Evaluation of Kangaroo Care on Newborn Thermoregulation

Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN

Kangaroo Care

Evaluate the benefit of Kangaroo Care to the neonate

Providing evidence-based research to provide mothers and newborns a more natural birth experience

Minimize separation of the maternal-infant couplet to enhance birth experience

Provide cost effective care

Purpose of the research

“What does the literature say about kangaroo care (KC), also known as skin-to-skin care, in

the regulation of the thermoregulatory system of the

neonate?

Problem Statement

In term newborns born vaginally, will the axillary temperature remain within the normal range in infants placed skin-to-skin immediately after birth compared with infants placed within minutes of birth under a radiant warmer during the first hours of life?”

PICO

Literature Eliminated

Critical evaluation of ten selected articles Articles were examined for appropriateness

to the purpose statement, reliability, and validity (Nieswiadomy, 2008, p. 63)

Qualifications of the researchers and the ethical content was also analyzed (Nieswiadomy, p. 29)

Articles not meeting criteria were eliminated

Narrowing the Literature

Literature Eliminated A comparison of skin-to-skin contact and radiant

heaters in promoting neonatal thermoregulation (Fardig, J., 1980).This was an outdated source

Keeping infants warm: Challenges of hypothermia (Mance, 2008).Involved preterm infants which did not meet the criteria set in the purpose statement

Temperature variation in newborn babies: Importance of physical contact with the mother (Fransson, Karlsson, & Nilsson, 2005).Article did not discuss skin-to-skin content and the research did not start until four to eight hours after birth

The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial (Ferber & Makhoul, 2004).Focused on infants neurological behavior with minimal discussion regarding temperature

Kangaroo mother care: 25 years after (Charpak et al., 2005).Difficult to follow, and mainly pertained to the unhealthy newborn in underdeveloped countries with a minimal discussion regarding temperature

Early skin-to-skin contact for mothers and their healthy infants (Anderson, Moore, Hepworth, & Bergman, 2003).Article only consisted of one page and required advance knowledge of statistics in order to understand

Literature Eliminated- continued

Literature Selected

Gretchen A. Dabrowski RN, BSN

Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies

Qualitative evidence-based discussion

Utilizes historical studies

The article’s findings provided evidence that “newborns placed skin-to-skin with mothers remained considerably warmer during the first three hours of life” (Dabrowski, p. 66)

Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies

Kangaroo Care at Birth for Full Term Infants: A Pilot

Study

Mary W. Walters, MS, RN.Kim M. Boggs, MSN, RN, BC.

Susan Ludington-Hoe, PHD, CNM, FAAN.Kimberly M. Price, RN, IBBCLC.

Barbara Morrison, PHD, FNP, CNM.

Level I qualitative research study

Approval obtained from hospital review board

All of the researchers practiced in women's health

Clear purpose statement

Outlined clearly in a systematic process discussing the descriptive design

Kangaroo care at birth for full term infants: A pilot study.

Judith S. Mercer CNM, DNScDebra A. Erickson-Owens CNM, Ms

Barbara Graves CNM, MN, MPH Mary Muford Haley CNM, MS

Evidence-based Practices for the Fetal to Newborn

Transition

Article listed additional findings to benefit neonate.

Clear summarization of articles reviewed Findings significant for the benefit of this

intervention (p<or =0.02-0.03) Large population used for study and randomized

controlled trials Benefits of KC care shown for long and short-

term. Article supports the benefit of maintaining and

increasing temperature when infant placed skin-to-skin

Recommendation made of KC care

Evidence-based practices for the fetal to newborn transition

Rintaro Mori, MD, PHD, MSc, FRCPCHRajesh KhannaDebbie Pledge

Takeo Nakayama

Meta-analysis of Physiological Effects of

Skin to Skin Contact for Newborns

Peer reviewed journal Recent publication 2010 Significantly related to the research

question Directly evaluated physiological parameters

affecting infants before-and-after the KC intervention to evaluate safety

Consisted of both systematic reviews and random-controlled trials

Methods categorized

Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers

Meta-analysis included 23 studies, consisting of 13 before-after studies, five randomized control trials, a cross-over trial, and four cohort studies

Limitations of studies were acknowledged Confounding variables were eliminated to

increase validity p value was < 0.05 making this study

significant in findings Findings of this article showed an increase in

body temperature during skin-to skin contact

Meta-analysis of physiological effects of skin-to-skin contact for newborns

and mothers (cont’d)

Barriers to the implementation of Kangaroo

Care

Barrier Bridge

The desire by the mother to allow visitors to hold the baby was reported (Anderson et al, 2003)

Provide education and encouragement to mothers regarding what KC is and the benefits KC has been shown to provide

