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kangaroo mother care.pptx

  1. 1. Kangaroo Mother Care (KMC) Mukesh Sah, MD Post graduate Medical Intern
  2. 2. Kangaroo Mother Care (KMC) 2
  3. 3. Background (1/2) 3 • The global prevalence of low birth weight (LBW) is 15.5%, which amounts to about 20 million LBW infants born each year (WHO, 2003). • Among which, 96.5% occur in developing countries.
  4. 4. Background (2/2) 4 • Globally, low birth weight (LBW) contributes to 60% to 80% of all neonatal deaths. • Preterm birth and small for gestational age is the most common direct cause of newborn mortality, is one of the reason for low birth weight. • Prematurity is the primary cause of newborn death accounting to 31% (NENAP, 2016).
  5. 5. What is Kangaroo Mother Care? • Kangaroo Mother Care (KMC) is care of newborn infants secured skin-to-skin to the mother • KMC is a powerful and easy to use method to promote the health and well- being of o Low birth weight (LBW) - infants with birth weight below 2500g o Preterm infants – infants with gestational age less than 37 weeks o Full term infants 5
  6. 6. Reasons why KMC was implemented (1/2) 6 • In 1979, while working in hospital of Bogota, Colombia, Dr. Edgar Rey & Hector Martinez, found out that: • Large numbers of LBW & preterm infants were delivered because of: oPoor Antenatal Care attendance oHigh incidence of toxaemia of pregnancy, anaemia & infections oShortage of staff & inadequate equipment
  7. 7. Reasons why KMC was implemented (2/2) 7 • High infection & mortality rate because of overcrowding • Large numbers of infants who were abandoned by their mothers
  8. 8. KMC Practice in Colombia 8 • Maternal-infant skin-to-skin contact was introduced to stable LBW infants surviving the first few weeks of life • Exclusive breastfeeding was encouraged • As long as infants could feed and were gaining weight, they were discharged, regardless of weight
  9. 9. • This practice resulted in: o Improved outcome for LBW infants o Decreased hospitalisation time o Less overcrowding o Less abandoned infants o Improved staff morale 9
  10. 10. Scientific evidence showed 10 “Incredible survival of Kangaroo Babies hence KMC practiced in rest of the of the world”
  11. 11. Why is it called Kangaroo Mother Care? • A newborn baby kangaroo (joey) is very immature at birth and very small in size. • The mother kangaroo’s pouch provides warmth, safety and a constant supply of food (milk) to the joey. 11
  12. 12. Similar to kangaroo care giving the human infant is also immature and especially the LBW infant benefits from skin-to-skin care because it provides warmth, safety and food. 12
  13. 13. Additionally… • As incubators and radiant warmer are expensive, require skilled staff and reliable electric power, many hospitals do not have them or not enough. • Babies born in hospitals who need incubators or radiant warmer to keep them warm often have to share them. 13
  14. 14. • Sharing incubators is risky because if one baby becomes ill he can easily pass the infection to the other baby. • KMC was developed as a way to maintain the normal body temperature of low birth weight and premature babies born in hospitals that do not have 14
  15. 15. Types of KMC 15 1. Continuous KMC or full KMC 2. Partial or intermittent KMC
  16. 16. Continuous KMC 16 • When KMC is practiced ideally for 24 hour except cleaning the diaper, or breast feeding. • At least 18 hours is compulsory. • KMC may discontinue for very short periods when the mother has to bathe or attend to other personal needs. • It requires support from the family members, including the husband.
  17. 17. Partial or intermittent KMC 17 • Less than 18 hours but it should not be less than 3 hours a day. • The duration of condition of the mother. intermittent infant and KMC depends the availability on the of the
  18. 18. Components of KMC 18 • Continuous skin to skin contact between baby’s front and mothers chest. • Exclusive breastfeeding.
  19. 19. 1. Continuous skin to skin contact between baby’s front and mothers chest • Place the baby between the mother’s breasts in an upright position • Continuous or intermittent 19
  20. 20. Eligibility Criteria for KMC: Baby 20 • All stable low birth weight babies are eligible for KMC. • Sick babies needing special care should be cared under radiant warmer initially. • KMC - started after the baby is hemodynamically stable. • HEMODYNAMICALLY STABLE: IS A MUST!!
  21. 21. Guidelines for practicing KMC according to weight allows initiation of KMC. • Birth weight >1800 g: These babies are generally stable at birth. Therefore, in most of them KMC can be initiated soon after birth. • Birth weight 1200-1799 g: It might take a few days for stabilization before KMC can be initiated. • Birth weight <1200 g: Frequently, these babies develop serious prematurity-related morbidities often starting soon after birth. It may take days to weeks before baby's condition 21
  22. 22. Eligibility Criteria for KMC: Mother 22 • Willingness • General health and nutrition • Hygiene • Supportive family • Supportive community
  23. 23. 2. Exclusive Breastfeeding • The kangaroo position is ideal for breastfeeding. • The cloth that wraps around the mother and baby is loosened to breastfeed. • Initially tube or cup feeding before breastfeeding is established. 23
  24. 24. 24
  25. 25. Pre-requisites for KMC 25 1. Support to the mother 2. Post discharge and follow up
  26. 26. Support to the mother 26 • Health care staff support in hospital o Emotional support – The mother needs encouragement if she is to give KMC o Teaching mothers the skill to take care of their LBW infants o After discharge infants need regular follow- up to check satisfactory weight gain at clinics close to home • Support from the family at home to help mother take care of her infant and practice KMC at home.
