Jan 2007 Article off site with permission
Kangaroo Care for Premature Babies
Premature babies, or preemies, require special attention and considerations. Preemies in the Intensive Care Nursery (ICN) at John Muir Medical Center- Walnut Creek Campus often receive what is called Kangaroo Care, a simple but powerfully effective therapy that is very helpful for baby and mom.
What Is Kangaroo Care?
Kangaroo Care is but one of the techniques of the ICN's developmentally supportive care, a constellation of techniques and caring modalities to meet the needs of its delicate, very sensitive preemies. It is a skin-to-skin experience in which a preemie is wrapped next to its mother's chest while the mother is resting in a reclining chair. The rise and fall of the mother's chest as she breathes and the sound of her heartbeat provide a soothing rhythm for the baby, says Sue Cleaver, ICN Clinical Coordinator. The mother's body warmth keeps baby comfortable and feeling safe.
The process gets its name from the experience of a kangaroo baby, known as a joey. A joey is born before it is fully developed and for its first six months lives in its mother's pouch. It then leaves the warmth and safety of the pouch to venture outside.
Does It Work?
Offering a strong endorsement for Kangaroo Care and her entire experience at the ICN is Janine Pearson of Martinez whose preemie, Nicholas, was born there. I just can't say enough about the experience, Pearson says. All the nurses and staff were so open. Dr. Scott, (Medical Director of the ICN) was first rate. They all listened to me and educated me.They made a big effort to get me any information or help I wanted.
Pearson explained that she entered the hospital when she was only 24 weeks pregnant and starting to go into labor. Since 24 weeks is far short of the 38 to 40 weeks of a full term pregnancy, she chose to enter the hospital where she could stay in bed and hope to postpone the birth. This tactic delayed the birth for a little over four weeks and Nicholas was born February 10, 2006 at 28 weeks and 5 days, weighing 3 lbs. He weighed 5 lbs. 12 oz. when he went home on March 28, 2006.
After birth, Nicholas was put on a continuous positive airway pressure device to facilitate breathing, Pearson explained. After the third day, Nicholas was off this machine and breathing well by himself. Then came Kangaroo Care, Pearson says It's as close to being in the womb as you can get.From the beginning, he settled down and seemed just to melt into me. It was so bonding and was very calming for him and me. And, Eric (his dad) liked doing it to. He fell asleep.
WHAT ARE THE BENEFITS?
Kangaroo Care is a simple practice with profound benefits, says Cleaver. Studies show these babies get off ventilators sooner, gain weight faster, do better with feeding and go home sooner. It also results in decreased parent anxiety. It's very empowering for them. They no longer feel like helpless bystanders.
Among the other Kangaroo Care benefits for preemies are:
Decrease in the output of stress hormones
Lower oxygen requirements
Benefits for moms include improved breast milk production, increased selfconfidence in caring for their preemie, knowledge that they are doing something positive for their baby, and less anxiety and depression. For dads, most of whom decide to offer Kangaroo Care also, the benefits include increased selfconfidence in caring for preemies and the knowledge they are helping their baby in a very significant way.
A guiding principle when caring for preemies is remembering that they would, under normal circumstances, still be in the womb. They are underequipped to deal with the stimuli they receive in the ICN, Cleaver says. They have to deal with bright lights, noise and the discomfort of medical procedures and they can quickly use up all their reserves of energy.
The main goal of 'developmentally supportive care' is to keep each baby as comfortable and free from stress as possible. For example, we put our little patients into a soft cocoon of buntings and blankets so that they can stay in a fetal position with their arms and legs tucked close to their body. That technique is only one of a long list of guidelines and directions all aimed at providing comfort and reassurance for the preemies.
Other Care Techniques
Another important element of ICN care is the Golden Hour Script, developed by a multidisiplinary team of physicians, nurses and respiratory therapists, which gives comprehensive guidelines for the stabilization of extremely premature babies. The Golden Hour- the first hour of a premature baby's life-is considered vital because the treatment provided during that time can have long term effects.
The process begins in the delivery room, Cleaver says. If a newborn is experiencing breathing problems, a tube is inserted into the baby's mouth and windpipe. The tube is attached to a special device called a Neopuff, which assists the baby's breathing by providing breaths at a constant pressure. With older devices it was possible to over inflate the baby's lungs because it was difficult to accurately control the pressure of each breath, Cleaver says. Now that risk is significanlty reduced.
The newly developed Golden Hour Script is a comprehensive guideline for doctors, nurses and other staff that has been incredibly successful, Cleaver says. Staff is completely supportive, because it works and they can see what it does for these tiny babies. We are getting babies off ventilators sooner and have observed a drop in chronic lung disease. We believe the Golden Hour Script will have long term effects for our premature babies and possibly help them go home sooner.