Effects of Kangaroo Mother Care in the NICU on the Physiological Stress Parameters of Premature Infants: A Meta-Analysis of RCTs

Objective: The aim of this study was to analyze the randomised controlled trials that explored the effect of kangaroo mother care on physiological stress parameters of premature infants. Methods: Two independent researchers performed a systematic review of indexed studies in PubMed, Embase, CINAHL, Cochrane and Scopus. We included data from randomized controlled trials measuring the effects of kangaroo care compared to standard incubator care on physiological stress outcomes, defined as oxygen saturation, body temperature, heart rate and respiratory rate. The PRISMA model was used to conduct data extraction. We performed a narrative synthesis of all studies and a meta-analysis when data were available from multiple studies that compared the same physiological parameters with the kangaroo method as an intervention and controls and used the same outcome measures. Results: Twelve studies were eligible for inclusion in this meta-analysis. According to statistical analysis, the mean respiratory rate of preterm infants receiving KMC was lower than that of infants receiving standard incubator care (MD, −3.50; 95% CI, −5.17 to −1.83; p < 0.00001). Infants who received kangaroo mother care had a higher mean heart rate, oxygen saturation and temperature, although these results were not statistically significant. Conclusions: Current evidence suggests that kangaroo care in the neonatal intensive care unit setting is a safe method that may have a significant effect on some of the physiological parameters of stress in preterm infants. However, due to clinical heterogeneity, further studies are needed to assess the effects of physiological stress in the neonatal intensive care unit on the development of preterm infants.

Noise Level and Frequency Experienced by Premature Infants Receiving Incubator Care in the Neonatal Intensive Care Unit

Purpose: The purpose of this study was to identify the noise level and frequency experienced by premature infants receiving incubator care in the neonatal intensive care unit (NICU). Methods: The participants were 20 premature infants receiving incubator care in the NICU of a university hospital in Daejeon Metropolitan city. The noise level was measured using a professional sound-level meter (ET-958, FLUS, Shenzhen, China) based on a noise classification table developed by the author. The data were analyzed with descriptive statistics, the t-test, analysis of variance, and Pearson correlation coefficients using SPSS for Windows version 22.0. Results: The average noise level experienced by premature infants receiving incubator care in the NICU was 51.25 dB (range: 45.0~81.7 dB). The frequency of noises was highest for factors related to nursing activities (40.3%), followed by human factors (29.1%), machine alarm sounds (20.1%), incubator operation (6.6%), and internal environmental factors (3.9%). Conclusion: According to the above results, the noise level experienced by premature infants receiving incubator care in the NICU exceeded the recommendations of the American Academy of Pediatrics. Therefore, it is necessary to develop an interventional program to reduce noise in the NICU, and to conduct follow-up studies to verify its effectiveness.

Oxidative Stress Biomarker Decreased in Preterm Neonates Treated With Kangaroo Mother Care

Objective: Due to physiological and metabolic immaturity, prematurely born infants are at increased risk because of maternal separation in many neonatal intensive care units (NICUs). The stress induced from maternal–infant separation can lead to well-documented short-term physiologic instability and potentially lifelong neurological, sociological, or psychological sequelae. Based on previous studies of kangaroo mother care (KMC) that demonstrated improvement in physiologic parameters, we examined the impact of KMC on physiologic measures of stress (abdominal temperature, heart rate, oxygen saturation, perfusion index, near-infrared spectrometry), oxidative stress, and energy utilization/conservation in preterm infants. Methods: In this randomized, stratified study of premature neonates, we compared the effects on urinary concentrations of biomarkers of energy utilization and oxidative stress of 1 hr of KMC versus incubator care on Day 3 of life in intervention-group babies ( n = 26) and control-group babies ( n = 25), respectively. On Day 4, both groups received 1 hr of KMC. Urinary samples were collected 3 hr before and 3 hr after intervention/incubator care on both days. Energy utilization was assessed by measures of adenosine triphosphate (ATP) degradation (i.e., hypoxanthine, xanthine, and uric acid). Oxidative stress was assessed using urinary allantoin. Mixed-models analysis was used to assess differences in purine/allantoin. Results: Mean allantoin levels over Days 3 and 4 were significantly lower in the KMC group than in the control group ( p = .026). Conclusions: Results provide preliminary evidence that KMC reduces neonatal oxidative stress processes and that urinary allantoin could serve as an effective noninvasive marker for future studies.

