kangaroo Breastfeeding Method Essay

Kangaroo Mother Care: The Benefits of Skin-to-Skin Contact with Newborns
Kangaroo Mother Care, or Skin-to-Skin contact with a newborn immediately after birth, has proven to be a highly beneficial practice, with hardly any negative impact. Kangaroo Mother Care, or KMC for short, provides a newborn the warmth, stimulation, safety, protection from infection, and love that they need. KMC has benefits for not only the newborn, but also significant benefits for the mother, including a boost in her self esteem. Through various studies, pediatricians and obstetricians have found little negative impact through the use of the Kangaroo Mother Care method. The only time it should not be used is in emergency situations, where a newborn is not stable enough to remain with the mother, or vice versa. The cases that do not allow for an infant to remain with the mother often result in surgeries. More hospitals and birthing centers have transitioned to KMC over standard care because of the physical and psychological benefits it provides. Skin to skin contact, or Kangaroo Mother Care, is a highly beneficial, though only barely emerging area of study in both Obstetrics and Pediatrics. If hospitals and birthing centers transition towards Kangaroo Care over standard care, infants will develop more to their potential. kangaroo Breastfeeding Method Essay

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Methods
The have been numerous studies performed to test the validity of the Kangaroo Mother Care method. Each study that has been researched provided an excellent insight to the positive outcomes the KMC method offered.

Flacking, Ewald, and Wallin investigated the rates of breastfeeding for premature infants for up to 6 months, corrected age, after using the kangaroo method of care. This study found positive effects on the length of breastfeeding times and exclusivity of breastfeeding while using skin to skin contact with very premature and premature infants. Flacking, Ewald, and Wallin found that with support of kangaroo care, mothers were able to sustain breastfeeding for a prolonged duration. kangaroo Breastfeeding Method Essay

An article in Developmental Psychology by Feldman, Weller, Sirota, and Eidelmanexplained (consider separating the two words) their research that proved the self-regulation benefits in premature and low birth weight infants when kangaroo care was used. The authors proved research in both animal models that showed negative and irreversible effects when separated from their mother after birth, even if just for a short amount of time. Human and animal models showed the positive effects of skin-to-skin contact, including an improved state organization, stress reactivity, physiological maturation, and attention. The authors also included a study that found that placing a premature infant in the nursery after birth proved detrimental to the infant’s vision and auditory development.2

Ferber and Makhoul focused their study towards the positive effects kangaroo care has on full term infants, not only premature or low birth weight infants. The authors performed a study where two different mother-infant groups were observed, one group using kangaroo care after delivery, the other did not. The authors found that the infants, who were in the KC group, slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements. kangaroo Breastfeeding Method Essay

The British Journal of Midwifery included an article by Gregson and Blacker, explaining not only the benefits of skin to skin contact for the infant, but also the mother. Gregson and Blacker found that kangaroo care reduces the length of hospital stays and improves breastfeeding rates upon discharge from the hospital. This study also tested the outcomes of kangaroo care with premature infants, and infants born to diabetic mothers. The authors study confirms that the outcome of kangaroo care is highly beneficial. kangaroo Breastfeeding Method Essay 4

Amy Johnson performed a study on the effects of KMC through the mother’s perspective. The study examined the experience that mothers, or their surrogate, have while using the Kangaroo Mother Care method. Mothers were especially noted to feel more needed after using KMC, and often, more joyful. Johnson found that mothers needed support while holding, meaning encouragement, planning, and teaching. The author also found that mothers who felt scarred or nervous before the birth, was more at ease after using the kangaroo care method. This study also found the need for quiet space often helped create a connection between mother and infant during skin to skin contact. kangaroo Breastfeeding Method Essay 5

The World Health Organization (WHO) presented information on how to improve the outcome of low birth weight infants through the beneficial technique of skin to skin contact, or kangaroo care. Though the book was geared more towards stable premature infants and infants born with a low birth weight, the information presented was highly transferrable to all infants after birth. This book could be considered a how-to guide for parents wishing to use KMC (Kangaroo Mother Care) after their child is born, but it also provides scientific research as to why the KMC way is highly recommended.6

