and their babies, an interaction that is often deferred by admission to a NICU. A review of the available literature indicates that nurses were apprehensive in practicing KMC in the intensive setting. There were concerns relating to dislodgement of intravenous lines and accidental extubation as well as apnoeic periods and oxygen desaturations during the practice itself. Some nurses were especially concerned about implementing KMC in low birth weight (<1000g) and ventilated babies. One seems to think that neonatal nurses were to be the advocates to the implementation of such practice in NICU’s, however inadequate knowledge and lack of available practice guidelines contributed to the delay in its inception in some institutions. We would like to think that neonatal nurses are at the forefront of the initiation and implementation of KMC. Their
«Only Sweden, Denmark, Belgium and the Netherlands have written policies that equally involve both parents in KMC»
knowledge, perceptions and experience would ultimately result in the promotion or outright abandonment of this practice. Two studies undertaken in the US
and Australia have thoroughly explored both knowledge and practice as well as the attitudes and perceptions of neonatal nurses towards KMC. Engler et al concluded from the results of a national survey that over 82% of respondents were practicing KMC in their NICUs and that nurses were knowledgeable about this practice. For certain infants, safety concerns and the reluctance of medical staff and families to initiate or participate in KMC were identified as major barriers in practice. There was a consensus that low gestational age and weight were not contraindications to this practice. 53% and 8% of respondents respectively, agreed that KMC could be extended to infants requiring mechanical ventilation and high frequency ventilation. This was reflective of the fact that many NICUs at the time did not permit KMC in these types of infants, particularly those
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requiring vasopressors. Chia et al study of attitudes and practices confirmed that neonatal nurses strongly support the use of KMC in the NICU. All the nurses were found to facilitate and encourage parents, the majority agreeing on its overall benefits for both parents and baby. There was also widespread acceptance that KMC can be practiced in low birth weight (<1000g) and intubated infants. Factors deterring its practice were potentially increased workloads, lack of institutional support, inadequate education and a dearth of comprehensive protocols, particularly in the case of smaller babies. Both studies also highlighted concerns relating to the safety and stability of infants and displacing equipment such as arterial/venous lines and endotracheal tubes. Ludington-Hoe et al recommended the practice of employing 2-3 nurses during transfer from incubator into KMC position to limit heat loss, distress and dislodgment of equipment. This would also decrease the amount of time the ventilator is disconnected.
The availability of continued guidance
and support to parents by nursing staff to relieve anxiety and promote confidence in handling their infant is equally important. Key types of support found to be useful to parents are information leaflets on KMC as well as a private and comfortable environment in which to practice KMC. ■
AH
REFERENCE References available on request (
magazine@informa.com)
LEARN MORE
The 5th Middle East Paediatrics Conference is taking place during Arab Health from 23rd-25th January 2012. This conference is for all those interested in learning about a wide variety of topics within Paediatrics, from babies to teenagers. Topics include infectious diseases, developmental behaviour and emergency medicine. To find out more and register your place as a delegate, visit
www.arabhealthonline.com
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