Kangaroo care: It's not just for marsupials
by Kathleen McDermott

Today's baby books may not show pictures of kangaroos with their babies in their pouches, but the idea of kangaroo care is catching on. If Gene Anderson and her research team have their way, kangaroo care will be commonplace.

Kangaroo care involves skin-to-skin contact as mothers and fathers hold their diaper-clad newborns on their chest right next to their skin. Not only is this a great bonding tool, but earlier research has shown that kangaroo care by the mother is a boon to the infant's development. The mother stabilizes the infant's temperature, respiration, and heart rate when the infant is lying on her chest with direct skin-to-skin contact.

Gene Anderson, the Mellen Professor of Nursing at CWRU's Frances Payne Bolton School of Nursing and a pioneer in kangaroo care, published an article on this topic in the March-April issue of MCN: the American Journal of Maternal Child Nursing. It documents the experiences of one of the first families to participate in her new randomized clinical trial examining the efficacy of kangaroo care for premature infants and the nurse's role in supporting kangaroo care. Under the supervision of specially trained research nurses, the family practiced kangaroo care with their premature son who was born at 32 weeks gestation.

Anderson's $1.1 million study, funded by the National Institutes of Health's National Institute for Nursing Research, is examining 100 healthy premature infants and their mothers at University Hospitals of Cleveland. The infants, who are 32-36 weeks gestation, are studied during their first five days in the hospital and followed for the next 18 months.

Others associated with the research are Robert Arendt, assistant professor of pediatrics at Rainbow Babies & Children' Hospital; Donna Dowling, CWRU assistant professor of nursing; Martha Miller, associate professor of neonatology at RB&C; and Meghan Moran, CWRU instructor of nursing.

Ordinarily kangaroo care begins several days or weeks after birth, but Anderson believes that it may be detrimental to separate mothers and infants at birth. The family she and her research team report on in the article began kangaroo care 4.5 hours after birth.

"We are working from the premise that the mother can help stabilize her infant," Anderson said. "Hospitals tend to separate the infant from the mother the minute anything goes wrong instead of thinking that the baby may need to be with the mother more than ever."

Most 32-week infants have trouble maintaining their temperature both inside and outside the incubator, Anderson said. The parents were able to prevent this problem by keeping the infant against their skin and simply putting another blanket over his back or adding a cap if necessary.

"If the mother has the opportunity to feed her baby in a self-regulatory way that allows her to respond to the baby's cues and to provide warmth, the infant is less likely to cry and expend too much energy," said Anderson.

Crying occurred twice as often in separated full-term newborn infants, and these infants also had pathological levels of salivary cortisol, a stress hormone. Anderson and her colleagues documented this in a previous NIH-funded randomized trial.

In the current study, the infant was taken to the neonatal intensive care unit following a vaginal delivery where he was placed under a warmer and received antibiotics intravenously. Nevertheless, the mother began kangaroo care four and one-half hours after birth.

Although the baby's father was reluctant to begin kangaroo care the first day because the baby was so small, he was attentive to his son and participated the second day. After doing kangaroo care several times, the father said he could still feel his son on his chest even when he was not holding him, Anderson said.

The mother said that she was less anxious when she had to attend to other things knowing the father was "kangarooing" their infant.

The nurses provided continuous support to the parents during the initial periods of kangaroo care when the parents were afraid they might disrupt the IV line and other equipment. The nurses also coached the parents about reading the baby's cues and helped them interpret information on the monitor until they learned how to do this for themselves.

Although the mother was discharged from the hospital on the second day and went home that night, she returned to the hospital the next three nights to "kangaroo" rooming in with the baby.

The nurses tube-fed the infant formula the day he was born and the following day, and thereafter fed him his mother's expressed breast milk. He began receiving oral feedings by breast and bottle on the 13th day after his birth. He was discharged three weeks following his birth, and began exclusively breast feeding on his actual due date.

"We found from our pilot studies and again from our experience with this initial family that kangaroo care can begin this early with premature infants, and that the parents learned how to do kangaroo care quickly," Anderson said. "We want to raise the awareness in health care professionals that kangaroo care is possible and that it can begin sooner even with smaller premature infants. We also want to reinforce the idea that the mother can help to stabilize her infant."

Anderson reported on one of the pilot studies for this research project in the January-February issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing. It focused on her research in Cali, Colombia.

| © 2003. Case Western Reserve University. |