WHO International Bibliography of KMC
WHO International Bibliography of KMC
WHO International Bibliography of KMC
Original articles 2
Abstracts, published 54
Textbooks addressing KC 63
Videos available 64
Protocols 65
Pamphlets 66
Related Literature 67
Co-sleeping/co-bedding 68
Notable presentations 76
The annotations are done by Dr. Susan Ludington and do not represent the
opinions or reviews of other members of the WHO Kangaroo Care Network.
1
Kangaroo Care BIBLIOGRAPHY Developed by Dr. Susan Ludington
Updated: 9/26/2004
The following is a list of professional articles. For some, the resource that
will be easiest and most comprehensive to have about Kangaroo Care is Dr. Susan
Ludington’s book called “Kangaroo Care: The Best You Can Do for Your Preterm
Infant.” Published in 1993 by Bantam Books. You can buy a copy from Dr.
Ludington at Frances Payne Bolton School of Nursing, 10900 Euclid Ave. room
322D, Cleveland, OH 44106-4904 or from La Leche League at 1400 N. Meacham Rd.,
Schaumburg, Ill. 60173 for the same cost. Several of the articles on this bib
are available for $1.00 (U.S.) each plus $2.00 for mailing and we will be able
to fulfill orders for up to five articles per request for items you are unable
to retrieve from your library resources. Please circle those you want and
submit payment and we will copy and send the articles to you. Thank you.
Mrs. Kangaroo, is it true
You are hiding someone new
In the pocket part of you?
There must be someone new and growing
It’s little ears have started showing.
Kitty McCausland RN, BSN, UCLA
UPCOMING CONFERENCES:
2004 September 28 KC Conference and Certification Program in Cleveland, OH that
includes skills laboratory and WHO Kangaroo Caregiver Credential.
2004 November 8-11. World Health Organization’s International Network of
Kangaroo Care workshop. Rio de Janeiro, Brazil. Welcome party is Nov. 7
````````````````````````
October 2006: World Health Organization’s International Network of KC meeting,
hopefully in the USA.
This bibliography contains original articles from all around the world,
published abstracts, published articles in foreign languages, a list of sample
pamphlets and protocols that are available and a list of researchers in the area
and what they are studying. Some of the articles listed are annotated. The
bibliography is available from:
Susan M. Ludington, CNM, Ph.D., FAAN
Walters Professor of Pediatric Nursing,
FP Bolton School of Nursing, Case Western Reserve Univ.
10900 Euclid Ave. Room 322D Cleveland, OH 44106-4904
(216) 368-6490 Email: Susan.ludington@.case.edu
Terminology: KC = Kangaroo Care; KMC = Kangaroo Mother Care (KC given by
mother); KFC = Kangaroo Father Care (KC given by father); KPC or PKC = Kangaroo
Parental Care (KC given by mother and father and data reported as results of
parental KC); KSC = Kangaroo SURROGATE Care (KC given by someone other than
biological parents).
ORIGINAL ARTICLES
_________(2004). Holding the very low birthweight infant: skin-to-skin
techniques. Neonatal Network. Article describe the nursing considerations and
techniques involved to successfully implment skin-to-skin holding for VLBW,
technology dependent infants. Implementation.
2
_______ (1997). “Kangaroo care” helps preemies. Indian Med Trib 5 (1-
2),1. This is a summary of the Bier study. Clinical report.
Affonso, D., Bosque, E., Wahlberg, V., & Brady, J. 1993. Reconciliation
and healing for mothers through skin-to-skin contact provided in an American
tertiary level intensive care nursery. Neonatal Network 12 (3), 25-32.
Mothers interviewed two years after preterm birth who had KC during
hospitalization had better resolution of the birth experience and were able to
move on better than control mothers who were still asking basic questions
about the hospitalization experience. KC helps closure over preterm birth. PT,
Qualitative, maternal feelings.
3
Anderson GC. (1999). Kangaroo care of the premature infant. In E.
Goldstein (Ed.) Nurturing the Premature Infant: Developmental Interventions in
the Neonatal Intensive Care Nursery. NY: Oxford University Press. pp.131-160.
This is a review of all studies to te 1999 date. Review, crying
Anderson GC, Chiu SH, Dombrowski MA, Swinth JY, Albert JM, Wada N. (2003).
Mother-newborn contact in a randomized trial of Kangaroo (skin-to-skin) care. J
Obstet Gynecol Neonatal Nursing,32 #5, 604-611. This reports the actual number
of hours mothers got KC in an RCT of early KC. 47 Kcers and 44 control LBW
preterm infants given KC.wrapped holding during first 48 hours after birth. KC
moms did very little KC when its practice was not structured (28.5% of
observations (not of time) if on Postpartum, 10.0% of observations if infant in
NICU). KC moms did wrapped holding 14.8% of observations on postpartum and 2.6%
of observations in NICU.(wrapped holding of Kcers = to wrapped holding of
controls on postpartum unit). Observations taken q 15 min for 1st 6 hours and
then as seldom as q3 hours for 24-48 hours postbirth. Kcers had 2x as much
contact as controls. When KC began was not specified and this was much less
than 82% of time as in Syfrett 1996 abstract. VERY LITTLE KC occurs naturally.
RCT, Preterm, Very Early KC.
Anderson GC, Dombrowski MAS, Swinth JY. (2001). Kangaroo Care: Not just
for stable preemies anymore. Reflections in Nursing Leadership, 2nd Qtr,
2001,32-34,45. An integration of the case studies published in MCN: Early KC,
Latch-on KC, Reflux KC, Twins, Triplets, Depression, Adoptive parent KC,
Grandmother KC. EARLY KC, Ventilated KC, SURROGATE KC, MULTIPLE KC, you name
it, its in here.
Anderson GC, Marks E., & Wahlberg, V. (1986). Kangaroo care for premature
infants. American Journal of Nursing. July 1986, 807-809.[erratum appears in Am
J. Nursing, 1986 Sept (86 #9), p. 1000]. A general overview of KC effects with
preterm infants. REVIEW
Anderson, GC, Marks E., Wahlberg V (1986). AGA preemies can be Kangaroo
infants too[Letter]. American J. Nursing, 86(9), 1000. Short letter providing
experience with AGA infants getting KC. Letter.
4
Cochrane Library, March 16, 2001. This relates plans for a meta-analysis of
Kangaroo Care. Good review of the literature and list of studies that will be
included. Meta-analysis preparation.
Anisfeld, E., Lipper E. 1983. Early contact, social suppost and mother-
infant bonding. Pediatrics 72(1), 79-83. On one day all moms (29) given KC
(immed. After birth put naked on moms abdomen for a total of 45-60 min. Then
transferred to nursery), on other day all moms(30) got routine care (taken to
warmer, wrapped, shown to mom, then to nursery) Then routine – saw moms q 4 hrs
for feed, most bottle fed. – day determined randomly. At 2 days observed q l min
x 15 min during feeding. KC moms had more affectionate behav than controls and
if in low social support group as compared to hi social support group. Quasi-
experimental, Fullterm, Delivery KC. Maternal behavior
Bar Yam, N.B., 2002. Kangaroo mother care: Restoring the original
paradigm for infant care and breastfeeding. J. Human Lactation, 18 (3), 289 for
a review of this film. FILM, BF
5
Bauer, K., Pasel, K., Versmold, H. 1996. Chest skin temperature of
mothers of term and preterm infants is higher than that of men and women.
Pediatric Research, 39(#4)Part2: 195A. Reports the chest temperature of women
who are not mothers, mothers of term and preterm infants, and chest temp of men.
Descriptive, not KC, chest temperature
Bauer, K., Uhrig, C., Sperling, P., Pasel., K., Wieland, C., & Versmold,
H.T. (1997). Body temperatures and oxygen consumption during skin-to-skin
(Kangaroo) care in stable preterm infants weighing less than 1500 grams. Journal
of Pediatrics, 130(2), 240-244. 22 stable preterms <1500 grms and AGA given
first KC in first wk of life. Continuously measures rectal temp, foot skin temp
and oxygen consumption for 1 hr in incubator, during 60 min of KC, and 1 hr in
incubator During KC, rectal temp is 0.2C and foot temp 0.6C higher than pretest.
During posttest, body temps returned to pretest. O2 consumption during KC
(6.1+0.9 ml/kg/min.) was not higher than in incubator (5.8+0.8 ml/kg/min. For
stable preterm infants <1500 gms and < 1 week of age, one hour of KC is not a
cold stress compared with incubator care. TRANSFER to mom took 9+ 4
min.GERMANY. Pretest-test-posttest, one group, NOT an RCT. Transfer time, rectal
temp, foot temp, oxygenation, oxygen consumption,stability
Bergh A-M, Pattinson RC. 2003. Development of a conceptual tool for the
implementation of Kangaroo Mother Care. Acta Paediatrica 92, 709-714. This
provides a conceptual model to assist the implementation of KC. Qualitative
6
research approach used in South Africa to elicit main issues in establishing a
program of KC and they developed a set of core questions to assist in decision
making about using KC at the institution level. Implementation
Bergman, N.J. 1998. Making newborn care work.Child Health Dialogue, Issue
11, 2nd quarter, p. 4. This document relates the role of KC in good care for all
newborns. Clinical Report.
Bergman, N. ???? Kangaroo mother care: Rediscover the natural way to care
for newborn baby. International J of Childbirth Education 18 (1), 30 & 27.
This is a simple to read reason why KC should be practiced with fullterm
infants. Article conveys two concepts: No separation and Breastfeeding. Review,
Full Term, BF.
Bergman, N.J., & Jurisoo, L.A. (1994). The "kangaroo method" for treating
low birth weight babies in a developing country. Tropical Doctor, 24, April
1994, 57-60.RCT.
Bier J-A.B., Ferguson A.E., Morales, Y., Liebling, J.A., Archer, D., Oh,
W., & Vohr, B. (1996). Comparison of skin-to-skin contact with standard contact
in low birth weight infants who are breast-fed. Archives Pediatric and
Adolescent Medicine, 150, 1265-1269. Gave KC once medically stable and no oxygen
support to 50 PT <3.3lbs BW for 10 minutes only each day x 10 days and measured
every minute HR, RR, SaO2, Axillary Temp, # Desats. First 10 minutes of 176 KC
sessions and 137 standard contact sessions were scored. RR, HR, temperature were
same between groups. SSC temps rose in first 5 minutes and then matched control
group thereafter. A warming effect of KC was seen. SaO2 was higher during KC and
fewer desats (<90%) during KC (11% of 1716 SaO2 recordings during KC) and 24% of
1334 recordings during standard care (swaddled by moms). No diff in mean daily
maternal milk expression, more stable milk production in KC. 90% of KC moms vs
61% non-KC moms were breastfeeding thruout hospitalization and 50% vs 11% were
still BF at l month after discharge. At 6 months, 20% of KC & 10% control still
BF. All mothers of multiples who Kced breastfed at discharge, and only 50% of
multiples in standard care were BF at discharge, but no mother of multiples was
still BF at 3 and 6 months. Moms and babies calm in KC. RCT, KCBF, BF,milk
production, milk expression, duration of BF, SaO2,oxygenation, HR, RR, Axillary
Temp, #Desats, stability,
Bier J., Oliver T, Ferguson, A., & Vohr B .(2002). Human milk improves
cognitive and motor development of premature infants during infancy. J Human
Lactation 18 (4), 361-367. BF
7
Boge, B. 1986. Anecdote from Gambia on Kangaroo Care. Comments at
International Nursing Research conference, Univ. of Alberta, Edmonton, Alberta,
CANADA.
Bowden VR, Greenberg CS, Donaldson NE. (2000). Developmental care of the
newborn. Online Journal of Clinical Innovations or CINAHL Information Systems
(Glendale, CA). 3, issue 7, 27 pages with 286 ref. Available online at
http://www.cinahl.com or from Cinahl Information Systems, 1509 Wilson Terrace,
Glendale, CA 91206. The 14 pages that appear online do not include all
references. In essence, KC is part of development care for all
NEWBORNS.FULLTERM, Developmental Care
Breitbach, KM. (2001). Kangaroo Care. In Craft & Rosenberg (Eds.) Nursing
Interventions for Infants. Thousand Oaks, CA: Sage Publ.pp. 151-162. This is a
chapter that talks about listing Kangaroo Care as a nursing intervention within
the taxonomy of the NANDA system for nursing diagnoses in the United States.
Defined it and listed 18 activities associated with Kangaroo Care. Terminology
8
quality questionable in 4 of 5 studies about duration of BF, No studies on
success of BF. Findings “fail to support the current initiative to implement
changes in clinical practice to include skin-to-skin contact. Methodological
flaws within the included studies prohibit firm conclusions being reached with
regard to the effect of skin-to-skin contact on the duration of BF, timing of
first BF or baby physiological factors (temperature and behavior. This review
highlights the need for further primary research to assess the effect of skin-
to-skin contact on the BF experience” (pg. 148). Across the studies, KC was
given for 15-90 minutes. Two studies in Spain, 1 Canada, 1 Austria, and 3 in
Guatemala. FULLTERM, Review. BF
Carlson SG. Fagerberg G., Horneman G., Hwang C-P., Larsson K, Rodholm M,
Schaller J. Danielsson B., Gundewall C. (1979). Effects of various amounts of
contact between mother and child on the mother’s nursing behavior: A follow-up
study. Infant Behavior and Development, 2, 209-214.17 Naked babies put in
mothers bed for 1-2 hrs immediately after delivery, baby placed on the mother’s
body in nursing position or at her side with its face touching the mother’s
breast. After 2 hrs, baby taken away, washed and put in crib at mom’s side.
(mom held infant for up to 5 min after birth, then taken away, washed andput in
crib). Observations began when infant took nipple and continued for two minutes
after letting go of nipple. This was six week Postpartum assessment of feeding
in the home.No group differences at 6 weeks as seen in 1978 study because
feeding at 6 wks is so routinized that it has lost its significance as a means
of communication. Fullterm, KCBF position
Cash, S., & O'Quinn, JLK., (1996). Kangaroo care is for full term babies
too. American Journal of Nursing, 96(10), 20. Short report of three fullterm
kc studies published elsewhere. FULL TERM
9
(1998) Kangaroo mother care for low birthweight infants: A randomized
controlled trial in different settings. Acta Paediatr 87: 976-985. Randomized
Controlled Trial. RCT, Mortality
Cerezo MR, de Leon R., Gonzales BJV. 1992. Mother child early contact
with “the mother kangaroo” program and natural breast feeding. Rev Latino Amer
Perinatol 12, 54-60. Randomized controlled trial of 61 infants in incubator and
51 infants in KC. Infants were observed during 3 month follow-up visits in NICU
follow-up clinic. 78% of KC infants were exclusively BF (34% for controls) at 3
months and no differences in morbidity, serum bilirubin/glucose,
hematocrit,blood culture, other cultures, feeding methods during
hospitalization, and increase in weight over the 30 days post discharge between
groups. Preterm, RCT, BF, Morbidity, Weight gain, infections, blood values.
