Monday, December 12, 2016

Kangaroo mother care

Nathalie Charpak, Rejean Tessier, Juan G. Ruiz, Jose Tiberio Hernandez, Felipe Uriza, Julieta Villegas, Line Nadeau, Catherine Mercier, Francoise Maheu, Jorge Marin, Darwin Cortes, Juan Miguel Gallego, Dario Maldonado.  Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. In press.


BACKGROUND AND OBJECTIVES: Kangaroo mother care (KMC) is a multifaceted intervention for preterm and low birth weight infants and their parents. Short- and mid-term benefits of KMC on survival, neurodevelopment, breastfeeding, and the quality of mother–infant bonding were documented in a randomized controlled trial (RCT) conducted in Colombia from 1993 to 1996. The aim of the present study was to evaluate the persistence of these results in young adulthood.

METHODS: From 2012 to 2014, a total of 494 (69%) of the 716 participants of the original RCT known to be alive were identified; 441 (62% of the participants in the original RCT) were re-enrolled, and results for the 264 participants weighing ≤1800 g at birth were analyzed. The KMC and control groups were compared for health status and neurologic, cognitive, and social functioning with the use of neuroimaging, neurophysiological, and behavioral tests.

RESULTS: The effects of KMC at 1 year on IQ and home environment were still present 20 years later in the most fragile individuals, and KMC parents were more protective and nurturing, reflected by reduced school absenteeism and reduced hyperactivity, aggressiveness, externalization, and socio-deviant conduct of young adults. Neuroimaging showed larger volume of the left caudate nucleus in the KMC group.

CONCLUSIONS: This study indicates that KMC had significant, long-lasting social and behavioral protective effects 20 years after the intervention. Coverage with this efficient and scientifically based health care intervention should be extended to the 18 million infants born each year who are candidates for the method.

Charpak N, Ruiz JG, Zupan J, Cattaneo A, Figueroa Z, Tessier R, Cristo M,
Anderson G, Ludington S, Mendoza S, Mokhachane M, Worku B. Kangaroo Mother Care:
25 years after. Acta Paediatr. 2005 May;94(5):514-22.

The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infant's cognitive development.
Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.

From the above article

Data from Bogotá suggest that infants allocated to continuous kangaroo position at 1 y had higher IQs than those given traditional care (KMC 101.1, control 97.4; p<0.02). At 12 mo of corrected age, a significantly higher Griffiths score was documented in preterm infants exposed to KMC (12.9 points higher) who had required intensive care and had been diagnosed as doubtful or overtly abnormal neurological development at 6 mo. This may be explained in part by the fact that KMC families (particularly mothers) are more sensitive to infant needs, and provide a more stimulating home environment. They are more active in seeking healthcare, which might have a positive effect in infants with transient or definitive neurodevelopmental conditions.

The main effect of the kangaroo position was on the development of personal relations and on planning functions related to brain developmental stage at birth. A similar trend was observed by Feldman et al. The explanations are based on three characteristics of the intervention. The first is the timing of the intervention, which is started early in hospital, as soon as the infant's physiological state is stabilized. This early start gives the infant qualitative compensation for lost intrauterine experience and avoids input overload. Developmental care during the last weeks of (extrauterine) gestation positively influences neurodevelopmental functioning  and appears to prevent frontal lobe and attentional difficulties in the neonatal period. The second explanatory characteristic is the kangaroo position itself, which induces combinations of sensory modalities: auditory stimulation through the mother's voice, olfactive stimulation from the proximity of the mother's body, vestibular–kinesthetic stimulation from the infant's location on the adult's chest, tactile stimulation from the permanent skin-to-skin contact, and visual stimulation, as the infant is placed in an upright position (60°), which allows him or her to see the mother's face and body and contextual elements as she moves around. Because multimodal sensory stimulation programs have been reported as having short-term impact on physical and mental maturation, we suggest that this KMC component may be positively related to mental development. The third explanation is related to breastfeeding, which will be discussed later.

Holding the infant in the kangaroo position has been associated with a positive effect on temperament; KMC infants being better organized and calmer and crying less. KMC also has a positive effect on the infant's capacity to emit cues and to respond to the mother's requests. KMC intervention is most effective when started within the first 3 d of life and when used for high-risk infants.

Breastfeeding as an integral component of KMC might contribute to significant gains in neurological development and IQ. KMC induces mothers to breastfeed their infants 42, and mother's milk has been associated with gains in IQ. A recent meta-analysis 44 clearly identified the short- and long-term (between 6 mo and 16 y of age) benefits of breastfeeding on cognitive development. On the basis of this and many previous papers, we believe that breastfeeding as a component of KMC could contribute to the enhancement of infants’ mental development.

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