Method Kangaroo (nursing premature babies). Caring for premature babies with the kangaroo method

In the US, the Kangaroo Method is called Kangaroo Care (KC). It is characterized by only one mandatory factor - physical skin-to-skin contact of mother and baby, and is used only when the child's condition is stable and does not cause concern. And although the CS has a rather profound effect on the child, a more complex CMS gives a much better effect.

The concept of the kangaroo method is based on the combination of all these factors and, although it is important for all newborns, it plays a particularly important role for premature babies.

As you might have guessed, the method owes its name to the kangaroo. This is a natural, prompted by nature itself, a way to keep warm, and hence the life of premature babies.

The kangaroo feeds its newborn baby with milk and during the first months of life it continuously wears it in a bag on its stomach, where the body of the kangaroo completes its formation.
This habitat gives the baby kangaroo everything it needs to harmonious development and growth warmth, comfort, food, incentives for development and a sense of security.

Of course, earlier in the departments of newborns, parents were allowed to take their children in their arms, talk to them, caress and stroke them. However, this cannot yet be called an application of the Kangaroo method. It can only be used when it is integrated into daily work and becomes an inseparable part of the process of physical and psychological adaptation. premature baby to family life.

This is achieved through parent education, professional training for pediatric nurses, and social and emotional support.

This method is especially suitable for deep care premature babies, and is also effective for children with normal weight, for example, in the case when the baby is sick, shows anxiety, cannot fall asleep.

Physical skin-to-skin contact between the baby and one of the parents is the best that mom and dad can give to the baby in the first days of life, except, of course, mom breast milk.

Every day, from one to several hours a day, children are laid out on the open surface of the breast of mom or dad. Its use accelerates the adaptation of babies to the world around them, they develop better and gain weight.

There are several key points in this method.

✅Early prolonged skin-to-skin contact of the baby and his mother, or rather the baby's body (facing mom) and maternal breast. The wider the skin is in contact, the better. In order to maintain body temperature more evenly, a warm soft diaper is covered on top of the baby and sometimes a hat is put on.

✅ Exclusively breastfeeding with expressed milk or directly from the breast.
For some especially premature babies additional nutrients may be prescribed.

✅Support mother-baby couple.
This means that the hospital staff do their best for the medical, emotional, psychological and physical well-being of the mother-baby couple, without separating them, from the use of state-of-the-art equipment to psychological support.

The method also includes a number of important points:

♻It is started in the hospital but can be continued at home.

♻Babies treated with this method are encouraged to discharge earlier

♻While staying at home, mothers are provided with needed help and support.

However, these factors are not always obligatory element and mainly depends on the development social services in the region.
An excellent example of excellent social support for mother-baby couples at home can be found in Colombia, where this method was first tested.

So, let's try to summarize. The kangaroo method includes three required elements:

✔Kangaroo Position - skin-to-skin contact for mother and baby.

✔ Kangaroo Nutrition - early and exclusive breastfeeding.

✔Support (Kangaroo Support)- cohabitation mother and baby with the support of the necessary technologies.

Evolution has created humanity in such a way that when we are born, we already have those skills that will allow us to adapt to the world around us, and everything that is needed for successful development a newborn is carrying it in your arms (skin-to-skin contact) and breastfeeding.

Premature babies need it especially badly.
And the more absurd is the separation of mother and child, often perceived as the norm.

This is an informational article. Be sure to check with your doctor before using any tips or techniques!

Prolonged physical contact between mother and newborn has a huge positive effect. Among other things, it helps to develop a sense of maternal responsibility and improve close connection paired with.

This review looks at three main types of physical contact between mother and child:

1. Skin-to-skin contact (Kangaroo method)

2. Carrying a baby

3. Using a sling

ADVANTAGES OF SKIN-TO-SKIN CONTACT (KANGAROO METHOD)

Skin-to-skin contact (Kangaroo method) for mammals is a natural type of mother-child interaction (Ferber et al., 2004). The present study of the Kangaroo method is mainly focused on its safety and effectiveness in neonatal care.

Premature babies.

The benefits of skin-to-skin contact have been most extensively studied in the care of preterm infants less than 37 weeks' gestational age. Historically, the main reason that contributed to the spread such practice, there was a financial component. The method was first tried in 1978 in Colombia. Due to a severe lack of hospital resources and room space, skin-to-skin contact has begun to be used to care for preterm infants with underweight as a measure of additional therapy, in addition to the standard medical care. (Whitelaw, 1985).

The practice of the Kangaroo method is based on the following principles:

- the position of the child (a child without clothes is located vertically on the mother's chest)

- Nutrition (fully or predominantly breastfeeding)

Discharge time (early discharge from the hospital)

In 2001, Dr. Charpak and colleagues conducted randomized controlled trials in which 746 children born weighing less than 2000 took part. Newborns were randomly divided into two groups.

