What are the benefits of kangaroo care for premature babies? How to do it?

Author: Meng Jingwen, deputy chief nurse, Peking University First Hospital

Reviewer: Zou Liying, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Kangaroo mother care for premature infants is a care model that has been strongly recommended in China in recent years.

Kangaroo mother care originated in Colombia in the late 1970s, when medical resources were very scarce. Doctors found that this method could replace incubators to maintain the body temperature of premature babies. In the 1990s, kangaroo mother care was introduced to China.

1. What is kangaroo mother care for premature babies?

Kangaroo care, as the name suggests, is to hold the premature baby upright on the chest like a little kangaroo, with skin against skin, for a long time. In addition to keeping the premature baby warm, if the mother performs kangaroo care, it can also stimulate the mother to secrete milk and breastfeed at the same time.

Figure 1 Original copyright image, no permission to reprint

Kangaroo mother care is such a model, and is also strongly recommended by the World Health Organization's guidelines for intervention methods to improve the prognosis of premature infants. It is mainly suitable for premature infants and low birth weight infants, with a birth weight of less than 2500 grams. In addition to mothers and fathers, other family members can participate in kangaroo mother care, which is now a very dominant participation model.

2. What assessment and preparation are needed before kangaroo mother care is performed on premature infants?

First, the doctor needs to assess whether the premature baby is suitable for kangaroo mother care and whether the members involved in kangaroo mother care are suitable.

For premature babies, even if they need non-invasive mechanical ventilation or invasive mechanical ventilation, if their vital signs are relatively stable, kangaroo mother care can be performed. The earlier it is implemented, the greater the benefit to the premature baby.

For family members, they must be willing to participate because they have to go to the hospital; secondly, participants must be in good health and have no infectious diseases, such as respiratory infections.

After the assessment, when doing kangaroo care, there should be a relatively private space in the neonatal intensive care unit or neonatal ward, because kangaroo care requires exposing the entire chest, so a separate room is needed to do it, or a screen should be used to block it. In addition, the ambient temperature is also very important. The indoor temperature in winter is generally 24℃-26℃, and the indoor temperature in summer is generally 26℃-28℃. This is the preparation of the space environment.

Members participating in kangaroo care should make good personal hygiene preparations, such as taking a bath or cleaning the chest, wearing a clean cardigan to prevent infection in premature babies; do not apply irritating skin care products or perfumes on the body.

In general, in the early stages, we need to do a good job of assessing the participants and premature infants, as well as preparing the environment and hygiene, etc.

3. How to perform kangaroo mother care for premature babies?

Before touching a premature baby, you must first clean your hands using the 7-step hand washing method. If the mother does it, she must take off her underwear, put on a cotton cardigan, and expose her entire chest.

Generally, a small hat is put on premature babies because the head accounts for a large part of the body surface area and a large amount of heat is easily lost from the head. Then the premature baby's clothes are taken off, leaving only diapers and a pair of small socks if necessary.

When ready, the participant holds the premature baby in their arms, between their breasts, with the head tilted to one side to avoid covering the mouth and nose. The baby's two small hands can be placed on the participant's breasts, and the feet are naturally bent, lying on the chest like a little frog. The participant can wrap the child in a cardigan for support, with one hand supporting the child's hips and hips, and the other hand supporting the back of the neck. A small blanket can be covered on the outside to avoid covering too thickly, which will affect the child's breathing. The participant can lie on a recliner in a very comfortable position, with a foot pad under his feet.

Figure 2 Original copyright image, no permission to reprint

During kangaroo care, medical staff will observe the premature baby's condition to avoid unexpected situations. Participants can also be given a mirror to observe the baby's breathing, oral area and facial conditions.

Kangaroo care is usually performed between feedings. Premature babies with a relatively large gestational age have a feeding reflex, so you can try to let the baby suck the mother's nipple. Premature babies with a very small gestational age do not have a feeding reflex yet, so you can first squeeze out the mother's breast milk and store it in the refrigerator, and let the baby suck the mother's nipple empty to exercise the sucking ability.

In principle, the longer the kangaroo care session for premature babies is, the better. This will make the effect more obvious. At the beginning, you can do it for half an hour or an hour at a time, and then gradually extend the time. If the child is very cooperative, lying very quietly and comfortably in the arms, and the participants do not feel tired, the longer the time, the better.

During the hospitalization of premature babies, parents learned kangaroo care, and they can do it themselves at home after discharge, preferably until 40 weeks of corrected age. When the baby is close to full-term, the child may not cooperate and is not suitable for kangaroo care.