An article in the Korean Journal of Women’s Health Nursing showed that results of a study performed by Lee and Bang. The study and article was geared more towards the psychology of the mother and the infant’s physiological stability. Lee and Bang found that after using the Kangaroo Mother Care method, maternal self esteem was higher when it came to caring for the newborn. The authors also found that KMC helped with the infant’s physiological stabilization in terms of their body temperature, respiratory rate, heart rate, oxygen saturation, and stability of the cardio-respiratory system in premature infants (SCRIP) score.7 kangaroo Breastfeeding Method Essay

Puig and Squassero performed research on the effects of skin to skin contact with newborns and their mother. Their research found that infants cry less when placed directly on their mother’s chest. Skin to skin contact also improves the mother-infant interaction, keeps the baby warm, and aides in breast-feeding for both the mother and the child. The authors researched not only the positive effects of initial skin to skin contact, but also the benefits of the varying lengths. It was important to note that no negative effects were found.8
An article, found in the Journalof Perinatology, was a research study comparing the effects of kangaroo care to standard care after a baby’s birth. The authors (Shohei, et al.) wanted to determine the outcome of kangaroo care through the first year of an infant’s life and whether or not it was more beneficial than standard care. The research found that infants cared for with KC (kangaroo care) tested better on various infant tests, such as NBAS and Bailey Scales. Kangaroo care was proven to have a more positive outcome on the mood, temperament, and development of infants up to age one.9 kangaroo Breastfeeding Method Essay

Results
Through the various studies, research has found Kangaroo Mother Care an upgrade from the usual standard care given to infants after they are born. KMC provides a great deal of additional support to newborns, whether preterm, low birth weight, or full term infants. Not only does skin-to-skin contact help the newborns, but it also helps the new mother. Breastfeeding is one of the greatest advantages associated with KMC. Through skin to skin contact, breastfeeding occurs with less force and frustration.

Preterm and Low Birth Weight Infants
Kangaroo Care was initially implemented in1978 by a Columbian pediatrician, Dr. Edgar Rey, following a realization of the inadequate equipment his hospital had.10 He found the Kangaroo Mother Care method to be even more beneficial than incubators in maintain body temperature, bonding, and breastfeeding. Dr. Rey was correct; after many years of research, KMC has still proven to be the best source for a newborn’s needs.

Various difficulties present themselves in preterm and low birth weight infants. The Kangaroo Mother Care method has been shown to stabilize an infant’s heart rate, body temperature, respiratory rate, and oxygen saturation.7 Lee and Bang scored the preterm infants using the SCRIP’s scoring method:
Table 1.SCRIP: Stability of the Cardio Respiratory System in Premature Infants Score kangaroo Breastfeeding Method Essay

The Kangaroo Mother Care method also allows for a shorter hospital stay for both mother and baby.4Gregson and Blacker found in their study of 107 women, their hospitalization stay was shortened from 5 days (the control group) to 4 days.4 Through the use of KMC, infants scored higher on the Apgar scale, which led to less severe medical measure, and shorter hospitalization. 4

When preterm or low birth weight infants are not placed directly on the mother’s, or surrogate’s, chest and are taken directly to the nursery, the infant and mother experience negative effects. Feldman et al., found irreversible, negative effects, even if just for a few moments, on both mother and child in an animal study, and correlated to human mother and child.2The authors also found negative auditory and visual effects on preterm infants placed in the nursery, instead of on the mother’s chest.2 kangaroo Breastfeeding Method Essay

Full Term Infants
Dr. Ferber and Dr. Makhoul’s study examined the effects of KMC on full term infants. Their research found infants who used the Kangaroo Mother Care method were more likely to sleep longer and more peacefully.3 Along with more sleep, infants also cried less when placed directly on the mother’s, or surrogate’s, chest.8 Skin to skin contact provided a stronger mother-infant bond and aided with breastfeeding.1

