Strategies for implementing kangaroo care
By Philips ∙ Turku University Hospital, Finland ∙ October 2024 ∙ 3 minutes
There is mounting evidence that kangaroo care (skin- to-skin contact) is a powerful, evidence-based developmental care strategy associated with improved short- and long-term outcomes for preterm babies.1
This clinical article focuses on:
Kangaroo care with the help of Philips transport monitoring
The importance of kangaroo care has gained attention in hospitals around the world, including at Turku University Hospital in Finland. The hospital admits 500-600 babies to its NICU each year, and 40-50 of them, on average, are premature infants weighing less than 3.3 pounds. A large meta-analysis has shown that skin-to-skin contact is associated with reduced mortality particularly at 3 – 12 months, and hospital readmissions – as well as and improves babies’ head growth in infants < 2000 g at birth.2
And a recent 2022 study examining early mother-baby kangaroo in the neonatal intensive care unit (NICU) showed that kangaroo care can improve the stress of preterm infants and their mothers with greater weight gain seen in preterm infants (28-34 weeks).2 The World Health Organization has taken note of findings like these and now recommends it as the standard of care for pre-term and low-birthweight babies.3
The hospital introduced kangaroo care to its practice many decades ago. But back then, the NICU wasn’t designed to be as family-centered as it is now. A recent move to a new, modern facility enabled kangaroo care to become more fully integrated in its NICU practices, thanks to a staff training “intervention” program, the addition of single-family rooms and the adoption of Philips IntelliVue X3 transport monitors.
A novel staff training program promotes parent involvement
The hospital created a Close Collaboration Training Program, which helps staff find ways to collaborate with parents to increase their presence in the unit and their skin-to-skin contact with their baby. “Kangaroo care should start as early as possible, and we try to give kangaroo care on a daily basis,” says Dr. Olli Turta, who works in the hospital’s NICU. The hospital’s entire NICU staff has participated in this training program, and the hospital has become a training center for other hospitals in this intervention.
To facilitate parents’ ability to connect with and hold their baby, the NICU team uses a care model called Couplet Care, in which a midwife cares for a postpartum mother while a nurse takes care of their newborn simultaneously in a stabilization room. In this treatment model, the baby and the mother are both moved to the same room, where the mother can start kangaroo care soon after the birth.
Portable patient monitors support skin-to-skin contact
In these stabilization rooms, the babies are monitored using a Philips IntelliVue X3 transport monitor. “Couplet Care is probably the most important reason why we started with the X3 wireless solution,” says Dr. Turta. “We can now move the baby, while continuing to have the baby monitored with the X3 wireless solution, to the parent’s bed.”
This makes kangaroo care easier, he says, because staff don't have to make room for the parent’s bed right next to the baby’s beside. He says that it’s more efficient to move the baby with the X3 monitor to the other side of the room to the parent. Also, since it’s wireless, monitoring cables and other equipment aren’t in the way. For twins and triplets in the same stabilization room, this wireless aspect be even more beneficial.
“We can now move the baby, while continuing to have the baby monitored with the X3 wireless solution, to the parent’s bed.”
Dr. Olli Turta
NICU, Turku University Hospital
Kangaroo care during transfers
After a few hours in the stabilization room, the mother and baby get transferred to a NICU family room using the same X3 monitor. “It is important that we can start the monitoring with the same equipment and continue to monitor during the transfer, so we see the monitoring data on the central monitors,” says Dr. Turta.
Kangaroo care can be done during transports like this with the father, who holds the baby against him while being moved in a special chair, says Dr. Turta. “This means that we don’t have to stop the kangaroo care within the transfer,” he says.
“We don’t have to stop the kangaroo care within the transfer.”
Dr. Olli Turta
NICU, Turku University Hospital
Later, as the baby gets more stable, families are able to move around the ward or the hospital with their baby using an X3 monitor.
An example of success
Turku University Hospital’s commitment to making a change in its NICU has paid off. Liisa Lehtonen, head of the Division of Neonatology, and colleagues have published a study evaluating the effectiveness of the Close Collaboration with Parents program in nine hospitals in Finland, that found that it increased parents’ presence and skin-to-skin contact in all of the hospitals. Either parent was present on average 453 minutes a day before the intervention, and 620 minutes after the intervention. The infants had skin-to-skin contact on average 76 minutes a day before the intervention and 114 minutes after the intervention.4
“We believe that the relationship between the parents and infants is the foundation for later child development,” says Dr. Lehtonen. “And that’s why this type of care lays a good foundation for later outcomes.”
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Footnotes
[1] Boundy EO, Dastjerdi R, Spiegelman D, et al. Kangaroo mother care and neonatal outcomes: a meta- analysis. Pediatrics. 2016;137(1):e20152238. doi: 10.1542/peds.2015-2238.
[2] Cristóbal Cañadas D, Parrón Carreño T, Sánchez Borja C, Bonillo Perales A. Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care. Int J Environ Res Public Health. 2022 Jun 11;19(12):7183. doi: 10.3390/ijerph19127183.
[3] WHO recommendations for care of the preterm or low birth weight infant. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO https://iris.who.int/bitstream/handle/10665/363697/9789240058262-eng.pdf?sequence=1
[4] He FB, Axelin A, Ahlqvist-Björkroth S, et al. Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatr. 2021 Jan 11;21(1):28. doi: 10.1186/s12887-020-02474-2. In the adjusted statistical model the increase was 99 minutes per day for present parent present and 24 minutes per day for skin-to-skin increase.