Charpak, N., Figueroa de Calume, Z., Ruiz, J.G. (1998). Kangaroo mother
care. The Lancet,351; March 21,1998, p.914-915.[letter, comment]
10
682-689. 1084 newborns were followed in this RCT. The risk of dying was
similar for both group as were growth indices. KMC is safe. RCT. Mortality, Wgt
Chen, C-H., Wang, T-M, Chang H-M, Chi C-S. (2000). The effect of breast-
and bottle-feeding on oxygen saturation and body temperature in preterm infants.
J. Human Lactation, 18(1), 21-27. 25 preterm infants given either bottle or
breastfeeding with KC. SaO2, HR, RR, temp noted every minute for 20 min. during
feeding. SaO2 and body temp sig. higher during KC breastfeeding. 2 apnea and 20
desat episodes in bottle feeding group, none in BF group. BF with KC is more
physiological and less stressful. PT, HR, RR, temp. SaO2, Desats, apnea, KC is
less stressful.
Chiu, S-H, Anderson, G.C., Burkhammer M.D. (in press for 2005). Newborn
infant temperature during skin-to-skin breastfeeding in dyads having
breastfeeding difficulties. Birth. 48 fullterms having Breastfeeding difficulty
at 12-18 hours postbrith had temporal artery temperature taken before, once
during, and after each of 3 consecutive breastfeedings in KC. Temp reached and
remained in neutral thermal range during KCBF. Descriptive, temporal artery
temp, KCBF, fullterm.
11
34, 208-212. FULL TERM
Chwo, M-J., Anderson, G.C., Good, M., Dowling, D.A., Shiau, S-H H., & Chu,
D.-M. (2002). Randomized controlled trial of early Kangaroo care for preterm
infants: Effects on temperature, weight, behavior, and acuity. J. Nursing
Research (Taiwan), 10 (2), 129-142. Thirty-four healty preterm infants in TAIWAN
were randomly assigned before first feed. KC was done during BF, controls were
clothed and wrapped and held that way for one hour, three times a day during
feedings. KC had higher TYMPANIC temps, more quiet sleep, more inactive awake,
less drowsiness, less crying. No diff in weight loss or acuity (LOS).RCT,
tympanic temp, quiet sleep, inactive awake, drowsy,cry, wgt, length of stay.
Cleary GM, Spinner SS, Gibson E., & Greenspan JS. (1997). Skin-to-skin
parental contact with fragile preterm infants. J. American Osteopathic
Association, 97(8): 457-460. Case study of 29 wk GA twin given maternal and
PATERNAL KC for 2 hrs on 19th day of life when on nasal cannula. All physiologic
patterns were more stable, NO bradycardia, no central or obstructive apnea, no
periodic breathing or desats during KC and this pattern persisted more than 2
hrs after KC ended. FATHERS (all data collapsed and reported as Parental KC;
PROTOCOLS included), HR, Bradycardia, Apnea, PB, Desats, Residual KC>
Clifford, PA, Barnsteiner J. (2001). Kangaroo care and the very low
birthweight infant: Is it an appropriate practice for all premature babies? J
Neon Nurs, 7(1): 14-18. 7 infants at CHOP (Children’s Hopsital of
Philadelphia)(6 vented) who started KC from 4-32 days of life showed physical
safety could be maintained during KC. Physiol. variables remained WNL during KC,
KC enables interactive relationship, promotes bonding. No exclusion criteria for
KC’s use. All wore hats, covered by blanket and parent’s shirt. Smallest was 25
wks who did kC at 10 days of age at 680 grams. Minimum KC was 30 minutes, range
was 58-84 mins of KC. 2 infants had UA lines, 6 with PICC lines. Stability of
baseline HR, No brady, no HR drift, no apnea, no cold stress and temp stability
was maintained. Vent KC, bonding, HR, Brady, Apnea, temp.
Closa Monasterolo R, Beneitez JM, Olive del MR, Martinez MJM, Papi AG.
(1998). “Kangaroo Method” in the care of premature infants admitted to a
neonatal intensive care unit. Anales Espanoles de Pediatria, 49(5): 495-498.
Has English abstract: studied 445 sessions of 38 stable preterm NICU infants
having 30-90 minutes of KC, 1-8 times a day. Physiology was stable, BF sessions
longer because babies slept/suck – intermittent KC does not allow BF by demand,
so smallest babies still need gavage supplementation. HR, RR, SaO2, temp, BF
session length. Descriptive study.
12
Collins, S., (1993). Baby Stephanie: A case study in compassionate care.
Neonatal Intensive Care, March/April 1993. p. 47-49. (No volume or # for this
journal). Descriptive, End-of-life KC
Colonna, F., Uxa, F., de Graca A.M., & de Vonderweld, U. (1990). The
"kangaroo mother" method: Evaluation of an alternative model for the care of
low birth weight newborns in developing countries. International Journal of
Gynaecology and Obstetrics, 31, 335-339. 3rd World
Craig S, Tyson JE, Samson J, Lasky RE. 1982. The effect of early contact
on maternal perception of infant behavior. Early Human Dev. 6, 197-204. .
Healthy term infants randomly assigned to KC or routine care. 23 KC placed in KC
on chest covered by blanket and then wrapped for move to recovery room and then
returned to KC on mother for approx 1 hr. 26 routine care infants(infant
13
wrapped, given to mom for 10 minutes then taken to nursery). Home visits made
one month after delivery and mothers interviewed regarding experience of
pregnancy, delivery, and first pp months and Broussard Maternal Perception of
Infant and Infant Behav Record. Moms in both groups perceived infants as less
difficult than average infant and no differences between groups seen with one
hour of contact, in either male or female infants.FULLTERM
Cristo M. 2002. Get this from Rejean Tessier. I don’t have it. Has to do
with maternal feelings of competence and adaptation to mothering role.
Curry, MAH. (1979). Contact during the first hour with the wrapped or
naked newborn: Effect on maternal attachment behaviors at 36 hours and three
months. Birth and Family J. 6(4), 227-235. 20 women randomly assigned to
wrapped (11) or naked baby (9)during 1st hour after birth- started after 5 min
APGAR and continued for 17-49 minutes. Blanket across the infant’s back. Behav
observed for 15 sec each minute x 15 minutes at 36 hrs postbirth and at 3 months
of moms at play. NO diff in attachment behaviors at either time. Temps taken q
15 minutes to be sure it was ok. FULLTERM, Temp, Maternal Behavior, RCT
Daga, S.G., & Shinde, S.B. (1987). Mother participation in NICU. ???
Daga, S.G., & Daga, A.S. (1989). Reduction in neonatal mortality with
simple interventions. Journal of Tropical Pediatrics, 35, 191-194. Mortality
Davanzo, R. (1993). Care of the low birth weigh infants with the kangaroo
mother method in developing countries. Guildelines for health workers. Bureau
for International Cooperation in Maternal and Child Health, WHO Collaborating
Center for Maternal and Child Health, Instituto per L'Infanzia, Via dell'Instrud
65/1, 34137 Triest, Italy. Guidelines
Davanzo, R., & Cattaneo, A. (1995). The kangaroo mother method. The
Kangaroo, 4(1)July: p. 6-9. This is a review of Sloan (Lancet, 1994) and
Charpak (Pediatrics 1994) articles with a commentary related to the recommending
Kangaroo Care for implementation on a global basis. The Kangaroo is a journal
published by the Bureau for International Cooperation in Maternal and Child
Health and is available by writing to the address listed in Davanzo
1993.Implementation
14
revealed no diff in maternal perception of 1st week at home,infant sleeping at 3
months was same,same # had had colic and meds for colic. KC infants given night
feeds twice as long, fewer reported problems with night feeding in KCs. Control
moms reported more difficult adaptation to infant and needed home help longer
(14.5 vs 7.6 days).FULLTERM, BF in KC,BF at 3 months, maternal behavior,
maternal perception, infant smile/crying RCT
Diaz-Rosello, J.L. (1996). Caring for the mother and preterm infant:
Kangaroo care. Birth, 23(2): 108-111. This is a review article with 17
references.LITERATURE REVIEW
Diaz-Rosello, J.L., Lozano, P.M. & Tenzer, S.M. (1990). Impaired growth
of low birthweight infants in an early discharge program. In UNICEF Oficina
Regional para La America Latina y el Caribe (Ed.), Primer Encuentro
Internacional Programma Madre Canguro. Bogota: UNICEF, 1990, pp. 283-306. 129
subjects studied. BF ,Wgt. Infants discharged in KC and exclusive BF do not
gain enough weight in first year. Later work showed that infant’s need
fortification of the breastmilk.
Doyle, L.W. (1997). Kangaroo mother care. The Lancet. Vol 350. December
15
13, 1997,p. 1721-1722. This is commentary on Charpak’s article. Commentary.
Durand, R., Hodges, S., LaRock, S., Lund, L., Schmid, S., Swick, D.,
Yates, T., & Perez, A. (1997). The effect of skin-to-skin breastfeeding in the
immediate recovery period on newborn thermoregulation and blood glucose values.
Neonatal Intensive Care, March/April, 1997, p. 23-27. Temperature at 120
minutes postbirth was higher than swaddled and cot infant’s temperature. No
differences I blood glucose levels was present. Fullterm, BF, Temperature.Blood
glucose, delivery KC
Engler, A.E., Ludington-Hoe, S.M., Cusson, R.M, Adams, R., Bahnsen, M.A.,
Brumbaugh, E.J., Coates, P., Grieb, J.K., McHargue, L.K., Ryan, D., Settle,M., &
Williams, D.M. (2002) Kangaroo care: National survey of practice, knowledge,
barriers, and perceptions. MCN, Amer. J. Maternal Child Nursing 27(3): 146-153.
537 (59%) of all NICUS in America returned surveys. Over 82% report practicing
KC, but mostly only upon request of mother. Nurses are knowledgeable. Barriers
are ifant safety concerns and reluctance by RN, NNP, MD and families. Units
that practice KC have more positive perception than units that do not practice
KC> >60% report that low GA or low weight are not contraindications. SURVEY.
Barriers
16
Bayley Mental/Motor, Temperament, Mat Behavior, alert, Mat. depression.
17
after birth. KC reduces infant stress (pg. 861). Fullterm, RCT, development,
sleep, quiet sleep,crying, alert state, flexed posture and flexed movements,
motor develop, stress.
Franck LS, Bernal H, Gale G. 2002. Infant holding policies and practices
in neonatal units. Neonatal Network, 21(2), 13-20. National survey of policy
and practice of conventional and KC holding. 215/400 responses from Level 3 and
Level 2 nurseries. 40% of units have policies for KC and only 26% have policy
for conventional holding; 73% offer parents KC with extubated infants, 45% offer
KC with intubated ones, paternal KC permitted in 68%, sibling KC in 2%,
grandparent KC in 6% of units, Many units permit KC with ventilated, CPAP,
artery caths, percutaneous venous caths, and chest tubes (p. 18). Benefits are
enhanced attachment and closeness. Readiness for KC determined by SaO2, HR, &
RR, not wgt, GA. 25-33% of respondents identified staff RN and MD has not
supportive of KC. Barriers to KC are infant stress, privacy, timing of parental
visit, and getting staff help.Descriptive Survey.
18
Furman, L., Kennell J. (2000). Breastmilk and skin-to-skin Kangaroo care
for premature infants. Avoiding bonding failure. Acta Paediatr 89(11), 1280-
1283. Regression analysis, BF, bonding/attachment
19
time.FATHERS
20
and observed for behaviors for 15 second every minute x 15 mins.KC moms had sig
increased attachment behaviors(fondling, kissing, en facing, gazing at, holding
baby close) but no caretaking differences. FT. Does not specify
randomization.Quasi-Experiment. Maternal attachment behaviors.
21
depression. PT, clinical report, infection, growth, LOS, Mat depression,Mat-
Neonatal Thermal Synchrony.
Hill PD, Aldag JC, Chatterton RT. (1999a). Breastfeeding experience and
milk weight in lactating mothers pumping for preterm infants. Birth, 26(4),
233-238. Average frequency of KC/wk was used as covariant in comparison of
single vs double pumping on milk yield from2-5 weeks PP. No infants were
breastfed during wks 2-5 PP.. KC was significantly related to 2=5 wk PP milk
yield (p=.017). PT, BF
Hill PD, Aldag JC, Chatterton RT. (1999b). Effects of pumping style on
milk production in mothers of non-nursing preterm infants. J.Human Lactation,
15(3), 209-216. PT, BF
Hosseini, R., Hashemi, M., & Ludington-Hoe, S.M. (1992). Preterm infants
and fathers: Physiologic and behavioral effects of skin-to-skin contact. Ursus
Medicus, 2, 47-55.FATHERS
Hurst NM, Meier P. 2001. Managing breastfeeding for preterm infants and
their mothers. Central Lines, 17(4), 1, 3-7. Refers to use of KC on pg 3 with
pictures and how helpful it is to promote breastfeeding.Differentiates starting
with KC and progressing to KC + nonnutritive sucking to BF. BF
Hurst, N.M., Valentine, C.J., Renfro, L., Burns, P. & Ferlic, L. (1997).
Skin-to-skin holding in the neonatal intensive care unit influences maternal
milk volume. J. Perinatology, 17(3): 213-217. 8 mothers started KMC during the
4 weeks postdelivery and 8 others in the following 4 weeks. All babies had been
ventilated. Mean 24-hour milk volumes at 2,3,4 weeks after delivery showed
strong linear increase in KMC infants, and no change in control infants’
mothers’ milk volumes.FULL-TERM, milk volume, BF
Johanson, R.B., Spencer, S.A., Rolfe, P., Jones, P., & Malla, D.S. (1992).
Effect of post-delivery care on neonatal body temperature. Acta Paediatrica,
81(11), 859-863. 300 infants (KC beginning immediately after birth when infant
put to breast under mom’s clothing or possibly under swaddling and kept against
mother’s breast) was as effective as oil massage or plastic swaddling in keeping
babies warm. Fullterm and Preemies were analyzed as one group, and there are
many methodological flaws. Kangaroo Care may or may not have been given.RCT
Johnston, C.C., Stevens, B., Pinelli, J., Gibbins, S., Filion, F., Jack,
A., Steele, S., Boyer, K., & Veilleux, A. (2003). Kangaroo Care is effective in
diminishing pain response in preterm neonates. 2003 Arch Pediatric and
Adolescent Medicine 157 (11), 1084-1988. 74 preterms 32-36 wks postconceptual
age and within 10 days of birth were in cross-over (served as own controls)
study of 30 minutes of KC and then heelstick in KC versus being prone in
incubator and getting heelstick in incubator. Premature Infant Pain Profile
scores over first 90 seconds of heel lance procedure were significantly lower by
2 points in KC. KC effectively decreases pain of heelstick. PT, Quasi-
22
Experimental, Pain
Kambarami RA, Chidede O, & Kowo DT. (1998).Kangaroo care versus incubator
care in the management of well preterm infants – a pilot study. Annals of
Tropical Paediatrics, 18(2), 81-86. 37 KC group gained twice as much weight per
day as the 37 controls, had shorter hospital stay, and better survival rate.
RCT. Weight, LOS, survival.