Shohei et al., found a year after their birth, infants who used the KMC method tested higher on various infant tests.9The Kangaroo Care method was proven to have a significant positive outcome on infant’s temperament, mood, and behavior, up to age one.9The results of the NBAS (Neonatal Behavioral Assessment Scale) test were:
Source:Shohei, O. et. Al. (July/August 2002). “Comparison of kangaroo care and standard care: behavioral organization, development, and temperament in healthy, low-birth-weight infant through age one.” Journal of Perinatology.No.22 (5).Retrieved on April 5, 2012. kangaroo Breastfeeding Method Essay

Effects on the Mother
The Kangaroo Mother Care method does not only provide positive outcomes for the infant, but also for the mother. The KMC method was noted to make the new mother feel more needed and closer to her child.5 Johnson’s study taught new mothers, or their surrogate (father, sibling, etc.) how to properly use the KMC method. The author also found the KMC method gives an anxious new mother a sense of calm and bond with her new baby.5

Skin to skin contact was also shown to improve the self esteem of the new mother.7 Lee and Bang found that the KMC method promoted a new mother’s self esteem by proving that she can be comforting to her new child.7 The authors gained this information directly from the new mother.

Skin to skin contact also helped the new mother with breastfeeding. When placed directly on the mother’s chest, the infant found its way to nurse, with very little outside help.1 KMC was shown to have empowering effects on breastfeeding and the bond it creates between the mother and child.1 kangaroo Breastfeeding Method Essay

Discussion
The Kangaroo Mother Care method has been used for only a short time, in terms of other compared to other medical practices. Though relatively new, the KMC method has many positive outcomes with very few, if any downfalls. The studies show the positive outcomes for all involved. In preterm or low birth weight infants, the KMC method helped to stabilize the heart rate, regulate body temperature, and reduce sleep apnea and crying.7 The KMC method was also useful in the same way with full term infants. In addition to regulation, full term infants were also observed having longer, undisturbed sleep cycles3, less crying, and higher scores on infant testing a year after birth, being skin to skin with their mother.9New mothers also benefited from the KMC method. The studies found out that they had a closer bond with their newborn. Furthermore, new mothers had a raised sense of self esteem and felt more comfortable with their new child.7

Conclusion
Though a fairly new practice, the Kangaroo Mother Care method has proven highly beneficial for both mother and newborn, whether preterm, low birth weight, or full term. The positive effects from skin to skin contact far outweigh the effects of standard care. More hospitals and birthing centers are implementing the Kangaroo Mother Care method. Because of this, more preterm infants have developed more to their potential. The transition stems from the physical and psychological benefits KMC provides, over standard care. Skin to skin contact, or Kangaroo Mother Care (KMC), is a highly beneficial, though only barely emerging area of study in both Obstetrics and Pediatrics. Through the positive effects it holds, more births use some form of skin to skin contact, whether for a preterm or not. kangaroo Breastfeeding Method Essay

Free the Nipple II: Breastfeeding in Public
“For you will nurse and be satisfied at her comforting breasts; you will drink deeply and delight in her overflowing abundance” (Isaiah 11) Nowhere in the Bible does it say breastfeeding is something to be looked down at, on the contrary, breastfeeding is introduced as a comforting situation not a stressful one for both the mother and infant. Even though some people think exposing breast in public is morally wrong, people should not see public breastfeeding as a wrong doing because infants who are breastfed have a less tendency to get sick and most important of all breastfeeding is part of nature.
Who in their right mind can compare a mother breastfeeding an infant with an ordinary woman flashing her breast out in public. There is a big difference between those two ideas but for a portion of the human population exposing breast in public is morally wrong no matter the situation. Attorney Tracey M. DiLascio states, “… public perception of female breasts transformed from food source to sexual object through the proliferation of war-era pin-up girls and magazines such as Playboy” (3). The sift of perspective from feeding breast to fun to look at breast comes from media and one’s own twisted mind. Humanity itself has taken things to a whole new level by interpreting situations based on what they have seen in the past. The word breast or boobs by itself automatically is associated with any kind of sexual activity kangaroo Breastfeeding Method Essay

