A Comprehensive Evidence-excerpts for Med Approved 4-11-2015
A Comprehensive Evidence-Based Review of Skin-to-Skin (Kangaroo) Care with Fullterm Infants
Susan M. Ludington-Hoe, R.N., CNM, Ph.D., FAAN
Barbara Morrison, R.N., CNM, FNP, Ph.D.
Gene Cranston Anderson, R.N., Ph.D., FAAN
This report has been supported in part by NIH-NINR 5RO1 NR04926 and NIH-NINR RO3 NR08587 to the first author and a Case Western Reserve University Frances Payne Bolton School of Nursing Research Incentive Grant to the second author.
Kangaroo Care (KC), skin-to-skin chest-to-chest contact between an infant and his/her parent, has been shown to be beneficial for preterm and Fullterm infants. The infant and mother must have full skin-to-skin contact, without any clothing or materials being present in the ventral are (no bras are allowed!) because fabric in the ventral area will impeded all brain-mediated responses to KC (Kress, Minati, Ferraro, & Critchley, 2011). Evidence regarding KC’s effects (physiological, psychosocial, behavioral, and breastfeeding outcomes) on Fullterm infants and their mothers and fathers was reviewed according to KC nomenclature that characterizes KC by its “starting” time. This comprehensive review covers 39 years of research and includes all types of studies, from qualitative through meta-analysis. Based on the evidence presented, anticipated outcomes and recommendations for practice conclude the review.
The new Maternity Care Practices in Infant Nutrition and Care (MPINC) criteria published by the Centers for Disease (CDC) Control and Prevention in the United States describe skin-to-skin contact (SSC) as a supportive hospital practice and mandate beginning SSC with the mother immediately after birth to improve breastfeeding outcomes (Centers for Disease Control and Prevention, 2009a, 2009b). Thus health professionals are eager to learn more about the evidence supporting the use of SSC. Another name for SSC is Kangaroo Care (KC), defined as skin-to-skin, chest-to-chest contact between infants and their mothers and fathers. The use of KC with preterm infants has become common because its safety and benefits for these infants and their parents have been established through meta-analyses (Conde-Agudelo, Diaz-Rosello, & Belizan, 2000, 2003, 2007; Ludington-Hoe & Dorsey, 1998; Mori, Khanna, Pledge, & Nakayama, 2010).
- Have the mother provide continuous KC until discharge. Mother and infant should remain in KC as much as possible throughout the postpartum stay for improved interactions, development, and breastfeeding (Kent et al., 2012;Vasquez & Berg, 2012). Continue KC as much as possible throughout the first three months of life (Chalmers, O’Brien, & Boscoe, 2009) and use KC as a FIRST intervention for breastfeeding problems (Vazquez & Berg, 2012). Remember, Kangaroo Care is the newborn’s playground (Winberg, 2005). Kangaroo Care’s continual use throughout the mother’s day can be accomplished using a tube top, slings, or wraps to position the infant near the breast while maintaining maternal modesty as the mother conducts routine postpartal activities. Commercial wraps and tops are available (Kangaroo Care increases oxytocin release in both mother and infant. Oxytocin, in turn, facilitates breastfeeding, bonding, maternal relaxation, uterine contractions, and minization of stress (Dordevic et al., 2008; Uvnas -Moberg, 2003; Uvnas-Moberg et al., 2005). Suckling maintains development of the anterior pituitary’s prolactin-secreting cells even when estrogen drops at birth – a condition that threatens prolactin cell integrity. Suckling also induces prolactin surges in maternal blood, supporting normal lactation (Uvnas-Moberg, 1999; Uvnas-Moberg, 2003). The colostrum delivered with the initial sucks is rich in T and B lymphocytes, enhancing infant immunity. 5. Keep the infant in KC at least until the first suckling at the breast has been accomplished. Also, sending the infant to the observation nursery at any time during postpartum is detrimental because once the infant is in the nursery, treatments, physical assessments, and screenings get clustered together and result in prolonged separation from the mother (Vazquez & Berg, 2012). Conducting these procedures at the mother’s bedside is the best practice.