  27. 27. Any family member can do it! 27
  28. 28. Early discharge and follow up 28 The mother continues to practice KMC after the infant is discharged. Eligibility criteria for discharge: • Baby’s general health is good and there is no concurrent disease such as apnoea or infection • Feeding well, and is exclusively or predominantly breastfed
  29. 29. • Follow-up visits ensured • Gaining weight (at least 15g/kg/day for at least three consecutive days) • Temperature is stable in the KMC position • Mother is confident 29
  30. 30. Benefits of KMC 30 • To the baby • To the mother • To the hospital • To the nation
  31. 31. Benefits to the baby best • Baby kept warm 24 hours as mother is the incubator • Breathing becomes regular as it reduces apnoea • Breastfeeding better and gains weight faster • Infants are much less stressed and this provides neurological protection to the infant • Better organized sleep patterns 31
  32. 32. Benefits to the Mother • Confidence in caring for her infant is boosted • Improved bonding between mother and infant due to the physical closeness between them • Mothers are empowered to play an active role in their infants care • Mothers are enabled to become the primary care giver of their infants • Breastfeeding is promoted 32
  33. 33. Benefits to the Hospital • Significant cost-savings as well as better outcomes o Less dependence on incubators o Less nursing staff necessary o Shorter hospital stay • Improved morale & quality of care • Better survival 33
  34. 34. Benefit to the Nation 34 • KMC result in healthier and more intellectual babies and thus adds to the nation wealth. • Decrease neonatal mortality and morbidity. • Simple and applicable everywhere and cost effective.
  35. 35. Preparing for KMC (1/4) 35 • Initiation of KMC • Counselling • When baby is ready arrange a time that is convenient to the mother and baby • Demonstrate her KMC procedure in a caring, gentle manner with patients
  36. 36. Preparing for KMC (2/4) 36 • Answer her all her queries and allay her anxieties • Allow her to bring other family members during this time o It helps in building positive attitude of the family and ensuring family support to the mother which is particularly crucial for post-discharge home-based KMC. o It is helpful if the mother starting KMC interacts with someone who is already practicing KMC.
  37. 37. Preparing for KMC (3/4) 37 • Mother's clothing KMC can be provided using any front-open, light dress as per the local culture. KMC works well with blouse and sari, gown. • Baby’s clothing Baby is dressed with cap, socks, nappy, and front open sleeveless shirt, Bhoto in winter.
  38. 38. Preparing for KMC (4/4) 38 • Supporting garment ▶ To carry the baby in kangaroo position – KMC sling or 3.5 meter cloth that will allow the mother or the father or the relatives to sleep with the baby in that position.
  39. 39. Time of Initiation • KMC can be started as soon as the baby is stable. • Babies with severe illnesses or requiring special treatment should be managed according to the unit protocol. • Short KMC sessions can be initiated during recovery with ongoing medical treatment (IV fluids, Oxygen Therapy). 39
  40. 40. Procedure of KMC privacy: Since it requires some ▶ Provide exposure of mother culturally acceptable privacy should be given in nursery, wards and NICU. 40
  41. 41. Kangaroo Position (1/2) • Baby should be placed between mother’s breast in upright position. • Head should be turned to one side in slightly extended position. The slightly extended head keeps the airway open and allows eye to eye contact with mother. 41
  42. 42. Kangaroo Position (2/2) 42 • Hips should be flexed and abducted in a “frog” position and arms should also be flexed. • Baby’s abdomen should be at the level of mother’s epigastrium. Mother’s breathing stimulates the baby thus reducing apnoea. • Support the baby’s bottom with a sling/binder.
  43. 43. Feeding • Explain about breastfeeding while in KMC • Can give express breast milk cup/spoon, orogastric tube 43
  44. 44. Monitoring • Important especially in early stage • Make sure neck in slightly extended position • Airway clear • Regular breathing • Pink in colour • Temperature normal 44
  45. 45. Can the mother continue KMC during sleep and resting? 45 • The mother can sleep with baby in kangaroo position in reclined or semi recumbent position about 30 degrees from horizontal. • This can be done with an adjustable bed or with pillows on an ordinary bed. • A comfortable chair with an adjustable back may be used for resting during the day.
  46. 46. When to stop KMC? • Till baby finds it comfortable and cosy • Once baby’s weight >2500gm and gestation >37 weeks 46
  47. 47. Post-Discharge Follow-up (1/2) 47 • Close follow up is a fundamental pre-requisite of KMC practice. Baby is followed once or twice a week till 37-40 weeks of gestation or till the baby reaches 2.5 – 3 kg of weight. • Thereafter, a follow up once in 2 – 4 weeks may be enough till 3 months of post- conception age. • Later, the baby should be seen at an interval of 1-2 months during first year of life.
  48. 48. Post-Discharge Follow-up (2/2) 48 • The baby should gain adequate weight (15-20 gm/kg/day up to 40 weeks of post-conception age and 10 gm/kg/ day subsequently). • More frequent visits should be made if the baby is not growing well or his condition demands.
  49. 49. THANK YOU!! 49