The Benefits of Kangaroo Care for Fathers with an Infant in the Neonatal Intensive Care Unit (NICU): Educational, Emotional and Paternal Role Support. Introduction Take a second to imagine you are a father, who has an infant admitted to the neonatal intensive care unit (NICU) for the first time. How are you feeling? Afraid? Confused, even? If your baby is admitted to the NICU, your first question probably will be: What is this place? With equipment intended for infants and medical staff specially qualified in newborn care, the NICU is an intensive care unit created for sick newborns who require specialized treatment. A common example for parent’s…show more content…
Additionally there is a lack of information in regards to how Kangaroo Care helps fathers develop paternal feelings, a sense of paternal competence and ability to handle the unexpected situation. Therefore, this study will focus on fathers’ and the benefits that Kangaroo Care provides for them. The research questions this study hopes to answer are as follows: (a) does kangaroo care help fathers develop paternal feelings, (b) will a fathers opportunity for being close to their infant and facilitating attainment benefit their paternal role in the neonatal intensive care unit, (c) will educational support and parenting techniques allow fathers to feel more connected with their infant? Ideally the interviews and focus groups will give neonatal intensive care unit staff a better understanding of the fathers experience with kangaroo care and what changes can be made to provide educational support, emotional support, and how to assist them in their paternal role. It should also be informative for all medical staff involved in working with infants and their caregivers. kangaroo Breastfeeding Method Essay