Barrier Bridge

The attitude of health care providers is noted to be a barrier to KC. This may be due to a lack of knowledge regarding the benefits of KC or fear of a change in practice

The provision of adequate education to both healthcare providers and patients, including their families, is a potential way to solve these barriers (Dabrowski, p. 65)

Patient preference is an important aspect of implementing any evidence-based nursing practice (Nieswiadomy, 2008, p. 8)

Nurses should provide education and support for kangaroo care, but allow patients to express their preference about the utilization of kangaroo care

Patient preference

The evidence highly supports a change in practice, encouraging skin-to-skin contact at birth

The evidence correlates well with the expectations of evidenced-based medicine research

Each of the articles selected clearly defines the purpose of the study

All of the selected articles are rated as level I or Level II, with the exception of one article, according to hierarchy of evidence

The articles chosen contain recent findings, with the oldest article being from 2007

Application of the Evidence

Skin-to-Skin Contact

“Birthing units that separate mothers and babies with the intention of preventing cold stress unwittingly increase the risk of cold stress, and at the same time deprive the pair of intimacy and bonding while delaying breastfeeding initiation” (Mercer et al., 2007, p. 267)

“The evidence suggests that skin-to-skin contact should be the mainstay of newborn thermoregulation” (Mercer et al., 2007, p. 267)

The benefit of increasing fetal well-being is the primary focus in these studies

Summary

Initiation of skin-to-skin contact immediately after birth is an evidence-based nursing practice

More effective than the use of radiant warmers

Has many other benefits

Cost effective and more natural extension of the birth process

Summary (cont’d)

Recommendation

Anderson, G., Shiu, S., Dombrowski, M., Swinth, J., Albert, J., & Wada, N. (2003). Mother-newborn contact in a randomized trial of kangaroo (skin-to-skin) care. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(5), 604-611. doi: 10.1177/0884217503256616

Anderson, G. C., Moore, E., Hepworth, J., and Bergman, N. (2003). Early skin-to-skin contact for mothers and their healthy newborn infants. Birth, 30(3), p. 206–207. doi: 10.1046/j.1523-536X.2003.00247.x

References

Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., and Worku, B. (2005), Kangaroo mother care: 25 years after. Acta Pædiatrica, 94(5), p. 514–522. doi: 10.1111/j.1651-2227.2005.tb01930.x

Dabrowski, G. (2007). Skin-to-skin contact: Giving birth back to mothers and babies. Nursing for Women's Health, 11(1), p. 64–71. doi: 10.1111/j.1751-486X.2007.00119.x

Fardig, J. A. (1980). A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation, Journal of Nurse-Midwifery, 25(1), p. 19-28. doi: 10.1016/0091-218(80)90005-1

Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. Pediatrics, 113, 4. p.858(8).  Retrieved from: http://www.pediatrics.org/cgi/content/full/113/4/858

▶ Ford, L. C. (2010). Evidence based nursing practice project: NURS 350 Research in nursing. Retrieved from Ferris State University School of Nursing, Ferris Connect website: http://myfsu.ferris.edu/webct/urw/lc1399024356061.tp1406116086031/displayContentPage.dowebct?pageID=1463932005011&resetBreadcrumb=false&displayBCInsideFrame=true

▶ Fransson, A., Karlsson, H., Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Archives of Disease in Child: Fetal Neonatal Edition, 90(6), p. F500-504. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721966/ doi:10.1136/adc.2004.066589

Galligan, M. (2006). Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN: The American Journal of Maternal Child Nursing, 31(5), 298-306. Retrieved from: http://www.nursingcenter.com/_PDF_.aspx?an=00005721-200609000-00007  .

Mance, M. (2008) Keeping infants warm: Challenges of hypothermia. Advances in Neonatal Care, 8(1), 6-12. doi:10.1097/01.ANC.0000311011.33461.a5

Mercer, J. S., Erickson-Owens, D. A., Graves, B., Mumford Haley, M. (2007). Evidence based practices for the fetal to newborn transition. Journal of Midwifery & Women’s Health, 52(3), p.262-272. doi:10.1016/j.jmwh.2007.01.005

Mori, R., Khanna, R., Pledge, D. and Nakayama, T. (2010). Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatrics International, 52(2), p. 161–170. doi: 10.1111/j.1442-200X.2009.02909.x

Nieswiadomy, R. (2006). Foundations of nursing research. (5th ed.). Upper Saddle, New Jersey: Pearson Prentice Hall.

Walters, M. W., Boggs, K. M., Ludington-Hoe, S., Price, K. M., Morrison, B. (2007). Kangaroo care at birth for full term infants: A pilot study. The American Journal of Maternal/Child Nursing, 32(6), p. 375-381. doi:10.1097/01.NMC.0000298134.39785.6c