C, Swinth J, Hadeed AJ, Anderson GC. Kangaroo care: research results, and practice implications and guidelines. Neonatal Network 1994; 13: 19-27.