Kambarami RA, Chidede O & Kowo DT (1999). Kangaroo care for well low
birth weight infants at Harare Central Hospital Maternity Unit—Zimbabwe.
Central African J. of Medicine, 45(3), 56-59. 613 mother-infant pairs,
implementation report. Implementation.
Kirsten G.F., Bergman N.J., Hann F.M. (2001). Kangaroo mother care in the
nursery. Pediatr Clinics North America, 48(2): 443-453. A general review of KMC
and its safety and effects, including BF effects. An easy to follow article
that relates implementation guidelines too.Review, Breastfeeding,
implementation, guidelines.
23
Klaus MH, Jerauld R, Fregers C,McAlpine W, Steffa M, Kennell JH. 1972.
Maternal attachment: Importance of first postpartum days. New England J.
Medicine, 28, 460-463. Mothers who had been allowed extended contact with their
FT infants immediate after birth showed more affectionate behavior one month
later than did mothers in a control group. Full term, Maternal affectionate
Behavior, RCT
Kledzik, T. (2005). Holding the very low birth weight infant: Skin-to-
skin techniques. Neonatal Network 24 (1 – Jan/Feb issue), p.???. This article
offers practical solutions for common barriers to skin-to-skin holding.
Skills,implementation.
Landers S. 2003. Maximizing the benefits of human milk feeding for the
preterm infant. Pediatric Annals, 32 (5), 298-306. This article summarizes
current knowledge of short and long term benefits of human milk feedings for
preterm infants and challenges in providing adequate nutrition, along with
strategies to assist in providing human milk feedings. Infection risk of human
milk are related too. On page 303 is a full section on Skin-to-skin holding
that even talks about the enteromammary pathway for protection of preterm
infants from nosocomial infection. Very positive review of KC. Preterm, BF,
enteromammary pathway
24
article about KC, but it states on page 335 that “KC has been shown to improve
the integrity of sleep” and that more studies of KC and sleep cyclicity are
needed.
Lincetto O, Nazir AI, Cattaneo A. 2000. Kangaroo mother care with limited resources. J Trop Pediatric,
46 (5), 293-295.
Lincetto, O., Vos, E.T., Graca, A., Macome, C., Tallarico, M., Fernandez,
A. (1998). Impact of season and discharge weight on complications and growth of
Kangaroo Mother Care treated low birthweight infants in Mozambique. Acta
Paediatr 87:433-9. morbidity, weight, development.
Ludington-Hoe, S.M., Anderson, G.C., Swinth, J., Thompson, C., & Hadeed,
A.J. (1994). Kangaroo care. Neonatal Network,13 (4), 61-62. (Letter).
25
each minute and means remained in normal clinical range showing safety. HR
approached tachy and brady in pretest and posttest period, but not in KC. HR
rose 8 bpm in KC and was significantly higher in KC than in control. (More
stable physiology in KC). Mean SaO2 dropped 1.0% in KC. Apnea, brady, and
periodic breathing recorded continuously on pneumogram and no apnea/brady
occurred during KC.Only one KC infant had one episode of PB during KC and many
controls had lots of PB in all periods. Significantly less PB in KC and between
groups. More regular breathing in KC during KC period than in control group.
Abdominal temp rose significantly (almost 1.0C)in KC and then dropped .05C in
postKC. PT, RCT, HR, RR, SaO2,abd.temp, apnea, brady, periodic breathing
Ludington-Hoe, S.M., & Golant, S.K. (1993). Kangaroo Care: The Best You
Can Do For Your Preterm Infant. N.Y., N.Y.: Bantam Books. Out of print,
available only from Dr. Ludington, Univ. of Maryland School of Nursing, 655 W.
Lombard Street, Baltimore, MD 21201 or from La Leche League International, 1400
Meacham Rd., Schaumberg, Ill. 60173. Cost is $12.95 + $2.00 shipping.
Ludington-Hoe, S.M., Hashemi, M.S., Argote, L.A., Medellin, G., & Rey, H.
(1992). Selected physiologic measures and behavior during paternal skin contact
with Colombian preterm infants. Journal of Developmental Physiology, 18(5), 223-
232. Descriptive study of preterms who got 2 hours of PKC immediately after
breastfeeding by mom. All three temps continuously rose in PKC and 5/11 subject
became hyperthermic during 2 hours of PKC. Infants predominantly slept in quiet
sleep during PKC, and fathers demonstrated good fathering behaviors during PKC.
Several fathers got tired of KC after 1.5 hours. Tympanic temp is difficult to
take during KC. Warming all the way down to the toe occurred. Behavioral
thermoregulation was demonstrated by 4/11 infants. Descriptive, Preterm,
FATHERS, Abdominal temp, toe temp, tympanic temp, fathering behavior.
26
infants did not cry at all! 15 minutes of KC baseline state and post-heel stick
state was significantly more time in deep sleep than when in incubator. No
differences in RR, oxygen saturation between groups and periods. Experimental
cross-over, HR, RR, SaO2, crying time, behavioral state, pain.
Martinez, G.H., Rey, S.E., & Marquiette, C.M. (1992). The mother kangaroo
programme. International Child Health, 3, 55-67.Clinical Report of practice.
27
of the Newborn: A Practical Guide. WHO: Geneva, pp. 30-37. This shows
developing nations how to keep babies warm in KC. This is a nice follow-up to
the SAREC report from Sweden. Available from Maternal and Newborn Health/Safe
Motherhood Unit. Reproductive Health (Technical support), WHO, 1211 Geneva 27,
Switzerland.
28
other things while daddy was kangarooing. Parents learn how to do KC quickly.
Review, PT,FT, VEKC, paternalKC, mat. Anxiety, cortisol, crying, learning to do
KC
Meier PP 2003. Supporting lactation in mothers with very low birth weight
infants. Pediatric Annals, 32 (5), 317-325. Reviews the Rush Mother’s Milk
Club Program elements, all strategies to improve BF, including Pictures of KC
on page 317, pg321, and a section on bottom left column page 320 says “Mothers
and fathers are encouraged to hold even the smallest ventilated infants in KC to
minimize apnea, bradycardia, and hypoxemia that can accompany bolus gavage
feedings” (pg. 320). Shows on page 320 the “My Mom Pumps For Me” recording
form for recording KC sessions. Preterm, Breastfeeding, Ventilated KC
Meier PP, Engstrom JL, Mingoletti SS, Miracle DJ, & Kiesling S. 2004. The
Rush Mother’s Milk club: Breastfeeding interventions for mothers with very-low-
birth-weight inants. J.Obstet Gynecol Neonatal Nurs, 33 (5), 164-174. Daily KC
is an integral part of the Rush Mother’s Milk Club program. They reviewed 207
VLBW records from 1997-1998. Lactation initiation is 72.9%, mean dose of own
mother’s milk at 15,30, & 60 days was 81.7%, 80.1%, and 66.1% respectively, of
total volume fed. 57.2% of hospital days infants were exclusively breastfed and
72.5% of hospital days infants received some of their own mother’s milk. The
outcomes of low income African American women are the highest in the literature
and these outcomes approach national health objective. PT, BF, lactation
initiation rate, % feeds of mothers’ own milk.
29
Messmer,P.R., Wells-Gentry, J., Rodriguez, S., & Washburn, K. 1995.
Mother’s feelings on Kangaroo care for their preterm infants. In P.L. Munhall &
V.M. Fitzsimons (Eds.)The Emergence of Women in the 21st Century. New York: NLN
Press., page 243-250.
Modrcin-McCarthy, M.A., Harris, M., & Marlar, C. 1997. Touch and the
fragile infant: Comparison of touch techniques with implications for nursing
30
practice. Mother Baby Journal, 2(4), 12-19. Provides overview of historical
perspectives on touch, Sister Callista Roy’s adaptation model as a framework for
touch studies, and a comparison of the types of touch (procedural, comforting –
that includes stroking, massage, tactile-kinesthetic touch, gentle human touch,
and Kangaroo Care (pg 17-18). Author admonishes one to “frequently monitor the
infant during kc for temperature instability, patency of tubes, and stimulation
tolerance”(pg. 17) and states that “minimal detrimental effects are associated
with KC if the infant is medically stable”17.
Moran, M, Radzyminski S.G., Higgins, KR., Dowling, D.A., Miller, MJ, &
Anderson, G.C. (1999). Maternal kangaroo (skin-to-skin) care in the NICU
beginning 4 hours postbirth. MCN(Amer.J. Maternal Child Nursing), 24(2),74-79.
A case study of a 32 weeker. Infant was 32 wks, 193 gr, got 6hrKC/day in 2-3 hr
intervals. To intermediate care on day 2, regained BW by Day 12, DC day 21,
exclusively BF at 40 wks, high normal develop at 18 mos. EARLY KC, BF, Develop.
31
competence in BF and extended lactation” pg. 312. Preterm, BF
Neu, M., Browne, J.V. & Vojir, C. (2000). The impact of two transfer
techniques used during skin-to-skin care on the physiologic and behavioral
responses of preterm infants. Nursing Research, 49(4), 215-223. 15 ventilated
preterms (MGA=30.2wks; Mwgt=1094g, Mage=18.3days) each received one day each of
transfer by nurse (sitting) or transfer by parent (standing)(14 Moms, 1 Father)
on 2 consecutive days in random order in interrupted time series, cross over
design. Min-by-min HR, SAO2 recorded manually for 30 min B4 & after transfer &
during 1 hr of KC. Axillary Temp was stable, HR increased, SaO2 decreased and
there was more motor disorganization with transfer.VENT KC, FATHER, Infant own
control.
Newport, M.A. 1984. Conserving thermal energy and social integrity in the
newborn. Western J. Nursing Research, 6(2), 175-192. 39 healthy fullterms got
KC, 37 got routine care. KC began after dried and covered with warm cotton
blanket and continued for 15 mintes; routine got dried and wrapped and put in
Montgomery warmer bed for 15 min. No temp differences, HR, RR had no diffs.
No diarrhea, no ketouria, and no diff in weight loss. FULLTERMS, no mention of
assignement method. Delivery KC
32
oxytocin and prolactin levels which are released by skin-to-skin contact. See
also Uvnas-Moberg K, Widstrom A-M, Nissen E, BjorvellH. 1990. Personality traits
in women 4 days postpartum and their correlation with plasma levels of oxytocin
and prolactin. J. Psychosomatic Ob & Gyn, 11, 261-273. Fullterms, maternal
personality, delivery KC. Get this we don’t have
33
metabolism, large bioavailability of zinc (and these are growth related
substances), and normal colostrums ejection reflexes (let down)don’t work if we
separate the infant right after birth (pg. 73). Birth weight loss is not a
physiologic necessity.Clinical report, weight, KCBF, antibodies in milk
34
midwifery, 44. 423-424.
Quasem I,Sloan NL, Chowdhury A, Ahmed S., Winikoff B, Chowdhury AMR. 2003.
Adaptation of Kangaroo Mother Care for community-based application. J
Perinatology 223 (8, Dec. 2003), 646-651. 35 expectant or newly delivered moms
were taught about KMC, did it and at 1 month postpartum were interviewed to
evaluate kMC experience. 77% of moms initiated KMC and 85% with LBW babies did
not. Moms delayed newborn bath and some slept upright with babies for 24hr/day
KC. KMC was quickly and popularly adopted. Includes simple guidelines for
choosing infants appropriate for KMC. Descriptive, PT/FT, Implementation,
maternal experience.
35
author’s reply to some comment.
Renfrew MJ, Lang S, Woolridge MW. (2001). Early versus delayed initiation
of breastfeeding (Cochrane Review). In: The Cochrane Library, Issue 1, 2001.
Oxford: Update Software. Available from http://www.update-
software.com/abstracts/ab000043.htm. Three studies reviewed comparing early skin
contact with late skin contact and BF. Early contact and BF was associated with
greater communication between mothers and infants but not with BF duration or #
of women BF aftter birth. The studies reviewed are from 1978,79 and 90 (before
KC really became established) and the first one does not say they did KC at all,
but just put baby to breast. The other two are clearly KC studies.
Rey, S.E., & Martinez, G.H. (1981). Maejo racional del nino prematuro.
Proceedings of the Conference 1 Curso de Medicina Fetal y Neonatal, Bogota,
Colombia: Fundacion Vivar, 1983. (Spanish). Manuscript available in English
from UNICEF, 3 UN Plaza, New York, NY: 10017.
Rey, E.S., & Martinez, H.B. (1983). Manejo rational de nino premature.
Proceedings of the conferences I curso de medicina fetal y neonatal, Bogota,
Colombia, March 17,1983, 137-151. THE ORIGINAL WORK OF THEIR PROGRESS FROM
1979-1983. BIRTH OF KC!!!
Richards M. (1994 Review of “Kangaroo Care: The Best You Can Do For Your
Premature Infant.” Birth, 21: 1. Review of Dr. L’s book.Says Dr. L comes on too
strongly in favor of KC and this might upset mother who cannot do KC
Righard, L., & Alade, M.O. (1990). Effect of delivery room routines on
success of first breast-feed. The Lancet, 336, 1105-1107. Comparison of
fullterm infants who laid on mother’s belly for 20 min. immediately after
delivery (n=34)(separation group) and were then removed were compared to those
who stayed nude on belly and chest for at least 1 hour (n=38)(contact group = KC
contact). The KC contact infants began crawling to the breast at 20 min, began
rooting, and at mean 50 min after birth most were sucking at breast. More KC
contact infants had correct sucking technique (24/38 vs. 7/34).
36
Roberts, K.L., Paynter, C., McEwan, B. (2000). A comparison of Kangaroo
Mother Care and Conventional Cuddling Care. Neonatal Network, 19(4), 31-35.
30healthy preterms, ≥30wk GA, no O2 help, with stable temp for 24 hrs, in crib
or incubator randomly assigned to 2 hrs 5days/wk x4 wks of KMC (n=16) or holding
while clothed (n-14). No control group in study because both groups got some
holding. No differences in weight gain, temperatures, duration of BF, parental
stress (PSS-NICU score), or parental expectations score. Limitations were
clinician values for temp & wgt gain, no calibration of scales or interrater
reliabilities, small sample size, and inability to do inferential stats because
of small sample size.Says Holding while Clothed is not a Control. RCT, PARENTAL
KC.
Roller, CG. (1999). Kangaroo care for a restless infant with gastric
reflux: One nurse midwife’s personal experience. MCN Am. J. Maternal Child
Nursing, 24(5): 244-246. Full-term infants who was given SURROGATE KC by the
CNM because mother was unavailable. Infant had severe and refractory GER but was
GER free during two feedings given with KC two days apart. SURROGATE KC
Salariya EM, Easton PM, Cater JI. 1978. Infant feeding. Duraiton of
breastfeeding after early initiation and frequent feeding. Lancet, II, 1141-
1143.Fultterm, BF. Get this one.