1.1 The problem – improving care and outcome for low-birth-weight babies
Some 20 million low-birth-weight (LBW) babies are born each year, because of either
preterm birth or impaired prenatal growth, mostly in less developed countries. They contribute
substantially to a high rate of neonatal mortality whose frequency and distribution correspond
to those of poverty.1, 2 LBW and preterm birth are thus associated with high neonatal and infant
mortality and morbidity.3, 4 Of the estimated 4 million neonatal deaths, preterm and LBW
babies represent more than a fifth.5 Therefore, the care of such infants becomes a burden for
health and social systems everywhere.
In affluent societies the main contributor to LBW is preterm birth. The rate has been
decreasing thanks to better socioeconomic conditions, lifestyles and nutrition, resulting in
healthier pregnancies, and to modern neonatal care technology and highly specialised and
skilled health workers. 6-8
In less developed countries high rates of LBW are due to preterm birth and impaired
intrauterine growth, and their prevalence is decreasing slowly. Since causes and determinants
remain largely unknown, effective interventions are limited. Moreover, modern technology
is either not available or cannot be used properly, often due to the shortage of skilled staff.
Incubators, for instance, where available, are often insufficient to meet local needs or are not
adequately cleaned. Purchase of the equipment and spare parts, maintenance and repairs are
difficult and costly; the power supply is intermittent, so the equipment does not work properly. kangaroo Breastfeeding Method Essay
Under such circumstances good care of preterm and LBW babies is difficult: hypothermia
and nosocomial infections are frequent, aggravating the poor outcomes due to prematurity.
Frequently and often unnecessarily, incubators separate babies from their mothers, depriving
them of the necessary contact.
Unfortunately, there is no simple solution to this problem since the health of an infant is
closely linked to the mother’s health and the care she receives in pregnancy and childbirth.
For many small preterm infants, receiving prolonged medical care is important. However,
kangaroo mother care (KMC) is an effective way to meet baby’s needs for warmth,
breastfeeding, protection from infection, stimulation, safety and love.
1.
Introduction
2
KANGAROO MOTHER CARE
1.2 Kangaroo mother care – what it is and why it matters
Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a
powerful, easy-to-use method to promote the health and well-being of infants born preterm as
well as full-term. Its key features are:
early, continuous and prolonged skin-to-skin contact between the mother and the baby;
exclusive breastfeeding (ideally);
it is initiated in hospital and can be continued at home;
small babies can be discharged early;
mothers at home require adequate support and follow-up;
it is a gentle, effective method that avoids the agitation routinely experienced in a busy ward
with preterm infants.
It was first presented by Rey and Martinez,9 kangaroo Breastfeeding Method Essay
in Bogotá, Colombia, where it was developed as
an alternative to inadequate and insufficient incubator care for those preterm newborn infants
who had overcome initial problems and required only to feed and grow. Almost two decades
of implementation and research have made it clear that KMC is more than an alternative to
incubator care. It has been shown to be effective for thermal control, breastfeeding and
bonding in all newborn infants, irrespective of setting, weight, gestational age, and clinical
conditions.10, 11
Most published experience and research concerning KMC comes from health facilities,
where care was initiated with the help of skilled health workers. Once a mother was confident in
the care she gave her baby, she continued it at home under guidance and with frequent visits for
specialised follow-up.
Evidence of the effectiveness and safety of KMC is available only for preterm infants without
medical problems, the so-called stabilised newborn. Research and experience show that:
KMC is at least equivalent to conventional care (incubators), in terms of safety and thermal
protection, if measured by mortality.
KMC, by facilitating breastfeeding, offers noticeable advantages in cases of severe morbidity.
KMC contributes to the humanization of neonatal care and to better bonding between mother
and baby in both low and high-income countries.12, 13
KMC is, in this respect, a modern method of care in any setting, even where expensive
technology and adequate care are available.
KMC has never been assessed in the home setting.
Ongoing research and observational studies are assessing the effective use of this method in
situations where neonatal intensive care or referral are not available, and where health workers
are properly trained. In those settings KMC before stabilisation may represent the best chance
of healthy survival. 14, 15
This guide will therefore refer to KMC initiated at a health facility and continued at home
under the supervision of the health facility (domiciliary KMC). KMC as described in this
document recommends continuous skin-to-skin contact acknowledging that it might not be
possible in all settings and under all circumstances. The principles and practice of KMC
outlined in this document are also valid for intermittent skin-to-skin contact, provided
adequate care is offered to LBW and preterm newborn infants when they are separated from
their mothers. Such intermittent skin-to-skin contact has been shown to be beneficial,16 if
3 kangaroo Breastfeeding Method Essay
complemented by proper incubator care. Guidance on skin-to-skin care may be used for
rewarming newborn infants with hypothermia or keeping them warm during transportation
to the referral facility.17
1.3 What is this document about?
