Kangaroo Care

Kangaroo Care (also referred to as Kangaroo Mother Care) has become a familiar sight in Neonatal Intensive Care Units (NICU) around the world in recent years. The image of fragile premature babies cradled against the chest of their parents highlights the importance of skin to skin contact and touch in the days and weeks after a baby is born.

Since the practice was observed to be saving lives in Bogata, Colombia in the 1970s and studied in the 1980s and 90s, research has clearly identified that premature babies and their families benefit from the connection. The practice has moved from being the only option in poor communities unable to afford the high tech equipment used by affluent countries to keep babies alive to replacing the equipment in many situations.

Intermittent Kangaroo Care sees babies spending periods of the day out of incubators and securely held directly against the chest of their mother, father or other caregivers. Essential oxygen, monitors etc remain in place and babies body temperature and heart rate are regulated through the skin contact. However, this part-time version of Kangaroo Care is different from the original concept, something known as Continuous Kangaroo Care.

Mother-Newborn ICUs have been established in some countries so that mothers can always be with their babies to provide continuous kangaroo care. Mothers receive their own post-birth care in these wards without being separated from their baby. If a mother is unwell, the selection of a surrogate ensures that the provision of kangaroo care continues until the mother recovers.

Current World Health Organization (WHO) recommendations indicate starting kangaroo mother care only after the baby is stabilized in an incubator or warmer, which can take on average 3-7 days. However, new research shows that immediate kangaroo mother care, which involves skin-to-skin contact with the mother and exclusive breastfeeding, started as soon as a preterm or low birthweight baby is born, dramatically improves survival.

“Keeping the mother and baby together right from birth with zero separation will revolutionize the way neonatal intensive care is practiced for babies born early or small,” said Dr Rajiv Bahl, Head of the Newborn Unit at WHO, and the coordinator of the study. “When started at the soonest possible time, kangaroo mother care can save more lives, improve health outcomes for babies and ensures the constant presence of the mother with her sick baby.”

The results of the immediate kangaroo mother care study indicate the need for a global paradigm shift in the care of small babies with zero separation of babies from their mothers by having dedicated Mother-Newborn ICUs. “The best way to nurture the newly born low birthweight baby, including in high-income countries, is through ongoing skin-to-skin contact with the mother, in a mother-newborn couplet care unit that provides care and medical treatment for both,” said Dr Bjorn Westrup, of the Karolinska Institute, Sweden, and a technical expert for the study.

Huge investment in infrastructure would need to be made to convert existing NICU wards designed to accommodate infants as patients. However, in those hospitals who have embraced the concept have seen great returns for such investment.

“Continuous Kangaroo Care is the standard at a neonatal unit in Uppsala, Sweden. The unit at The University Children’s Hospital, Uppsala oversees the provision of continuous Kangaroo Care throughout the baby’s entire hospital stay where the parents continuously hold their baby 24/7. The hospital supports their philosophy to keep parents and their babies together at all times in many ways including offering specially designed clothing to allow baby’s to receive Kangaroo Care and parents be mobile at the same time, to providing procedures such as blood tests and inserting naso-gastric tubes whilst being held in safety and comfort against their chests of their parents.”

It is time to change the way we think of the mother/baby dyad when babies are born prematurely. While mothers of healthy full term babies leave hospital with their baby in the arms, those whose infants need additional care in the early weeks or months of life are allowed a few days to recover from the birth and then are discharged and become visitors of the NICU and may need to navigate accommodation near units away from their own community and supports and spend their time transporting expressed breastmilk (EBM) , travelling to and from the hospital and absorbing the costs of fuel, parking and meals as well.

In the short term, Intermittent Kangaroo Care is certainly better than the days when parents were banned from even visiting their premature babies. But we should not accept good enough as best. Governments, hospitals and the community should consider these changes of the highest priority and do everything possible to reduce the separation of mothers and babies.