37
Schaller J, Carlsson S.G., Larsson K. (1979). Effects of extended post-
partum mother-child contact on the mother’s behavior during nursing. Infant
Behavior & Development, 2, 319-324. RCT, FUllterm
Schanler RJ. (2001). The use of human milk for premature infants.Pediatr
Clin North Am 2001, 48(1), 207-219. This review article covers the role of
fortification and states “the potential stimulation of an enteromammary pathway
through skin-to-skin contact provides species-specific antimicrobial protection
for premature infants, and this needs to be explored. Thus, neonatal centers
should encourage the feeding of fortified milk, together with skin-to-skin
contact, as reasonable methods to enhance milk production while potentially
facilitating the development of an enteromammary response.”Review
Scochi, C.G., Kokuday, Mde L., Riul, M.J., Rossanez, L.S., Fonseca, L.M.,
Leite, A.M. (2003). Encouraging mother-child attachment in premature
situations: Nursing interventions at the Ribeirao Preto clinical hospital.
Review Latino American Enfermagen, 11 (4), 539-543. Clinical report of nursing
interventions in University Hospital NICU of Univ. of Sao Paulo. KC is
encouraged at first parental NICU visit. All aspects of program have promoted
Maternal-infant attachment. PT, Clinical report, attachment, maternal feelings.
Sepkowitz, S. (1985). The marsupial mother. The Lancet, July 13, 1985, p.
100.
38
Sleath, K. (1985). Lessons from Colombia.Nursing Mirror, 160(4), 14-16.
Sloan, N.L., Camacho, L.W.L., Rojas, E.P. , Stern, C., & Maternidad Isidro
Ayora Study Team. (1994). Kangaroo mother method: Randomized controlled trial
of an alternative method of care for stabilized low-birth weight infants.
Lancet, 344 (8925)September 17, 1994, 782-785.Randomized controlled trial,
Development.
Smith S. 1996. Skin-to-skin contact for premature and sick infants and
their mothers. In Contemporary Issues in Nursing, Biley F & Maggs C (Eds.).
Edinburgh: Churchill Livingstone, 31-78.VENT KC, Cross Over, Own Control
Smith SL (2002). Infant holding in intensive care. AACN News, 19(2), pg.
4, 5. Short clinical scenario of KC with intubated infant that gives Smith
chance to review the lit again and say that KC with intubated infants may not be
the best practice. She reviews her study here as well.
Smith SL. 2003. Research corner: Myth vs. Reality: Holding intubated
infants in the NICU. AACN News.nsf. Available on http://www.aacnnews.nsf. A
case study of Jay, a 26 weeker who is 38 days old and intubated and given KC
starts this report of myths that she dispels. Myth #1 is Intubated infants are
physiologically more stable when held than when in incubator; She says the
rectal temp of a 772 gram decreased to 37.2 during KC, showing the fragility of
very small infants during KC (But 37.2 is a great temp!!!). She reviews Neu’s
work and concludes that the “data regarding safety and efficacy of KC on
intubated VLBW infants is conflicting. Clinical review, Vent KC.2nd report of
temp drop during KC.
39
ms2). LF/HF ratio was 6.7ms2 during KC and was between 6.8 – 8.1 ms2 during
incubator. Gestationally older infants (32-34 weeks corrected age) had
increased power (but not significantly different) in the low and high frequency
regions than 28-29, 30-31 wk infants. Significantly higher temp and
significantly higher FiO2 during KC than incubator, and lower (but not sig)
SaO2, but the data are not given as these are reported in another study and just
mentioned here. PT, Cross-over design, HRV, Temp, SaO2,FiO2
Sontheimer, D., Fischer, C.G., Scheffer, F., Kaempf, D., & Linderkamp, O.
(1995). Pitfalls in respiratory monitoring of premature infants during Kangaroo
care. Archives Disease in Childhood Fetal Neonatal Edition, 72(2), F115-117.
Sosa R, Kennell JH, Klaus M. Urrutia JJ. 1976. The effect of early
mother-infant contact on breastfeeding, infection, and growth. In Elliott K,
Fitzsimmons DW (Eds.) Breastfeeding and the Mother. Ciba Foundation Symposium
vol. 45, NY: Elsevier Excerpta Medical, 1976: 170-193. This is a report of 3
studies conducted in Guatemala. Primip moms of NSVD of 37-42 weeks GA. Study
#1: KC group (n= 30) given 45 minutes KC under radiant warmer beginning after
episiotomy repair; control (n= 30) had mom and baby separated for 12-24 hours
with FU at 35 days, 3,6,9,12 mos. KC group BF for mean 173 days during 1st
year, controls for 274 days. Fewer infections in KC. Early postnatal KC did
not result in an increase in BF. Study #2: KC (n=34) got 45 minutes post
delivery, control (n=34) separated for 12-24 hours. KC group BF for mean 159
days over 1st year, control for 109 days: KCers BF longer, & fewer infections
in KC. Study #3: KC (n= 20)also got 45 minutes of KC, and controls (n=20) were
separated for 12-24 hours and third group (n=20) got nude infant at 12 hrs
age. KC group BF for mean # of 96 days over 1st year of life, controls Bf for
mean of 104 days. KCers did not BF longer in Study #3. Observations at 36
hours in study #3 showed KC moms had sig more maternal affectionate behavior
(being en face, looking, talking, fondling,kissing, smiling to infant), but no
diff in proximity behavior (keeping baby in mom’s bed or holding it close) or
in taking care of baby (burping, wiping mouth). Conclusion:KC moms BF 50%
longer than controls (p.183).Wgt gain sig more at 6 months (4.5kg kc VS. 3.7kg
non-KC) and sig. More at 1 yr (6.0kg vs 5.7kg) maternal sensitive period is
<12 hours and early Mat-infant contact PP has far-reachinhg effects on infant
health during 1st yr. RCTs Full-term, BF, Infection, Wgt gain.
40
Stening W, Roth B. 1999. Dissemination of the Kangaroo Method in Germany.
J Perinatology 19(6): 450-451. 91%of German NICUs offer KC; ¾ of those to
ventilated infants with “good or very good” experiences. Most offer it for 30-
60 minutes, but they think this is too short. Hypothermia is infrequent,
infection is not found, spontaneous extubation of ventilated pts. is a
problem.Implementation, Infection,
Svejda MJ, Campos JJ, Emde RN, 1980. Maternal-infnat “bonding”: Failure
to generalize. Child Development, 51, 775-779. Randomized controlled trial.
Extra contact or routine care. KC (n=15) for 15 min after episiotomy repair
and then gowned moms had nude infant with them for 45 min when in own room.
Then 90 min of wrapped contact at each feeding for breastfeeding.Control
(n=15), 1-5 min of contact at delivery with wrapped infant and 30 min at each
feed starting 4-6 hrs after delivery. In the first 36 hrs, extra contact moms
had 10 additional hours of contact as compared to 15 gowned mothers who looked
at baby in a crib while still in the DR, held the wrapped infant briefly
before going to nursery. No differences in maternal behavior between groups or
between situations were seen. RCT, fullterm.
Swinth JY, Anderson GC, Hadeed AJ. (2003). Kangaroo Care with a preterm
infant: Before, during and after mechanical ventilation. Neonatal Network. 22
(6), 33-46. Case study of infant with mild RD at 2-18 hrs postbirth without
improvement til KC began. 4.75 hrs of pre-ventilation KC, 4.0hr of VentKC, and
6.0 hrs of post-ventilationn KC given. KC assisted in recovery from RD and
fostered maternal relaxation and reduces maternal stress. Vent KC, Case study,
Maternal relaxation, Mat stress, sleep, crying, FiO2, SaO2, protocol for
positioning and securing lines on pg.35.
Swinth JY, Nelson LE, Hadeed A, Anderson, GC. (2000). Shared kangaroo care
for triplets. MCN Amer.J. Maternal Child Nursing, 25(4): 214-216. Mom had 4 kids
at home, had naturally occurring triplets at 35 weeks. One was IUGR. Held all 3
simultaneously at 6 days of life and quickly came to know each baby as an
individual. Babies nuzzled up easily in KC. Triplets were co-bedded in nursery.
Triplet preterm KC.
Syfrett EB, Anderson GC, Behnke ML, Hilliard B. in progress. Very early
kangaroo care for healthy breastfed preterm infants: A pilot randomized
controlled trial. Available from Dr. Anderson
Sywulak, H.C.M. 2002. Kangaroo mother care: Rediscover the natural way to
care for your newborn baby. J. Human Lactation, 18 (3), 289-290. I think this
is a review of Nils Bergman’s film.
41
37-38 weeks PCA, and other Kcers i.e father, grandmother) or incubator care
(kept in incubator til appropriate wgt gain and discharged at 1700gm). At 12
month 336 took Griffiths test . At 12 months KMCers had higher IQ, and the more
premature the infant (30-32 weeks) and sicker and for those with diagnosed
abnormal or doubtful neuro develop at 6 months age, the higher the significance.
The main kmc effect was on 3 subscales: Hearing and Speech, Personal-
Social[development of personal relations]and Performance. and on planning
functions related to brain developmental stage at birth. KMC provides BRAIN
CARE. RCT, 24 hr KC, Developmental,Paternal KC, Surrogate KMC, Mixed fullterms
with Preterms and LBW, LOS, Grandmother
Tessier, R., Cristo, M., Velez, S., Giron, M., Figueroa de Calume, Z.,
Ruiz-Palaez, J.G., Charpak, Y., Charpak, N. (1998). Kangaroo Mother Care and the
Bonding Hypothesis. Pediatrics, 102 No.2 August 1998. Abstract e17, pg. 390-391.
Randomized controlled trial.
Tessier R et al. See under ABSTRACTS for KMC as method of protecting high
risk preemies against developmental delay.
Toma, T.S. (2003). Kangaroo mother care: The role of health care services
and family networks in a successful program. Cad Saude Publica, Rio de Janeiro,
19 (supple 2), S233-S242. 14 men and women answered questionnaires about how to
get KC done for their infants. Health workers needed to address personal and
family problems that prevented KC, and consider history of perinatal death,
other kids in household, paternal/family involvement, and household management
so that KC can be implemented. Descriptive, implementation.
Tomlin AC. (1993). Review of Kangaroo Care: The Best You Can Do For Your
Preterm Infant by Ludington-Hoe and Golant. Library J. 118(14), 214-215. Sept.
1, 1993.
42
care in sick very preterm infants. Acta Paediatrica 88(12), 1402-1404. Took 17
infants (12 on CPAP, 1 on vent, 4 no 02 support) conveniently sampled from
other study. Had pretest-test-posttest design, 60 min or more of KC on median
age of 3 days of life. Infants were median age 28 weeksGA, median BW 1238g,
median wgt on study day 1072 g. 8 infants were fed 4-20 ml human milk by NG. KC
did not stop due to infant deterioration in any subject (1403). One infant had
brief apneic spell >60 sec during blood sampling. During KC Sa02 was 88-98, FiO2
had to be decreased by 0.09 in one infant, increased by 0.05 and by 0.12 in two
infants. TcPO2 increased spontaneously in 9/17 infants and varied in others.
TcpCO2 changed <o.5kPa in 15/17 infants (in two infants went from 5.2-6.3 or
6.5kpA). PaCo2 changed <0.8kpa in 15/17. In one infant paCO2 increased from 5.7
to 7.5 and decreased from 5.9 to 4.4 kpa in another. Arterial pH changed <0.06
in 15/17 infants, and decreased from 7.35 to7.28 and 7.31 in two infants. HR
range 130-180 BeforeKC and 135-190 after KC. No bradycardia occurred. Temp was
unchanged or increased <0.2C in 8/15; decreaed <0.5C in 6 and 0.5-0.9 in 2/15.
The lowest post-KC temperature was 36.2 after a drop of 1.0C in one infant.
Before KC, infants were crying, awake. AT 30 minutes of KC 16/17 were quiet
sleep, 1 was drowsy. AT 60 minutes of KC15/17 quiet sleep, 2 were awake. NG feed
tolerated without adverse effects. Sick and very preterm infants tolerate KC
early in life (1404). “Tolerability of of repeated, prolonged periods of KC (<4
hrs) has been excellent” in their nursery (1404). Descriptive, VENT KC, KC
+NG,Apnea, Behav.state, HR, SaO2,temp, TcPo2, TcpCO2, Bradycardia, arterial pH,
and arterial CO2, FiO2. sleep, crying, awake, CPAP
Van Rooyen, E., Pullen, A.E., Pattinson, R.C., Delport, S.D. 2002. The
43
value of the kangaroo mother care unit at Kalafong Hospital. Geneeskunde. The
Medical Journal, April 2002, 6-10. This is a report of 18 months of mandated
practice of KC with low birthweight PRETERM infants in South Africa at the
public hospital. 466 infants were admitted to the 24-hour/day KC unit over 18
months. 81% (n=375) of the infants weighed less than 1751 grams; 12% weighed
less than 1251 grams.Average Length of stay was 13 days, average wgt gain was
23g/day. 85% were fully BF at discharge(the other 15% had HIV). One infant died
in the KMC unit and 32 were transferred back to NICU for infection. Length of
stay for infants <1300 g was decreased by 3 days when compared to LOS prior to
KMC. Before KMC follow up was <50%; after KMC follow-up was 321 (69%), and 47%
attended more than once. Implementation,Preterm, 24 hr/day KMC, wgt gain,
length of stay, BF,infection, follow-up.
Villalon U,H., Alvarez C,P., Barria H, E., Caneleo H, D., Carrillo M, L.,
Duran G, S., Luz Feres R, C., Mansilla A, P., Navarro C, A., Olivares G, C., &
Torres R, V. 1992. Effect of early skin-to-skin contact on temperature
regulation, heart rate, and respiratory rate in healthy, full-term newborns. Rev
Chil Pediatr, 63: 140-144. Gave KC immediately after birth for 4 hours(92
newborns, , KC= 47, remainder were controls who got routine maternity ward care.
No diff between groups in HR, RR and ability to regular body temp;93.6% (n=44)
of KC moms and ALL STAFF “expressed very good opinion about KC. KC can be used
safely with fullterm healthy newborn with environmental temp as low as 19
degrees C. FULLTERM RCT, TEMP, HR., RR, Mat Impression, Staff Impression,
delivery KC
Villalon, UH, Alvarez, CP. (1993). Short term effects of early skin-to-
skin contact (kangaroo care) on breastfeeding in healthy fullterm newborns. Rev.
Child Pediatr. 64(2), 124-128. Randomized controlled trial of 119 dyads(KC=59)
who got early KC (started 2-4 hrs postbirth) vs controls who stayed in
observation nursery for first 4 hrs postbirth in Chile. 89.9%KC vs. 63.3%
control breastfeeding at 24 hrs postbirth; 93.3% KC vs. 66.7% control BF at
discharge; 78.8% KC vs. 56.2% control BF at 14 days postdischarge. Maternal
self confidence at discharge (89.9KC vs.53.3m p<.001) and 14 days
(97%).FULLTERM. RCT
44
that mortality and abandonment decrease (p.24), includes report of 33 Kcers in
Sweden and less HR, lower o2 needs, less restless, better temp maintenance,
fewer digestive probs, more milk, and 24/33Kcers (83%) BF at discharge vs 45% in
control (p. 25. Has BF cycle wheel for KC. Clinical Report and
review.Breastfeed.