Cerebral oxygenation during skin-to-skin care in preterm infants not receiving respiratory support

ObjectiveSkin-to-skin care (SSC) has proven benefits in preterm infants, but increased hypoxic and bradycardic events have been reported. This may make clinicians hesitant to recommend SSC as standard care. We hypothesised that regional cerebral oxygenation (rStO2) measured with near infrared spectroscopy is not worse during SSC compared with standard incubator care.DesignProspective, observational, non-inferiority study.SettingSingle tertiary perinatal centre in Australia.PatientsForty preterm infants (median (IQR) 30.6 (29.1–31.7) weeks' gestation) not receiving respiratory support were studied on day 14 (8–38).InterventionsRecordings during 90 min of incubator care, followed by 90 min of SSC. Each infant acted as their own control and caregivers were blinded to the rStO2 measurements.Main outcome measuresThe primary outcome was the mean difference in rStO2 between SSC and incubator care. The prespecified margin of non-inferiority was −1.5%. Secondary outcomes included heart rate (HR), peripheral oxygen saturation (SpO2), time in quiet sleep, temperature and hypoxic (SpO2 <80% for >5 s) or bradycardic events (HR <80 bpm for >5 s) and time spent in cerebral hypoxia (rStO2<55%) and hyperoxia (rStO2>85%).ResultsMean (SD) rStO2 was lower during SSC compared with incubator care: 73.6 (6.0)% vs 74.8 (4.6)%, mean difference (95% CI) 1.3 (2.2 to 0.4)%. HR was 5 bpm higher, SpO2 1% lower and time in quiet sleep 24% longer during SSC. Little evidence of a difference was observed in temperature. The number of hypoxic or bradycardic events as well as the proportion of time spent in cerebral hypoxia and hyperoxia was very low in both periods.ConclusionsMean rStO2 was marginally lower during SSC without observed differences in hypoxic or bardycardic events but an increase in time spent in quiet sleep.Trial registration numberThis trial is linked to Australian New Zealand Clinical Trials Registry: identifier 12616000240448. It was registered pre-results.

Comparison between heater with incubator care in providing warmth to low birth weight newborns

Prevention of excessive heat loss is fundamental to survival of low birth weight (LBW) newborns. Highly expensive incubator is not available in most of the health care facilities of Bangladesh. Warm cot care by heater or with light bulbs may alternatively help in maintenance of temperature of LBW newborns in health care facilities where incubator is not available. So far i know no such study was conducted before in our country, this study was carried out to show the effectiveness of warm cot care in comparison to incubator care. The present study was cross sectional descriptive type study conducted in the Department of Neonatology, Mymensingh Medical College over a period 1 year from January 2009 to December 2009. Fifty neonates weighing 1200-2000g with gestational age ? 30 weeks to 40 weeks were allocated to an incubator group and similar number with same criteria were taken as cot care group. In cot care group, those babies were selected that are not supposed to cot care due to lack of incubator. The study showed that there were no differences between infants warm cot care versus incubator care. The temperature of the study patients showed that 34(68.0%) and 36(72.0%) maintained normal temperature all the time during hospital stay prior to discharge and rest 16(32.0%) and 14(28.0%) in cot and incubator group respectively became either hypothermic or hyperthermic. Mild hypothermia/cold stress was 7(14.0%) in cot and 4(8.0%) in incubator group. Moderate hypothermia and severe hypothermia was none in both groups. Hyperthermia/fever was 9(18.0%) and 10(20.0%) in cot and incubator group respectively. Analysis reveals that no significant difference was found between two groups. The body temperature of the low birth weight babies (weighing1200-2000g) can be satisfactorily maintained in the low-cost warm cots without the help of incubators which are costly and not available in most of the health care facilities in the developing countries like Bangladesh. DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16691 Community Based Medical Journal 2013 July: Vol.02 No 02: 4-8

Kangaroo Mother Care: A Simple Method to Care for Low-Birth-Weight Infants in Developing Countries

Kangaroo Mother Care (KMC) is an effective way to meet baby's needs for warmth, breastfeeding, protection from infection, stimulation, safety and love. Mother acts as an incubator as kangaroo and put low birth infant vertically in between the chest for warming. The term kangaroo care is derived from practical similarities to marsupial care-giving. The premature infant is kept warm in the maternal pouch and is close to the breasts for unlimited feeding. It provides an alternative to incubator care, without separation from the mother. The importance of KMC in low- and middle-income countries has been highlighted as a contributing factor to the achievement of the Millennium Development Goal 4 that targets a reduction by two-thirds of under-five mortality rates from 1990 to 2015. This programme is mediated by humoral, autonomic and somatic behaviours, expressed ultimately as innate competency in breastfeeding behaviours. It is simple, acceptable to mothers and can be continued at home.DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16256 J Shaheed Suhrawardy Med Coll, 2013;5(1):49-54

Randomized Crossover Trial of Kangaroo Care to Reduce Biobehavioral Pain Responses in Preterm Infants: A Pilot Study

Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30—32 weeks’ gestational age, 2—9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother—infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.