This document describes the KMC method for care of stable preterm/LBW infants (i.e.
those who can breath air and have no major health problems) who need thermal protection,
adequate feeding, frequent observation, and protection from infection.
It provides guidance on how to organize services at the referral hospital and on what is
needed to introduce and carry out KMC, focusing on settings where resources are limited.
Evidence for the recommendations is provided18 whenever possible. However, for many
statements, especially those related to secondary procedures, sound evidence is not available as
in many other fields of health care. In these cases, the text reports the experience of health
professionals who have implemented KMC for many years, many of whom carefully revised
previous versions of this document.
For breastfeeding counselling and support, readers should refer to Breastfeeding Counselling:
A Training Course -Trainer’s Guide.19 For HIV and infant feeding, refer to HIV and Infant Feeding
Counselling: A Training Course -Trainer’s Guide. 20
Management of medical problems of small babies is not part of this guide. Further guidelines
can be found in textbooks or the WHO document Managing newborn problems. A guide for
doctors, nurses and midwives. 56
1.4 Who is this document for?
This text has been prepared for health professionals in charge of LBW and preterm newborn
infants in first referral hospitals in settings with scarce resources.
It is not written for all potential care providers. Practical instructions (or protocols) adapted
to the categories of health workers available in different settings should be prepared locally. kangaroo Breastfeeding Method Essay
It is also aimed at decision-makers and planners at national and local levels. They need
to know whether KMC suits the needs of their health systems, whether it is practical and
feasible, and what is required to implement it successfully.
1.5 How should this document be used?
KMC guidelines have to be adapted to specific circumstances and available resources at
national or local level. This document can be used to develop national and local policies,
guidelines and protocols from which training material can be developed. This document cannot,
as it stands, be used for training purposes. Other training material and activities, especially on
breastfeeding support and counselling on HIV and infant feeding, are needed to acquire all the
necessary skills. We hope that pre-service institutions will include those skills in their curricula.
kK
4
KANGAROO MOTHER CARE
5
This chapter reviews the evidence on KMC, from both developing and developed countries,
with regard to the following outcomes: mortality and morbidity; breastfeeding and growth;
thermal protection and metabolism, and other effects. The experience with KMC has been
reviewed by several authors,12, 13, 16 , 21, 22 and in a systematic review.23We also present evidence kangaroo Breastfeeding Method Essay
on the acceptability of the intervention for mothers and health-care staff.
While reviewing the evidence, regardless of the outcome, it became clear that it was
important to highlight two essential variables: time of initiation of KMC, and daily and overall
duration of skin-to-skin contact.
Time of initiation of KMC in the studies under consideration varied from just after birth
to several days after birth. Late initiation means that the preterm/LBW infants have already
overcome the period of maximum risk for their health.
Length of daily and overall duration of skin-to-skin contact also varied from minutes (e.g. 30
minutes per day on average) to virtually 24 hours per day; from a few days to several weeks.
The longer the care, the stronger the possible direct and causal association between KMC and
the outcome. Furthermore, when KMC was carried out over a long period of time, care was
predominantly provided by the mother rather than the nursing staff or the conventional
incubator.
Some other variables that might have affected the outcome of KMC are:
the position in which the baby was kept;
the changes in the type and mode of feeding;
the timing of discharge from the institution and the transition to home care;
condition at discharge;
the intensity of support and follow-up offered to mothers and families after discharge from the
institution.
Many other factors (e.g. social conditions, environment and health care, especially services
offered for KMC) may be associated with the positive effects observed in KMC studies. It is
very important to separate the effects of these factors from those deriving from KMC. Below,
in reviewing the evidence, we try to address those additional factors.
No published study on KMC was found in the context of high HIV prevalence among mothers. kangaroo Breastfeeding Method Essay
2.
Evidence
6
KANGAROO MOTHER CARE
2.1 Mortality and morbidity
Clinical trials
Three published randomized controlled trials (RCT) comparing KMC with conventional
care were conducted in low-income countries.24-26 The results showed no difference in survival
between the two groups. Almost all deaths in the three studies occurred before eligibility,
i.e. before LBW infants were stabilised and enrolled for research. Infants weighing less than
2000g were enrolled after an average period of 3 -14 days on conventional care, in urban thirdlevel hospitals. The KMC infants stayed in hospital until they fulfilled the usual criteria for
discharge, as the control infants did, in two of the studies,24, 26 while in the third study they were
discharged earlier and subjected to a strict ambulatory follow-up.25The follow-up periods lasted
one,26 six24 and twelve months,25 respectively.
The RCT carried out in Ecuador by Sloan and collaborators showed a lower rate of severe
illness among KMC infants (5%) than in the control group (18%).24 The sample size required
for that study was 350 subjects per group for a total of 700 infants, but only 603 babies were