45
Whitelaw, A., Heisterkamp, G., Sleath, K., Acolet, D., & Richards, M.
(1988). Skin-to-skin contact for very low birth weight infants and their
mothers. Archives of Diseases in Childhood, 63, 1377-1381.
Whitelaw, A., & Liestol, K. (1994). Mortality and growth of low birth
weight infants on the kangaroo mother program in Bogota, Colombia. Pediatrics,
94(6), 931-932.BF, Wgt gain
Whitelaw, A., & Sleath, K. (1985). Myth of the marsupial mother: Home
care of very low birth weight babies in Bogota, Colombia. Lancet 1, (8439)May
25, 1206-1208.
46
98 days vs 36 days in control group. RCT, Fullterm, BF
Dala Sierra, E., Pineda Barahona E., Banegas R.M. (1994). Experiencia
madre Canguro (Kangaroo Mother Experience0. Rev Med. Hondur 62, 43-46. RCT
Delval, A.C. (1998). The Kangaroo method: a bond in caring for
prematures.(French). Rev Infirm 1998 Feb;35:26-28.
47
De Luca, T, Agostino R, Muggia A, Butturini F. 1995. Il metodo marsupio.
Neonatologica 9(2), 121-125.
Ezinga, G., & Ezinga-Scotten, D.E. (1985). Onderzoek naar het eventueel
ontstaan van hypothermi en hyppoglykemie bij thuisgeborenen na langdurig
huidcontact postpartum. Ned Tijdschr Geneeskol, 129, 449-451. FULLTERM
Fischer, C.B., Sontheimer, D., Bauer, J., & Linderkamp, O. (1997). Die
Kanguruhpflege Fruhgeborener. Stand der Forschung und Erfahrungen in
Heidelberg. Padiatrische Praxis, 52(4), 609-619. (Kangaroo care of premature
infants. Status of research and experience in Heidelberg. Has English abstract
on page 617).
Gomez Papi, A., Baiges Nogues, M.T., Batiste Fernadez, M.T., Marca
Gutierrex, M.M., Nieto Jurado, A., Closa Monasterolo, R. (1998). Metodo canguro
en sala de partos en recien nacidos a termino (Spanish). An Esp Pediatr 1998
Jun;48(6):631-633. English is: Kangaroo method in delivery room for fullterm
babies.. 533 normal fullterms were given KC as soon as dried and for next two
hours. Temperature of infant was related to duration of KC and 96% had axillary
temp >36, 98.5% of infants stayed awake with KC, and KC infants who breastfed
during KC stayed longer in KC. If infant had more than 50 min. of KC he had 8
times more probability of breastfeeding spontaneously. Moms tolerated it well
though they were tired. FULLTERM, DELIVERY ROOM. Descriptive study, Axillary
temp, Awake state, BF, Mother’s toleration of KC.
Hamm, S., Stoffel, L., Strebel, E., & Wyss, E. (1993). Method for
strengthening the mother-child relationship. As warm as in the kangaroo pouch.
Krankenpflege-Soins Infirmiers, 86(8), 9-11.
Hargboel, A. (1987). Luna- A child who has tried the Kangaroo Method.
Foraldre og Fodsel, #1. No page numbers listed.
48
Laine, A.M. (1987). Kangaroo care in Turku's University Hospital
Pediatric Clinic. Katilolehti,92(5): 171-176.
49
Mulet, R.C., Figueroa de Leon, R., Gonzalez, J.V.B. (1992). Mother-child
early contact with the mothers kangaroo program and natural breastfeeding.
Rev.Latin.Perinat. 12,#3-4, 54-60. See annotation under English section.
Pignotti MS, Rubaltelli FF. (1997). Kangaroo Care: Parents’ answers and
staff problems. Riv Ital Pediatri 23, 1054-1057. In three years 95% of LBW and
VLBWs (580-2000 gm, 25-38wkGA) got KC. Nurses had difficulty with organization
and surface space and time for mothers; mothers firmly believe in KC and its
help in forming relationship with infant and nurses.Italian with English
Abstract
Riskin A & Bader D. 2003. Breast is best—human milk for premature babies.
Harefuah, 142 (3), 217-222, 236, 237. Review article of how breastmilk is best
for preemies. States “support of lactation in mothers of preemies mandates
protection of the mother and child bonding process and early skin-to-skin
contact “Kangeroo care” (pg. 217). PT, Review, BF
Shiau SH. (1999). The effects of kangaroo care on sleep and crying of
healthy fullterm newborns. Nursing Research (China), 7(3): 198-208. 22 Kcers
and 22 standard care infants (No sig difs between groups on demographics)were
compared. Kcers had significantly less total crying (7.14 min vs 10.73, p=.000)
on days 1 & 2 but not 3; Kcers had more sleep (total47.64 min vs.40.36, p=.000
on days 1,2,3) and less awake time (total 14.55 vs. 17.45 min, p=.046) and less
awake time on day 3 but not on days 1,2. FULLTERM, RCT crying, sleep,
wakefulness Chinese.
Stening, W., Lohe, M., Meiritz, N., Rutenfranz, P., & Roth, B. (1996).
Kanguruh-methode bei Fruhgeborenen. Monatsschr Kinderheilkd, 144: 930-937. (Has
English Abstract pg. 931)
50
Cabrol D., Pons JC (eds.) Obstetrique Paris: Flammarion Medicine-Sciences. P.
151-154.
Villalon UH, Alvarez CP, Baria HE et al. 1992. Effect of early skin-to-
skin contact on temperature regulation, heart rate, and respiratory rate in
healthy, full-term newborns. Rev Chil Pediatr, 63: 140-144.FULLTERM. See review
under English section.
Villalon, UH, Alvarez, CP. (1993). Short term effects of early skin-to-
skin contact (kangaroo care) on breastfeeding in healthy fullterm newborns. Rev.
Child Pediatr. 64(2), 124-128. FULLTERM. BF and maternal confidence. See review
under English section.
Warren L, Tan GC, Dixon PD, Ghaus K, (2000). Breastfeeding success and
earl discharge for preterm infants: The results of a dedicated BF programme. J.
Neonatal Nursing 6 (2), 43-48.BF Get this from D. Dowling.
Yin Y, Wang R., Lee MM, Yuh Y. (2000). Influence of kangaroo care and
traditional nursing care on premature physiologic parameters (Chinese). Nursing
Research (China), 8(3), 362-374. Observations 5 min before leaving incubator,
5,15,and 30 min after starting KC (30 min), and 5 min after return to incubator
each day x 7 days.No diff in HR (157.7vs161.4), RR (47.6 vs. 48.9/min), SaO2 (by
HP monitor)(96.2 vs 95.3%), and body temp (36.9 vs.37.0). Both seemed safe.
.Preterm, quasi-experimental pretest-test-posttest, HR,RR,SaO2,Temp.
51
Yin Y, Wang R,Lee MM, Yuh Y. 2003. Mothers’ satisfaction: KC vs.
traditional nursing care for premature babies (Chinese). J Nurs (China), 50 (2),
37-47. English abstract available: Preterms <2000 g and moms non-randomly
assigned to traditional or KC care. No diff in mat satisfaction before test;
both groups sig. Increased satis after 7 days of 30 min/day KC, but KC group
increased satisfaction more (93.2 vs. 83.2, p<.001). Mothers are more satisfied
with KC. PT, Quasi-Exp, maternal satisfaction.
The following research investigations of Kangaroo Care are reported in the 1990
UNICEF publication of the First International Conference on Mother Kangaroo
Program, Bogota, 1990. The full text is available, free of cost, from UNICEF, 3
UN Plaza, N.Y., NY 10017. Also called Primer Encuentro Internacional-Programa
Madre Canguro.
1. Martinez, H., Rey, E., Navarett, L., & Navarette, C.M. Mother kangaroo
program at the Maternal-Infant Institute in Bogota, Colombia. p. 21-44.
3. Gonzales de Pinzon, L.E. Visual and ocular validation of the mother kangaroo
program at the Maternal-Infant Institute in Bogota. p. 57-62.
4. Correa, J.A., & Ramirez, H. Mother Kangaroo program at the Leon the 8th
Clinic neonatal service at the Social Security Hospital in Antioquia, Colombia.
p. 63-86.
5. Valencia, M.L., & Velez, J.D. Mother kangaroo program at the San Rafael
Yolombo Hospital in Antioquia, Colombia, p. 87-90.
6. Gomez, L.A. Evaluation of two years of mother kangaroo program at the Caldas
Regional Hospital in Antioquia, Colombia. p. 91-102.
7. Restrepo, f., & Lopez, L.S. Mother kangaroo program at the General Hospital
of Medellin, Colombia. p. 103-106.
9. Vargas, N.B., & Correa, J.D. Fathers kangarooing and their ideas and
psychological responses. p. 127-132. FATHERS
10. Lopez, J.M. Experiences with the mother kangaroo method at the Joaquin Paz
Borrero Hospital in Cali, Colombia. p. 133-142.
12. Feraudy, P.Y. Mother kangaroo program: Ambulatory care of the low birth
weigh newborn at the San Gabriel Hospital in La Paz, Bolivia. p. 153-176.
13. Arandia, R., & Morales, L. Mother kangaroo program at the University of San
Simeon in Cochabamba, Bolivia. p. 177-200.
15. Stern, C., Sloan, N.L., & Pinto, E. Mother kangaroo program- Care of low
birth weight neonates in Quito, Ecuador. p. 205-232.
16. Arestegui, R.U. Evaluation of the pilot program of mother kangaroo at the
San Bartolome Hospital in Lima, Peru. p. 233-248.
52
17. Arestegui, R.U. Information about the mother kangaroo pilot program at the
San Bartolome Hospital in Lima, Peru. p. 249-254.
18. Martinez, J.C. Mother kangaroo program is a great opportunity for modern
neonatal help. p. 255-260.
20. de Molina, H. Evaluation of mother kangaroo program at the Dr. Luis Edmundo
Vasquez Hospital in Chalatenango, El Salvador. p. 279-282.
21. Diaz-Rosello, J.L.D., Lozano, P.M., & Tenzer, S.M. Impaired growth of low
birth weight infants in an early discharge program. p. 283-306.
22. Meza, G.C., Rosales, J.M., & Pineda, D.P. Efficacy of mother kangaroo
program in the development of low birth weight infants at Roosevelt Hospital in
Guatemala. p. 307-350.
23. Mulet, R.C., Figueroa, de Leon, & Gonzales, J.V. Efficacy of mother
kangaroo program in the development of low birth weight neonates at the Social
Security Obstetric Hospital in Guatemala, p. 351-361.
29. Wahlberg, V. Alternative care for premature infants - the Kangaroo method:
Advantages, risks, and ethical questions. p. 421-430.
30. Borel J., B., Mayorga G, V., & Vado L., C. Alternate care for neonates
weighing less than 1800 grams in the Bertha Calderon Roque Women's Hospital,
Managua, Nicaragua. p. 431-450.
31. Davanzo, R. Care of the low birth weight infant with the Kangaroo mother
method in developing countries. p. 451-474.
32. Virgin, C. The kangaroo method brings the child back to its mother: Present
and future in Denmark. p. 475-484.
Abstracts
Agbodjan-Djossou AO, Akue D., Peeira SB, Maboudou AL, Assimadi JK. 2000.
The raising of premature inants by KM: Experience at Tokoin Teaching Hospital
Lome-Togo. Paper presented at 3rd International KM Congress, Jakarta, Indonesia,
Nov. 22-25, 2000. Report of 66 infants, 30-33wksGA given KC. Daily mean wgt
gain was 22.8gs.Mean duration of KC was 13 days. No mortality.
53
favorire l’attaccamento madre-banbino nei neonati di peso molto basso (NPMB):
Risultati preliminari. Italian J of Pediatrics, Supplement 14(5), vol. 14(5): p.
136.
Anderson GC, Chiu S-H, Albert J, Dombrowski MAS. (2002). Types of contact
in a randomized trial of KC. 13th Biennial Conference of International Society of
Infant Studies. April 18-21, Toronto, CANADA.
Anderson GC, Chiu S-H, Dowling DA. (2000). Effect of early skin-to-skin
(Kangaroo) care on toe temperature in preterm infants. Unspecified number of
subjects,Preterm, RCT. Available from Gene Anderson
54
Anderson GC, Chiu SH, Pagliotti F, Dowling D. (2001). Early kangaroo
(skin-to-skin) care: Effect on toe temperature (Vascular perfusion) in preterm
infants. Proceedings of Midwest Nursing Research Society meeting, Cleveland, OH,
April 2001. Toe temp rose from 32.6 (prekc) to 34.2 (KC) and dropped to 33.9
(postkc), suggesting possibility of increased vascular perfusion of internal
organs in 31 preterms . RCT, Toe Temp.
Anderson GC, Dombrowski MAS, Swinth JY. 2001. Extending typical kangaro
(skin-to-skin) care to other vulnerable populations: Why not? Presented at
Midwest Nursing Research society Annual Meeting, Cleveland, OH, March 2-5, 2001.
Case study reports of 11 uses of KC,including a respiratory distress baby given
KC and not foregoing ventilatory support.
Anderson, G.C, Marks, L, & Wahlberg, V. (1987). Kangaroo care for preterm
infants around the world: State of the art. Society for Research in Child
Development Biennial Meeting. (not published).
Argote, L.A., Rey, H., Ludington, S., Medellin, G., Castro, E., &
Anderson, G. (1991). Dificultad respiratoria transitoria y contacto piel a piel
temprano como manejo. Memorias de XVII Congreso Colombiano de Pediatria, Cali,
Colombia, p. 532.
55
1995. Skin-to-skin contact improves physiologic states of breast-fed low-
birthweight infants. Ped Res 37 (4)Part 2, 103A.
Charpak, N., Figueroa, Z., Ruiz, J.G., & Charpak, Y. (1997). Kangaroo
mother versus traditional care for newborn infants (<2000 grams). A randomized
controlled trial. Pediatric Research, 41(4), Pt. 2, 192A. 382 KC started KC
upon discharge and practiced it 24 hours/day. 364 infants in incubators in
minimal care unit in hospital were compared to KCs at term, 3,6,9, 12 months.
No differences in growth, developmental indices, or in length of breastfeeding
beyond 3 months (at 3 mos, more KC breastfeeding than controls. Also no
difference in infection.
Chwo, Miao-Ju, 2000. Early kangaroo care for 34-35 week preterm infants:
Effects on temperature, weight, behavior, and acuity. Presented at Biennial
Convention of the 12th Biennial International Congress of Infant Studies,
Brighton, England, July 2000. 34 healty preterm infants in TAIWAN were randomly
assigned before first feed. KC was done during BF, controls were clothed and
wrapped and held that way for one hour, three times a day during feedings. KC
had higher TYMPANIC temps, more quiet sleep, more inactive awake, less
drowsiness, less crying. No diff in weight loss or acuity (LOS). PT, RCT, temp,
sleep , wght, length of stay.
Chwo, Miao-Ju, & Huang, Li-Hung (2002). Effects of very early kangaroo
care on infant’s extrauterine adaptation and maternal birth-related fatigue.
