FEATURE NEONATOLOGY
article intends to review the available literature on KMC within the realm of the Neonatal Intensive Care Unit (NICU) and its potential clinical application in the ventilated neonate.
PHYSIOLOGICAL STABILITY IN THE PRETERM NEONATE DURING KANGAROO CARE Research indicates that KMC has a role in maintaining and improving physiological parameters of ventilated preterm infants such as temperature, heart rate, respiration and oxygen saturations. Additional benefits include improved sleep patterns, brain maturation and development and decreased pain response during painful procedures. There is convincing evidence to support this practice in infants of more than 28 weeks’ post-conceptional age with stable parameters at the time of KMC. Its success in infants of lower gestational age particularly those suffering from acute respiratory distress who are mechanically ventilated has been extensively researched. Drosten-Brooks initially observed two ventilated infants during KMC; they showed signs of decreased oxygen requirements and increased quiet sleep. In 1993, Gale et al examined 25 ventilated
infants who were closely monitored during KMC. They found infants between 30-33 weeks gestation or weighing 1.2-3 kg had stable temperature, pulse, respiratory rate and oxygen saturations parameters. The converse was seen in infants of less than 30 weeks gestation or those weighing less than 1.2 kg. Ludington et al (1999) were able to provide evidence to the contrary. They observed 12 very premature infants weighing less than 1kg, requiring ventilation. An overall stability in physiological parameters was demonstrated with decreased oxygen needs. Although Smith observed increased oxygen requirements and a reduction in body temperature in
«We can conclude that KMC can support breastfeeding competency and facilitate early discharge rates»
14 low birth-weight ventilated infants with chronic lung disease at an average of 34 days post birth, these results cannot be generalized. More recently, Swinth et al observed an infant of 33-week gestation presenting with mild respiratory distress
at birth. It was noted that when KMC was instituted at the early stages of the disease this has led to worsening clinical condition, however following stabilisation a graduated increase of KMC duration has assisted the infant’s recovery from respiratory distress. We should note that the variability
in all of the above studies might be accounted to varying equipments, transfer technique and infant’s positioning during KMC. The possibility of extending KMC to ventilated newborns has been gaining more recognition especially that clinical outcomes can be positively measured. It is worth noting that despite available studies, there is insufficient number of cases to come to firm conclusions. The wide range of variability in patient’s characteristics and underlying co-morbidities in all of the above studies represents an obstacle to some neonatologists to adopt KMC as routine practice in NICU’s. Even amongst developed nations especially in Europe, the current practices were diverse. In a survey of 284 NICUs in eight European nations, five out of the eight countries studied 41-100% of units offered KMC routinely, 6-40% offered the practice ‘on request sometimes’ and ‘only on request’ between 2-18%. Three countries did not offer KMC to mothers.
Arab Health Issue 5 2011 67
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88