recruited. Recruitment, in fact, was interrupted when the difference in the rate of severe illness
became apparent. The other controlled studies conducted in low-income countries revealed no
significant difference in severe morbidity, but found fewer hospital infections and readmissions
in the KMC group. Kambarami and collaborators from Zimbabwe also reported reduced
hospital infections.27 High-income countries report no difference in morbidity. However, it is
notable that no additional risk of infection seems to be associated with skin-to-skin contact.24-27
Observational studies showed that KMC could help reduce mortality and morbidity in
preterm/LBW infants. Rey and Martinez,9
in their early account, reported an increase in
hospital survival from 30% to 70% in infants between 1000g and 1500g. However, the
interpretation of their results is difficult because numerators, denominators and follow-up in
the KMC group were different from those in the historical control group.28 Bergman and
Jürisoo, in another study with an historical control group conducted in a remote mission
hospital without incubator care in Zimbabwe,14 reported an increase in hospital survival from
10% to 50% in infants weighing less than 1500g, and from 70% to 90% in those weighing
between 1500 to 1999g. Similar results are reported from a secondary hospital in nearby
Mozambique.15The difference in survival, however, may be due to some uncontrolled variables.
The studies in Zimbabwe and Mozambique, conducted in hospitals with very limited resources, kangaroo Breastfeeding Method Essay
applied KMC very early on, well before LBW and preterm infants were stabilized. In the early
study by Rey and Martinez, KMC was applied later, after stabilization. In both cases the skinto-skin contact was maintained virtually 24 hours a day.
Charpak and collaborators, in a two-cohort study carried out in Bogotá, Colombia,29 found
a crude death rate higher in the KMC group (relative risk = 1.9; 95%CI: 0,6 to 5.8), but their
results reverted in favour of KMC (relative risk = 0.5, 95%CI: 0.2 to 1.2) after adjustment for
birth weight and gestational age. The differences, however, were not statistically significant.
The two cohorts recruited in two third-level hospitals, showed many social and economic
differences. KMC was also applied after stabilization and 24 hours a day. In a controlled but
not randomized trial carried out in a tertiary-care hospital in Zimbabwe, there was a slight
difference in survival in favour of the KMC infants, but this might have been due to differences
in feeding.27
7
Conclusion
On balance the evidence shows that although KMC does not necessarily improve survival, it
does not reduce it. After stabilization, there is no difference in survival between KMC and good
conventional care. The hypothesis that KMC might improve survival when applied before
stabilization needs to be further explored with well-designed studies. If such an effect on
survival exists, it will be more evident and easier to demonstrate in the poorest settings, where
mortality is very high.
As for morbidity, while there is no strong evidence of a beneficial effect of KMC, there is
no evidence of it being harmful. In addition to the little evidence already published,14, 15 some
preliminary results on a small number of newborn infants with mild respiratory distress seem to
confirm that very early skin-to-skin contact might have a beneficial effect.30 A word of warning
about discharge: KMC infants discharged during the cold season may be more susceptible to
severe illness, especially lower respiratory tract infections, than those discharged during the
warm season.31 A closer follow-up is needed in such cases.
It should be noted that all the studies so far have taken place in well-equipped hospitals, kangaroo Breastfeeding Method Essay
yet arguably the most significant impact of KMC will be felt in settings with limited resources.
There is an urgent need for further research in these settings. In the meantime, it seems that
where poor conventional care is available, KMC offers a safe substitute, with little risk of raised
morbidity or mortality.
2.2 Breastfeeding and growth
Breastfeeding
Two randomized controlled trials and a cohort study carried out in low-income countries
looked at the effect of KMC on breastfeeding. All three studies found that the method increased
the prevalence and duration of breastfeeding.25, 26, 29 Six other studies conducted in high-income
countries, where skin-to-skin contact was applied late and only for a limited amount of time per
day, also showed a beneficial effect on breastfeeding.32-37The results of all these studies are
summarized in Table 1.
It appears that KMC and skin-to-skin contact are beneficial for breastfeeding in settings
where it is less commonly used for preterm/LBW infants, especially if these are cared for in
incubators and the prevailing feeding method is the bottle. Other studies have shown a positive
effect of skin-to-skin contact on breastfeeding. It could therefore be expected that the earlier
KMC is begun and the earlier skin-to-skin contact is initiated, the greater the effect on
breastfeeding will be.

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Growth
The two-cohort study conducted in Colombia29 revealed slower weight gain in KMC
infants when compared with the control group, but the two cohorts also showed many social
and economic differences. In the subsequent RCT25 no difference in growth was observed at
one year of age. In another RCT,26 KMC infants showed a slightly larger daily weight gain while
they were cared for in hospital, but in the overall period of study their growth did not differ
from that of the control group. Similar results in terms of daily weight gain were observed in kangaroo Breastfeeding Method Essay

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