Presentation at International Conference on Tradition, Evidence, and Innovations
in Nursing, March 21-23, 2002, Phuket, Thailand. 49 fullterm dyads randomly
assigned to KC (n=24)(60 minutes of KC after newborn care) or control (n=25)
(routine newborn care, no skin-to-skin contact). Temp, HR, SaO2 and Beh. State
and maternal fatigue measured at beginning and every 15 minutes. KC had sig.
Higher Temp (37.30 vs. 37.00 at 60 min), no sig diff in HR, or SaO2 at any time,
no Bradycardia in either grp and KC had more quiet sleep (41%vs. 13.5%) and
alert inactivity (27.6% vs. 2.8%) than controls. Controls had more drowsy and
cyring (38.5 vs. 15.1%) than KC.. KC moms had less fatigue @ 60 min (37.67 vs.
42.36) RCT. Fullterm, temp, HR, SaO2, Brady, State, Fatigue. Delivery KC
56
Dombrowski MAS, Anderson GC. 2001. Salivary cortisol and depression in
postpartum women participating in a study of Kangaroo (skin-to-skin) care with
preterm infants. Paper presented at Midwest Nursing Research Society, Cleveland,
OH, March 2-5, 2001. Salivary cortisol collected on filter paper at 6 hrs
postbirth and twice a day on days 1-5 postbirth. RCT.
Dowling, DA., Anderson, GC, Miller MA. Moran M., Radzyminkink, S., &
Higgins, K. (1999). Maternal Kangaroo Care (Skin-to-Skin) Care in the NICU
Beginning Four Hours Postbirth. Proceedings of 23 Annual Midwest Nursing
Research Society Conference., 4/11/99., p. 82.
Engler, A. & Ludington SM. (1999). Kangaroo care in the United States: A
national survey. J. Investigative Medicine, 47 (2): 168A.
Ferreira, C., & Ludington, S. (1994). Does frequent skin contact improve
respiratory pattern in preemies? Respiratory Care, 39(11): 1061.
Gloppestad, K. 1994. Differences between fathers and mothers initial close
contact with their prematurely born infants. Proceedings of the 7th Biennial
Conference of European Nurse Researchers. “The Contribution of Nursing Research:
Past-Present-Future. Vol. 1 July 306 , 1994, p. 297.
Hales D, Kennell J, Klaus M, Mata L., Sosa R, Urrutia J. 1975. The effect
of early skin-to-skin contact on maternal behavior at twelve hours. Pediatric
Research, 9, 259. 9 Guatemalan mothers gave KC for 45 minutes once episiotomy
repair complete and in recovery room under heat panel and then to nursery til 12
hours old; 10 controls got to see swaddled infant 12 hours later. At 12 hours
postbirth, KC moms did more fondling,kissing, en face looking, looking, and
talking to baby but not more caretaking. RCT FULLTERM Maternal Behavior,
attachment behaviors. Abstract only.
57
Herzenstiel G. 2000. Introduction of KMC in Malawi, East Africa; An
example of successful implementation of KMC in a 2nd/3rd level hospital in a
country without resources. Presentation at 3rd International KMC congress,
Jakarta, Indonesia, Nov. 22-25, 2000. Zomba Gen Hospital cares for 4500
newborns/yr, 20% are Preemies. This is report of how to implement KMC by
building a K ward with 12 beds.
Hsieh, Y-H, & Huang, M-C. 2000. Preliminary study of KC for preterm
infants: Effect on parent-infant relationship. Unknown presentation site.
Write to author at Yu-Hui Hsieh, No. 539, Jong-Shiaw Rd, Chia-Yi City 600,
Taiwan, ROC. 16 parents with KC exerpeince completed 8 item open ended
questionnaire to express experience with KC. Kc decreases parents’ anxiety,
increases self confidence in caring for infants, and promotes relationship. See
manuscript in J. Nursing Research (china) listed under foreign languages for
full report.
Ludington, S.M. 2000. EEG-basd sleep before and during Kangaroo care.
Presentation at the 12th Biennial meeting of the International Congress of Infant
Studies, Brighton, England, July 2000. Data from 10 subjects shows that quiet
sleep doubles, active sleep drops, delta brushes increase and indeterminate
sleep does not change. Intensification of sleep is seen in KC.
58
Midwest Nursing Research Society meeting, Chicago, Il. March. Preterm, RCT
Ludington, S.M., Swinth, J., & Nguyen, N. (1996). Skin contact compared
to incubators for prevention of heat loss in preterm infants. Infant Behavior
and Development, 19 (Special ICIS issue), p.
Ludington-Hoe, S.M., Anderson, G.C., Rey, H., Argote, L.A., & Hosseini, B.
(1992). Transitional physiology and state behavior of Colombian preterm infants
in skin-to-skin (Kangaroo) care and open-air cribs beginning in the delivery
room. Infant Behavior and Development, 15 (Special ICIS issue), 537.
Numprasert, W. 1996. Kangaroo care for LBW infants and the bonding and
59
adaptation roles of mothers. Masters Thesis abstract. First 40 moms assigned to
KC in first two days postpartum; second 40 moms got routine care. Infant
bonding and maternal role adaptation higher in KC group. Bonding, Maternal Role
Adapt.
Rojas, M.A., Kaplan, M., Mayes, L., Sherwont, E., Quevedo, M.E.,
Ehrenkranz, R. (1998). Extended traditional holding (*TH) and skin-to-skin care
(SSC) for newborn infants < 1500 GRAMS. A randomized controlled trial. Results
of an interim analysis.Ped Res 43(4), Part 2, 191A. This team at Yale
University had parents hold 45 infants up to 4hrs/day, twice a day until infant
was 2000 gms or discharged. TH was wrapped and held supine; SSC was wearing only
diaper, prone at 45° incline. No sig diff in daily caloric intake, rate of wgt
gain, or incidence of positive cultures (even tho TH had 6 cases of sepsis; KC
had 3 cases of sepsis). No deaths in either group. RCT with M & SD, WGT,
Calories, Sepsis, mortality.
60
Serenius E, Lindberg I, & Stuge E. (1999). Early Kangaroo Care in sick
very premature infants. Ped Res, 45(4), 224A, Part 2. Same as Tornhage et al.,
1999 study.
Shiao S. 1998. Nursing care for low birthweight infants: Kangaroo Care.
Paper presented at the Health Promotion for Thai Children Conference, Bangkok,
Thailand. KC has been in Thailand since 1994. 34 infants given KC at 7 days
age (about 34 wks) and no hypothermia, no apnea, earlier discharge. Grwth & Dev.
WNL.Developmental outcomes. Randomization unknown.
Swinth JY, Anderson GC, Hadeed AJ. 2003. Kangaroo (skin-to-skin) care with
a preterm infant before, during, and after mechanical ventilation. Neonatal
Network, 22 (6), 33-38. Case study of 33 wk GA infant who required
supplemental O2 at 2 hrs postbirth and with no improvement started KC at 18 hrs
of age for 1.25 hours, and then two hours later for another3.5 hrs. AT 45 hours
of age infant was intubated and then got more KC before extubation at 90 hrs
postbirth. KC given before, during and after ventilation and it assisted in
recovery from respiratory distress, fostered maternal relaxation, and minimized
maternal stress. PT, VENT KC, Resp. distress, Maternal relaxation, Maternal
stress.SaO2, FiO2
Swinth, J.Y. & Ludington-Hoe, S.M. 1998. Kangaroo Mother Care during
Phototherapy: Effect on Bilirubin Profile. Infant Behavior and Development,
vol. 21 Special ICIS issue, April 1998, p. 708.
Syfrett, E.B., Anderson, G.C., Behnke, M., & Neu, J. (1993). Early and
virtually continuous kangaroo care for lower-risk preterm infants: Effect on
temperature, breastfeeding, supplmentation, and weight. Proceedings of the
Biennial Conference of the Council of Nurse Researchers, Washington, D.C.:
American Nurses Association, November 1993.
Syfrett, E.B., Anderson, G.C., Behnke, M. & Neu, J.(1993) Kangaroo care
for 34-38 week infants beginning in the delivery room: Four infants and what we
learned. Proceedings of the 8th Annual Nursing Conference in
Neonatology.Kangaroo Care: Changing Times and Emerging Trends. Boston, MA:
61
Brigham and Women's Hospital, June 13, 1993.
Syfrett EB, Anderson GC, Behnke M, Neu J, Hilliard ME. (1996). Very early
kangaroo care beginning at birth for healthy preterm infants and mothers who
chose to breastfeed: Effect on outcomes. Paper presented at the workshop on the
kangaroo mother methods for low birth weight infants. World Health Organization.
Maternal-child health collaborating center, Trieste, Italy. This is the same as
the 1993 abstracts, and no paper was published of this report.
Tessier R., Cristo M, Velez S., deC, Zita Figueroa, Charpak Y, Ruiz-Pelaez
JG, Charpak N. (1998). Kangaroo mother care (KMC): A method of protecting high
risk premature infants against development delay. Pediatric Research 43(4),
Supplement 2 April, 1998. Abstract # 1347. pg. 230. KMC and mental and physical
growth at 6 & 12 months. N=553 (280 in KC once adapted to extrauterine life and
able to breastfeed and gets kangaroo nutrition. Carried in KC at home; 273 in
traditional care in incubator, no KC) infants <2001 grams. Results #1: KMC
infants had more stimulating environment being carried in KMC. #2: KMC have
higher IQ than TC.RCT, development
Tessier, R., Cristo, M., Velez, S., Giron, M., Figueroa de Calume, Z.,
Ruiz-Palaez, J.G., Charpak, Y., Charpak, N. (1998). Kangaroo Mother Care and the
Bonding Hypothesis. Pediatrics, 102(2): 390-391.
Wilkerson SA, & Crout L.(1998) Kangaroo care with very premature infants.
Midwest Nursing Research Society, 22nd Annual Research Conference, April 1998,
p. A218. Infants were able to tolerate KC even with intubation and Ivs. All
rested for longer periods of time after KC.
All abstracts from the 2nd WHO KC Network meeting in Bogota, Nov. 1998 are
now available on the Kangaroo care website at Javeriana listed under websites on
this bib at the end.
62
(Tactile interventions) and Chapter 15 (Caregiving and the environment)you’ll
find KC. KC is considered an individualized developmental family centered care
intervention.
Merenstein G.B., Gardner, S.L. (2002). Handbook of Neonatal Intensive
Care. 5th Edition. In Chapter 12: Pain and Pain Relief on page 210 “skin-to-skin
contact (Kangaroo Care) between mothers and healthy newborns during heelstick is
a potent analgesic intervention that reduces cry (by 82%), grimace (by 65%), and
heart rate.” And in Chapter 13, The Neonate and the Environment: Impact on
Development by Gardner SL and Goldson E. There is a whole paragraph and Box 13-3
called “Benefits of Kangaroo Care/Skin-to-skin contact” that lists parental and
numerous neonatal benefits of KC.
Verklan TM, Walden M (Eds.) 2004. Core Curriculum for Neonatal Intensive
Care Nursing. St. Louis, MO: Elsevier. On page 68 it states “13. Provide
Kangaroo Care (skin-to-skin) time if mother desires” as a nursing intervention
for mothers with perinatal substance abuse. On page 243-244 it says that
“therapeutic touch may include: Kangaroo Care,or skin-to-skin holding. NICU
parents performskin-to-skin contact with their diaper-clad infant who is resting
prone and semi-upright against the mother or father’s barechest covered by a
blanket. Warmth, rise and fall of the chest, tactile sensation of skin-to-skin,
smell of parents, and maternal breast, and the parent’s tender, quiet,
vocalizations, breathing sounds, and heartbeat comprise the sensory modalities
stimulated during KC. This provides low-intensity stimulation to the earlier
developing senses and is most appropriate for the nicu infant. It has
controversial use with extremely premature infants during acute illness phase.
Maintaining physiologic and behavioral stability during transfer from bed to
parent and back remains a challenge.” It lists positive physiologic benefits
(pg. 243) and positive developmental benefits on page 244. Review, PT,Substance
Abuse,
VIDEOS/SLIDE PRESENTATIONS
VIDEOS
Armstrong, H., & Kamau, M. (1986). Feeding low birthweight babies. Co-
produced by IBFAN and UNICEF (ESARO). Videotape available from Tony Tirado,
UNICEF, Division of Information, RTFSH9-F, 3 UN Plaza, N.Y., NY 10017
63
Gloppestad, K. (1987). From Separation to Closeness: Parent's
Experiences with Closeness. Available in English or Norwegian from Kari
Gloppestad, Dept. of Pediatrics, National Hospital University of Oslo,
Pilestredet 32, 0027 Oslo 1, Norway (25 minutes) $140.00 Shows parents doing KC
with ventilated infants long before anyone thought this was possible.
VENTILATED
INJOY VIDEOS. 1999. Breastfeeding and Kangaroo Care for your NICU Baby.
Order #BP501. Made in 1999, Cost is $129.95. Lasts 8 minutes. InJoy Videos,
1435 Yarmouth, Suite 102-C, Boulder, CO 80304. 303-447-2082 or 800-326-2082.
Rice, Ruth D. 1998. Kangaroo Care. Available from Ruth D. Rice, Ph.D.,
6455 Meadow Rd., Dallas, TX 75230, (214) 363-7244.
64
Drosten-Brooks. F. 1993 in MCN on page 253 has elements of a protocol with
any infant, not just those ventilated.
Evanston Hospital, 2650 Ridge Ave., Evanston, Ill. 60201. Protocol lists
criteria,implementation, guidelines for transfer, including transfer of
intubated infant, and documentation.Mechanically ventilated.
Gale, G., & VandenBerg, M.A. (1998). Kangaroo Care. Neonatal Network, 17
(5): 69-71. Lists a protocol for KC with preterm infants.
Nyqvist,KH 2004. How can Kangaroo mother care and high technology care be
compatible? J Human Lactation, 20 (1), 72-75. Includes the policy in use at
Children’s Hospital in Uppsala, Sweden.
The JOHNS HOPKINS HOSPITAL protocol can be obtained from Dr. Ludington, as
can the Univ.of Maryland Medical System protocol.
Page, J. 1995. Kangaroo care; Enhancing infant and parent well-being in
the NICU. The Perinatal Newsletter, 12(1), Jan/Mar 1995. Has protocol with
preterm infants that uses standing transfer method.
St. Agnes Medical Center, Protocol for Kangaroo Care. Write to Ms. Sheri
Fogarty, Neonatal Intensive Care Unit Nurse Educator, St. Agnes Medical Center,
900 Caton Ave., Baltimore, MD 21229 (410) 368-2630.
St. Joseph’s Hospital, PO Box 4227, Tampa, FLA 33677-4227 has “Protocol:
Kangaroo Care” with assessment, reportable conditions, safety, care, consult,
patient instruction and documentation guidelines included.
St. Mary’s Hospital Med Ctr., Infant ICU,707 S. Mills St. Madison,
Wisconsin 53715-0450. Includes list of inclusion and exclusion criteria.
St. Mary’s Hospital, 901 45th Street, West Palm Beach, FL. 33416-4620.
Includes purpose, description, procedure, parent readiness, implementation, and
documentation.
Sarasota Memorial Hospital NICU, Ms. Deborah Hanson, RNC, 1700 S. Tamiani
Terrace, Sarasota, FL 34239-3555
York Health System. Kangaroo Care Policy and Procedure. York Health
System. 1001 S. George Street, York, PA 17405, (717) 851-2199.
PAMPHLETS
65
Breitbach, K. (1993, 2004) What is Kangaroo Care? University of Iowa
Hospitals and Clinics pamphlet. Content is History of KC, Benefits of KC (a
list), When can Baby start KC? How to Get Started. Available from
www.vh.org/pediatric/patient/pediatrics/kanga/
Hoover, Kay. Post birth care impacts breastfeeding. Has lovely pictures
of how to implement Kangaroo Care. Compiled by Kay Hoover, Med. IBCLC,
Philadelphia Dept. of Public Health, Office of Maternal and Child Health, 500
So. Broad Street, 2nd Floor, Philadelphia, PA 19146 (215) 685-6825.
Promina Cobb Hospital Special Care Nursery, 3950 Austell Road, Austell,
GA 30001. (404) 732-4414 Fa: (404) 732-4421. Ms. Pat Beckett, RNC, Dept.
Manager of Special Care Nursery.
Larimer, Krisanne 1401 Washington St., #18, Canon City, CO 81212. Has
wonderful pamphlet for parents, done in part by parents of formal premies, and
it tells what KC is all about and how to do it with ventilator infants and all
others, even those of OSCILLATING Ventilation.
Related Articles
Ali Z, & Lowry M. 1981. Early maternal child contact: Effects on later
behavior. Dev. Med Child Neuro 23, 337-345. Not a KC article,but good content
on early contact’s influence on later development.
66
Jarvella R, Navojorsky BJ, Klaus MH 1975, Mother-to-child speech at 2 years –
effects of early postnatal contact. Behavioral Pediatrics 86, 141-144).
FullTerm, RCT, Maternal Behav RCT
Liu D., Diorio J, Day JC, Francis DD, Meaney M. (2000). Maternal care,
hippocampal synaptogenesis and cognitive development in rats. Nature
Neuroscience, 3(8): 799-806. A direct relationship between maternal behavior and
hippocampal devel is present: rat pups who had hi levels of licking, grooming
and nursing showed increased expression of NMDA receptor subunit and brain-
derived neurotrophic fact BDNF mRNA, increased cholinergic innervation of the
hippocampus and enhanced spatial learning and memory.
Olausson H, Lamarre Y., Backlund H, Morin C, Walllin BG, Starch G, Ekholm S, Strigo I, Worsley K, Vallbo
AB, Bushnell MC. 2002. Unmyelinated tactile afferents signal touch and project to insular cortex. Nature Neuroscience 5
(9), 900-904. Human hairy skin has dual tactile innervation: fast-conducting myelinated afferent fibers, and slow
conducting unmyelinated (C) afferents that respond to light touch, creating the sensation of pleasant touch. Thesefibers
activate the insular cortex (LIMBIC system), but not the somatosensory areas S1 and S2. C touch afferents is a system
for limbic touch that may underlie emotional,hormonal, and affiliative responses to caress-like, skin-to-skin contact
(emotional aspects of touch). Gentle, caressing skin-to-skin touch , especially on arm and in palms, is pleasant
experience.
Meier, P. (1988). Bottle and breastfeeding: Effects on transcutaneous oxygen pressure and temperature in
preterm infants. Nursing Resesarch, 37(1), 36-41.
Meier, P. & Anderson, G. (1987). Responses of small preterm infants to bottle and breastfeeding. Maternal and
Child Nursing, 12, 97-104.
Meier, P., Engstrom, L.L., Mangurten, H.H., Estrada, E., Zimmerman, B., & Kopparthi, R. (1993). A model to
provide breastfeeding support services in the NICU. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 22, 338-
347.
Co-sleeping/Co-bedding
______, 1995. A sister’s helping hand. Reader’s Digest, condensed from Sheehan, N, Worcester
Telegram and Gazette Nov. 18, 1995.
______. 1997. Cosleeping (bedsharing) among infants and toddlers. J Devel Behav Pediatr 18 (6), 408-
412.
American Academy of Pediatrics, Task Force on Infant Positioning and SIDS. 1997. Does bed sharing
affect the risk of SIDS? Pediatr 100 (2), 272.
Byers JF, Yovaish W, Lowman LB, Francis JD. 2003. Co-bedding versus single bedding premature
multiple-gestation infants in incubators. J. Obstetric, Gynecologic & Neonatal Nursing, 32 (3), 340-347.
Physiologic stability and behavioral effects of cobedding: RCT (16 CB; 21 controls), Sig diff in daily wgt, feeding
amount, high activity HR. No diff in parent state anxiety, mat attachment, parental satisfaction, infant sleep-wake
synchronicity, stress cues. Demonstrates SAFETY of CB, but no clinical improvement in infant or parent
outcomes. Recommends that co-bedding be used. RCT, safety, physiology, sleep wake states between infants.
Epstein R, Here P, Tzischinsky O, Lavie P. 1997. Changing from communcal to familial sleep
arrangement in the Kibbutz: effects on sleep quality. Sleep 20 (5), 334-339.
Hanks CC, Rebelsky FB. 1977. Mommy and the midnight visitor: A study of occasional cosleeping.
Psychiatry 40, 277-280.
67
Kaplan SL, Poznanski E. 1974. Child psychiatric patients who share abed with a parent. J Am Acad Child
Psychiatr 2, 344-356.
Lozoff B, Wolf AW, Davis NS. 1984. Cosleeping in urban families with young children in the United
States. Pediatr 74, 171-182.
Lutes LM, Altimier LB. 1999. Co-bedding multiple premature infants. J. Investigative Med 47 (2), 168A..
McKenna JJ. 1993. Cosleeping. In Carskadon MA (Ed). Encyclopedia of sleep and dreaming. NY, NY:
Macmillan, pp. 145-148.
McKenna JJ.YEAR? SIDS in cross cultural perspective: Is infant-parent co-sleeping protective? Med
Anthrop 10, 9-53.
McKenna JJ. 2003. Mother-infant co-sleeping with breastfeeding: adaptive behaviors worth fighting for.
Breastfeeding Abstracts 23 (1), 3-5.
McKenna J, Mosko S. 1994. Sleep and arousal, synchrony and independence among mothers and infants
sleeping apart and together (same bed): An experiment in evolutionary medicine. Acta Paediatr Scand Suppl 397,
94-102.
McKenna, J., Thomas, E., Anders, T., Sadeh, A., Schnectman, V. & Glotzbach, S. (1993). Infant-parent co-
sleeping in an evolutionary perspective: Implications for understanding infant sleep development and the sudden infant
death syndrome. Sleep, 16, 263-282.
McKenna J, Mosko S, Richard C et al., 1994. Mutual behavioraland physiological influences among solitary
and cosleeping mother-infant pairs; Implications for SIDS. Early Hum Dev 38, 182-201.
McKenna, J.J., Mosko, S.S., & Richard, C.A. (1997). Bedsharing promotes breastfeeding. Pediatrics, 100(2):
214-219.
McKenna J, Mosko S, Richard C. (1999). Breast feeding and mother-infant cosleeping in relation to SIDS
prevention. In Trevathan W, Smith N, McKenna J. (Eds.). Evolutionary Medicine. NY, Ny: Oxford Univ Press, 53-74.
Mosko S, Richard C, McKenna J. 1995. Infant sleep and arousals during bedsharing. Ped Pulmonol 20, 340.
Mosko S, Richard C, McKenna J, Drummond S. 1997. Infant arousals in the bed-sharing environment:
Implications for infant sleep development and SIDS. Pediatr 100, 841-849.
Mosko S, Richard C, McKenna J. 1996. Infant sleep architecture during bedsharing and possible implications
for SIDS. Sleep 19, 677-684.
Mosko S, Richard C, McKenna J. 1997. Maternal sleep and arousals during bedsharing with infants. Sleep, 20
(2), 142-150.
Nyqvist KH, Lutes LM (1998). Co-bedding twins: A developmentally supportive care strategy.
J Obstetric, Gynecologic Neonatal Nursing, 27, 450-456.
68
Richard CA, Mosko SS. 2004. Mother-infant bedsharing is associated with an increase in infant heart rate.
Sleep. 27(3), 507-511. HR recorded in 15 infants in bed sharing night vs solitary night. 8 infants routinely bedshared
with mother the other 7 slept alone. Fullterm infants at 11-15 weeks old. HR is lower when solitary sleeping. Infant
temperature was significantly the cause (by regression analysis), and HRV was higher during solitary sleeping than bed
sharing in QS and AS and REM sleep. Increased sympathetic activity in states 3,4 (drowsy and awake) and in REM
sleep due to temperature. Sensory differences account for some physiologic differences between infant sleep in the two
conditions. FT. HRV, Temp, HR
Schacter FF, Fuchs ML, Bijur PE, Stone RK. 1989. Cosleeping and sleep problems in Hispanic-American
urban young children. Pediatrics 84, 522-530.
Swinth JS, Nelson LE, Hadeed A, Anderson GC. 2000. Shared kangaroo care for triplets. MCN, Am J
Maternal Child Nursing, 25 (4), 214-216. Speaks to co-bedding on page 216 and states that KC is the ultimate co-
bedding. Case study.
Touch SM, Epstein ML, Pohl CA, Greenspan JS. 2002. The impact of co-bedding on sleep patterns in preterm
twins. Clinical Pediatrics (Phila), 41(6), 425-431. 12 hrs preCB and 12 hrs of CB cardiorespiratory recording. 22 CB
infants (11 sets of twins) at 31.8wks GA studied at 33.5 wks Corrected age. # of central apnea decreased (57 pre CB, 18
CB) with CB, no diff in Bradys, PB, No temp instability, no increase in O2 requirements during CB. Decrease in central
apnea probably due to more frequent arousal by twin. RCT, Apnea,B,PB, temp, oxygen requirements.
Willinger M, Ko C-W, Hoffman HJ, Kessler RC, Corwin MJ. 2003. Trends in infant bed sharing in the United
States, 1993-2000. Arch Pediatr Adolesc Med 157 (1), 43-49.
REFERENCE TO KANGAROO CARE
______, 1995. Appropriate technologies can help make motherhood safer.
Safe Mother, 18, 4-8. Review of available technologies and KC is one that is
identified as keeping the infant warm against the mother’s skin and is
recommended. Review. Temperature.
Anand, KJS, & Scalzo, FM. (2000). Can adverse neonatal experiences alter
brain development and subsequent behavior? Biol Neonate, 77, 69-82. Repetitive
pain, sepsis, maternal separation in rodents and other species have been
associated with multiple alterations in the adult rat brain. He proposes that
NMDA receptor activity from maternal separation leads to increased apoptosis in
multiple areas of the immature brain, and exposure to repetitive pain may cause
excessive NMDA activation resulting in excitotoxic damage to developing neurons.
On pg. 72 “kangaroo care may provide additional physiological and
neurodevelopmental benefits in critically ill neonates.” Pg 73 “Improved
clinical and neuromaturational outcomes have resulted from developmentally
supportive nursing care and “KC” in preterm infants” and cites Ludington and
Swinth, 1996.
Anderson, G.C. (1977). The mother and her newborn: Mutual caregivers.
Journal of Obstetric, Gynecologic, and Neonatal Nursing, Sept/Oct. , 50-57.
69
Aucott S., Donohue PK, Atkins E., Allen MC. 2002. Neurodevelopmental care
in the NICU. Mental Retardation and Developmental Disabilities Research Reviews,
8(4), 298-308.On page 304 are 1.33 columns of KC, mostly citing the Conde-
Agudelo 2002 Cochrane Review. Says that parent disenfranchisement is biggest
NICU problem, and KC corrects this on page 304. There is a whole column devoted
to KC history (very brief) and outcomes of the 2002 Conde-Agudelo meta-analysis.
Review
Bowie BH, Hall RB, Faulkner J, Anderson B. 2003. Single-room infant care:
future trends in special care nursery planning and design. Neonatal Network 22
(4), 27-34. On page 28 it states: “Also in the early 1990s several articles
were published documenting the benefits of skin-to-skin(kangaroo) care, andfor
the first time in many nurseries, parents were encouraged to participate in the
care of their preterm infant.” And “Privacy became limited;movable screens were
used to give a sense of privacy for breastfeeding mothers and for parents
providing Kangaroo Care.” They have drawing of KC in a single-room on page 31.
PT. Not KC study per se.
Drummond T. 1998. Touch early and often. Time July 27, 1998, p. 54-55.
Speaks to Dr. Tiffany Fields work with massaging preterm infants and their
improvement in weight gain.
Epstein, R., Herer, P, Tzischinsky, O., & Lavie, P. (1997). Changing from
communal to familial sleep arrangement in the Kibbutz Effects on sleep quality.
Sleep, 20(5): 334-339. Better quality sleep when they change from communal
sleep to sleeping with families.Communal sleep group slept worse than children
examined during Golf War. Improvement in sleep quality is due to children's
increased sense of security when sleeping with their families.
70
thermoneutral range while the infants were receiving KC. They concluded that KC
was conducive to recovery from birth fatigue in 34- to 36- week preterm infants.
Chwo et al (2002) randomly assigned preterm infants to groups, those receiving
KC and those not receiving KC, and found that infants receiving KC had higher
mean tympanic temperature, more quiet sleep, and less crying than those who did
not recive KC. In one survey of 537 NICUs in the United States (Engler et al.,
2002), 82% of the NICUs were practicing KC. Enlger found that nurses perceived
some barriers to its use, such as has lack of scientific knowledge about whether
KC care was appropriate for all neonates, as well as some nurses’ concerns about
infant safety.” Then it goes on for another whole paragraph relating Gene
Anderson’s case studies, saying KC has positive parental and infant outcomes
with a depressed mother, when begun within 4 hours of birth in an NICU, for
twins and adolescent parents, for adoptive parents, for triplets and a mom with
pre-eclampsia.
Hill ST, Shronk LK. 1979. The effect of early parent-infant contact on
newborn body temperature. JOGN Nursing Sept/Oct. 1979, 287-290. This was study
comparing 50 dried, wrapped infants in parental arms to 50 dried, wrapped infant
under radiant warmer just after birth. No differences in temperatures.
Kattwinkel, J., Brooks, J., Keenan, M.E., & Malloy, M. (1997). Task force
on infant positioning and SIDS: Does bed sharing affect the risk of SIDS?
Pediatrics, 100(2): 272.
71
Meier P, Engstrom JL, Mingoletti SS, Miracle DJ, & Kiesling S. 2004. The
Rush Mothers’ Milk Club: Breastfeeding interventions for mothers with very-low-
birth-weight infants. J.Obstet Gynecol Neonatal Nursing 33 (2), 164-174. On
page 166: “Evidency based nonpharmacologic techniques to help preent low milk
volume, such as pumping at the infant’s bedside, skin-to-skin care, and suckling
at the emptied breast, are routinely employed by bedside nurses. PT,
implementation evaluation, BF.
Mosko, S.S., Richard, C., & McKenna, J. (1997). Maternal sleep and
arousal during bedsharing with infants. Sleep, 20(2): 142-150.
Murdoch, D.R., & Darlow, B.A. (1984). Handling during neonatal intensive
care. Archives of Diseases in Childhood,59, 957-961.
Schanler, RJ. (1995). Suitability of Human Milk for LBW Infants. Clinics
in Perinatology, 22(1): 207-222. A nursery policy that advocates early skin-
to-skin contact between LBW infant and mother may improve host defense of the
infants”(211). “Guidelines for feeding LBW infants must include skin-to-skin
contact to promote development of maternal antibodies”(217). Premise is that
baby’s skin picks up NICU pathogens and when in contact with mom’s skin passes
them to her. She then makes antibodies, “it is possible that the mother may
make specific IGA antibodies against nosocomial pathogens in the infant’s
environment and pass them along to the infant in her breastmilk”.
72
role of cholescystokinin and opioids. Peptides, 24 (5), 779-788. In rats and
humans, maternal proximity enables infant to smell maternal odor. Mat odor
activates cholecystokinin and opioids (neuropeptides) that help infant learn
that this is feeding time and help infant regulate his emotions, particularly
stress reactivity as opioids are endogenous narcotics that calm the infant and
reduces state level. KC is mentioned as it helps infants self-regulate and
moderate effects of some risk factors. Thus,KC is probably quieting due to
opioid secretion.
Whitby C., de Cates, C.R., Roberton, NRC (1982). Infants weighing 1.8-2.5
kg: Should they be cared for in neonatal units or postnatal wards? The Lancet,
1 (Feb. 6, 1982), pp 322-325. Infants without problems do well in cot care in
regular postnatal wards, similar to the very early Kangaroo Care studies.
Wingert P, & Noonan D. 2000. New hope for Preemies. Newsweek Special
Issue, Fall/Winter 2000, , p. 51-52. Has two pixs of KC.
______. (1998). Infant Care. Redbook, Oct. 1998 issue. Refers to the
University of Maryland as a resource site for Kangaroo Care information. The
article has a few paragraphs of KC information.
73
jumpstart. Ooh Baby! Spring 2002, p. 18-19. Quotes Dr. Ludington’s book and
gives good input for parents to think about KC in advance of preterm birth.
Di Caelers. 1999. Kangaroo Care Saves Little Lives. The Argus, April 6th,
1999. Lay report of KC practice at Groote Schuur Hospital in Cape Town, South
Africa.
Fantin L. 1997. Midwives told kangaroo care for humans too: Professor
describes the benefits of cuddling premature infants. The Salt Lake Tribune,
Sunday March 9, 1997. Reports on Dr. Ludington's presentation about Kangaroo
Care.
Fischman, J. (1999). Taking a Cue from Kangaroos. US News & World Report.
June 7, 1999, pg.66 This is an easy to read, one page report of KC in USA.
Mettler, L. 2001. Kangaroo Care. Help for Preterm Infants and Hope for
their Parents. Baby Years, Sept. 2001. This is a general article with many
references to Dr. Ludington and her book and how to give KC to premature
infants. Copy available from lynmaddox@mindspring.com
Norton, D. (1995). Kangaroo love for preemie babies. Living and Loving,
September 1995. 133-135.
Smyth, A. (1992). Kangaroos know that cuddles work best. The Independent.
Tuesday, August 18, 1992, pg. 11.
74
intensive care. UCLA Nursing, 6(1), 10-11.
Notable Presentations
de Leon, F. (1992). "The kangaroo care method: Application and use."
Presentation at International Well Start, 8/20/92, San Diego. LOOK FOR HIS
MANUSCRIPT UNDER MULET et al., 1992.
Bergman, Nils. Family physician in South Africa who did a study in Zimbabwe and
now runs a maternity hospital where KC is practiced regularly for all fullterm
newborns.
Best, Paige. Fall 2001 Doctoral student at Johns Hopkins University School of
Public Health. She is studying infant care practices in Bangladesh, identifying
how rural mothers recognize prematurity and then how they care for them to
prevent hypothermia. Second phase of study will be to teach practices to avoid
hypothermia, including KC and use of tempadots (if baby is warm enough, the
tempadot shows a smiley face)to insure warmth. Will try to teach KC to them
too. pbest@jhsph.edu
Ann Bigelow. July 2002 got approval to study maternal infant interaction in the
newborn period, 1 month, 2, a nd 3 months postbirth. KC grp will KC 6hrs/day
for 1st month beginning KC within 1 hour of birth. Salivary cortisol at birth
and 1 month and measuring developmental outcomes. Contact her at
abigelow@stfx.ca
Joy Browne, R.N. Ph.D.
Children’s Hospital of Denver
Email: Browne.Joy@tchden.org (Browne, Joy)
They conducted research on the physiologic disorganization associated with
transfer into and out of kangaroo care (Neu et al., Nursing Research, August
2000).
Cattaneo, Adriano.
75
Unit for Health Services Research and International Cooperation
Instituto per l’Infanzia, Vil dell’Istria 65/1, 34137 Trieste, Italy
Phone; +39 040 3785 236; Fax: +39 040 3785 402, Email: cattaneo@burlo.trieste.it
Chia, Pauline (Summer and Fall 2000- masters student at The University Lodge
(Room B101) La Trobe University, Bundoora, 3083, Australia. Studying nurses
attitudes toward KC. Home address is 1 Brockhampton Drive, Singapore 559095.
Email: chiasioktin@hotmail.com
Cooper, Sharla, RNC, NNP, MSN. 3247 Woodview Rd. S.W. Roanoke, VA 24018. Email
is scooper@runet.edu Home; 540-772-4456 wk: 540-981-7103. Working on Nursing
Doctoral dissertation called KC at the breast for preterm infants during GAVAGE
FEEDING: Effect on infant physiology and maternal lactation. Began work June
1999.
DeMarco, Patrice
79 Beach Rd.
Shelburne, VT 05482
In Dec. 2000 starting a study of KC on serum values (glucose etc.) in
fullterm neonates.
76
more subjects.
Teresa Farley, MSN, CPNP
Developmental Pediatric services
8210 Walnut Hill Lane, suite 604
Presbyterian Hospital
Dallas Texas 75231
(214) 345-4156
Fax: 214-696-3014
In 1995 started a study of HR, RR, SaO2 and temperature during transfer
into and out of KC and during KC and rest periods with ventilated preterm
infants.
Hanson, Deborah email: nphanson@hotmail.com. Began in June 1999 studying end tidal
CO2, tidal volume and minute volume of KC vs. incubator condition in ventilated
infants. Also has experience with KC for dying babies.
C. Celeste Johnston
Assoc. Professor, School of Nursing
McGill University
3506 University St.
Montreal QC H2X 3PY
phone: (514) 398-4157
Fax: (514) 398-8455
email:' md28@musica.mcgill.ca
Doing research on 15 minutes of Kangaroo Care on infant pain using the
Premature Infant Pain Profile, published in PAIN, Nov. 1996. Did 74 infants
with KC, Archives of Diseases in Childhood Fetal and Neonatal Edition, 2003
published that KC reduced pain. 2004 now examining KC in another study with an
animal model too.
77
Juhyun Lee
Doctoral Student, School of Nursing Johns Hopkins University
525 N. Wolfe Street, Baltimore, MD 21205-2110
(410) 467-4477; email is jleej@jhmi.edu
Fall 2000 she is starting study of KC’s efficacy in increasing
breastfeeding in preterm population, and changes in quantity and quality of
milk, and immunological markers.
Madalynn Neu, RN, Ph.D., / April 2002 received K award to study 3 seession over
an 8-wk period of KC holding vs. swaddled holding and measuring vagal tone and
salivary cortisol levels of mothers and babies during the three sessions.
78
Franche: 613-737-8651
Premature infant's physiologic response (50 ventilated preterms- looking
at HR, RR, SaO2, and vent settings) and Maternal stress . Infant stress measured
by physiologic homeostasis.
Vicki Pearce. 200 Joe Westbury Mews Dr. Summerville, So. Carolina 29485 ( 843),
871-3680. Doing a study to determine if NICU babies who get KC stay less long
than those do not get KC. Starting in Feb. 2000.
Dr. Gherardo Rapisardi – does work in Italy with Dr. Pignotti. Can be reached at
gherapi@dada.it
Kathryn Roberts, R.N., Ph.D.
Professor of Nursing, School of HECS, Faculty of SITE
Northern Territory University
Darwin, Northern Territory, Australia 0909
Office: (089) 46-6071
Fax: (089) 46-6595 email: kay.roberts@ntu.edu.au
Studying maternal and infant outcomes of KC. Published in Neonatal
Network, June 2000, vol. 19 #4, 31-35.
Cindy Roller, R.N., MSN. Doctoral student of Gene Anderson’s at Case Western
Reserve who was NRSA funded in Fall 1997 for phenomenology study of the meaning
of Kangaroo Care to teenage mothers.
Shandler, Richard, Nancy Hurst and Chantelle Lau. Have just in 1998 completed
an NIH trial of effect of skin-to-skin contact on maternal milk production.
See Hurst publication in 1997. Working at Texas Children’s Hospital,
Fax for Ms. Nancy Hurst: 713-770-3633.
Shiau, SH. Randomized controlled trial of Kangaroo care with FULLTERM infants.
Effects on maternal anxiety, breastmilk maturation, breast engorgement, and
79
breastfeeding status.
Sandra Smith, University of Utah. email: SLeeSmith@msn.com. Doing a study
looking at RR, SaO2, FiO2 and heart rate variability of ventilated preterm
infants before, during, and after Kangaroo Care. Dissertation finished in spring
1999- expect results soon. Early indications are that KC is infant temperature
rises and that SaO2 might fall. Study was finished June 1999 and is being
reported on Feb. 16, 2000 in Salt Lake city.
Amy Wallig NNP MS, Kathy Leef RNC MS, Susan Imam NNP MS, and Robert Locke DO
Medical Center of Delaware
4755 Ogletown-Stanton Road
Newark, DE 19718
Amy Wallig phone:302-733-2396
Susan Imam phone: 302-733-4387 Page Op:302-733-1900 beeper 2431
This Medical Center of Delaware is a complete NIDCAP unit with several NIDCAP
certified staff RNs and they are doing a study of ventilated KMC with a 15
minute pretest, KMC, 15 minute postest of non-invasive pulmonary function
testing: SaO2,HR, RR, temp, resistance, compliance, pCO2, pO2. Length of KMC
unknown. Study was up and running with 4-5 ventilated preterms at any time in
their nursery in Fall 1997.
Terry Zeilinger doing data collection of age, wgt, Fi02 and Sa02 before and
during KC, along with length of session and skin temp range. Martin Luther
Hospital-Anaheim, 1830 W. Romney Dr., Anaheim, CA 92801-1854.
OTHER NOTABLES IN KANGAROO CARE WORK
Christensson, Kyllike NMTD.Dr. Med. Sc. Karolinska Instituet, Dept. of
International Health and Social Medicine, S-171 77 Stockholm, Sweden Phone +46
6 728 77 88; Fax: +46 8 31 15 90; email: Kyllike.Christenss@Phs.Ki.sc
Fundacion Canguro, Carrera 7 No.46-20, Apto. 2001, Bogota, Colombia.
Telephone: +57 1 221-5572; email: herchar5@colomsat.net.co
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1998. BBC. “Kangaroo Care Counters the Cold.” This is a summary of
Christensson’s 1998 article in the LANCET.
http://news.bbc.co.uk/hi/english/newsid_184000/184480.stm
2000 Bergman, Nils. “Charge for the future of KC: A public health imperative.”
Available at http://kangaroo.javeriana.edu.co/abstract42.htm. This is a report of his
presentation at the First International Kangaroo Care Conference held Oct. 23-
25, 1998 in Baltimore, MD.
2003 Bergman, Nils. Kangaroo Mother Care website, listing his tour dates,
the KMC Shop with videos, postcards, Kangacarrier Shirts for sake, and
reference list. Go to www.kangaroomothercare.com
2004
Hospitals with Seasoned, Active Programs of KC
WASHINGTON
Kadlec Medical Center, 333 Swift Ave., Richland WA 99352
RN: Mrs. Joan Swinth MD: Anthony J. Hadeed
PENNSYLVANIA
Thomas Jefferson University
NICU: (215)-955-8346
MARYLAND
Anne Arundel Medical Center
-Soothies Avilable through Puronyx, 990 Park Center Drive, Suite E.,
Vista CA 92083. 800-944-4006 or 760-597-1460, Fax: 760-597-1466,
www.puronyx.com
Carrying Devices-
Nurtured by Me, Ellen Shatzkin, 53 Beverly Rd. White Plains, NY 10605, (914)
328-2226 or (914) 686-3203. This is an elaborate blouse and pouch. $65.00
Dr. Nils Bergman has a carrying device that includes a blouse that is available
from his website (See under websites, 2000, Nils Bergman).
Dr. Elise Van Rooyen makes a simple carrying device that is used in all northern
province hospitals of South African. It is machine washable, wraps easily, comes
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with good instructions, and is available for $10.00 from S. Ludington, Bolton
School of Nursing, 10900 Euclide Ave., Cleveland, OH 44106-4904. email her at
sml15@po.cwru.edu to order.
Snug-a-roo. Quilted carrier for preemies (turn down center flap for KC). Has 2
pages instruction (806) 795-8775.
Chairs-
La Napoule or La Fuma Lounge Chair (it goes by both names). All movement is
from legs, not arms and moms love this chair and can stay in it for 24 hours
without fatigue, discomfort, or episiotomy pain. This is the one they use in
Europe and it works well, folds up into extremelly little space and is easy to
move about. Comes in white, black or dark green. This can often be bought in
Patio and Pool or Boat shops. Or you can order it from Hammacher-Schlemmer,
item # 67821G in the SKYMALL catalog of United Airlines, cost is $179.95. call
1-800-sky-mall.
4/11/04 I just saw the La Fuma/La Napoule chair at COSTCO yesterday for $88.00.
The chair they have there is called the Fabric Lounger and is available from
CWC, PO BOX 34535, Seattle WASHINGTON, 98124-1535, ask for item # ITM ART
306122.
-The Kangaroo Care Chair- comes with l0 year warranty. Looks like regular
padded chair. Get it from www.ioahealthcarefurniture.com or write to Mr. Fabio
Delmestri, Executive Vice President, IoA Healthcare, 829 Blair Street,
Thomasville, NC 27360. Phone 336-475-7106 or Fax 336-476-3016.
FOUNDATIONS
Fundacion Canguro
Transversal 39A No 46-29
Santafe de Bogota, COLOMBIA
Tel-fax; 57-1-222-70-45
Tel: 57-1-222-01-30
Home page is http://kangaroo.javeriana.edu.co
The KC mailing list is a forum to seek and exchange informaiton on KMC. To
suscribe to the KMC email list, send a message to:
majordomo@hermes.javeriana.edu.co with no subject and write in the body of the
message: subscribe kangaroo.
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