The children of the first group were nursed according to the "Kangaroo" method. Throughout the day, these children were in vertical position on the mother's chest in direct bodily contact with her. Thanks to the body heat of an adult, the body temperature of the children was maintained within normal limits. Newborns were fully breastfed, and, if necessary, received additional baby food. They were observed until the daily weight gain was at least 20 g. The children were carried upright at the chest for as long as they assumed this position.

Children of the control group were kept in incubators until their body began to independently regulate body temperature, and the average daily weight gain did not reach the level of the experimental group. Typically, they were discharged when body weight had risen before 1700. In the classical practice of neonatal intensive care, parental access to children was limited.

As a result, newborns in the treatment group were discharged earlier, were less susceptible to infectious diseases, and most of these infants remained breastfed beyond three months of adjusted age.

Kangaroo Mother Care (KMC) refers to the skin-to-skin contact between mother and child that occurs from the moment the child is born. In accordance with this method of nursing newborns, children are exclusively breastfed (without the use of additional baby food, even if the child is premature). The focus of this technique is the interaction between mother and child. Research results have shown that the "Mother Kangaroo" method can achieve best results physiological development of the child and stabilization of the body as a whole than with therapy using incubators (Bergman et al., 2004); children gained weight better, were discharged from the hospital earlier, and were breastfed longer (Ramanathan et al., 2001); this method had a positive effect on the development of the maternal instinct and contributed to the establishment of mother's attachment to the baby (Tessier et al., 1998).

An analysis of the results of three studies (Conde-Agoudelo et al., 2003), which included 1362 underweight children, showed that the Kangaroo Mother method reduces the risk of nosocomial infections, the occurrence serious illnesses lower respiratory tract over 6 months of observations and contributes to the conservation of exclusively breastfeeding after discharge. Babies born using the "Kangaroo" method had a large daily weight gain.

Concerns about the quality of the research methodology led the authors to abandon the idea of recommending the Kangaroo Mother method as a common practice in the treatment of small children. Although the assumption that it reduces the incidence in children and does not have any side effects, were confirmed, the scientists considered the collected evidence insufficient.

The Kangaroo Method is a simplified version of the Mother Kangaroo Method. It is also based on skin-to-skin contact, but does not require constant mother-to-carry, exclusive breastfeeding, and early discharge. Three preliminary studies have shown that the Kangaroo method also improves the condition newborn babies.

The first study reported that children treated with the Kangaroo method had higher tympanic temperature, slept better, and cried less (Chwo et al., 2002) than control children. High tympanic temperature (within the normal range) is the main indicator of the positive dynamics of the state of newborns and characterizes the ability of their body to effectively thermoregulate.

The second study examined the safety of the Kangaroo method. Premature babies were carried continuously for three hours. The results showed that the children of the experimental group did not experience apnea, bradycardia and intermittent breathing. Compared to infants receiving standard treatment in the intensive care unit, the newborns of the experimental group improved the nature of breathing, it became more regular.

The third trial (Ludingoton et al. 2006) involved 28 premature babies. In the experimental group of infants who were nursed by the "Kangaroo" method, sudden awakenings and rapid eye movements were much less common, the stages of development of newborns were shorter. The sleep of the child of the experimental group corresponded more to the normal nature of the sleep of a full-term infant.

It has been found that the Kangaroo method helps women to breastfeed, which is especially important for premature babies, as they are much more prone to disease. Breastfeeding provides infants with significant immune and nutritional properties milk that infant formula cannot provide.

Bayer et al.'s 1996 study included 50 children. Mothers using the Kangaroo method had more stable milk production and continued breastfeeding for at least a month after discharge.

In addition, 119 mothers of very low birth weight infants participated in a prospective observational study. The Kangaroo Method has been shown to largely determine the establishment of successful lactation after 40 weeks of adjusted age (Furman et al., 2002).

Less clear evidence of the benefits of using the Kangaroo Method in nursing preterm infants is provided by other studies. In particular, an increase in heart rate and body temperature has been found, as well as a decrease in irregular breathing (Ludington et al., 1994). In a comparative study of the children of the experimental group, who were nursed according to the "Kangaroo" method, and the control group, it was found that the children of the experimental group had a more mature physiological state of the body and better organized sleep and wakefulness cycles. At the age of 3 months, children in the control group had a higher emotional threshold for negative reactions and woke up easier (Feldman et al., 2002b).

In another study, 70 preterm infants were divided into two groups, one of which was treated with the Kangaroo method. This method has been found to accelerate behavioral and autonomic development. nervous system. (Feldman et al., 2003).

Feldman's research team (Feldman et al. 2002a) found that by the age of three months, the Kangaroo method helps to establish parental care and the best family microclimate. Six months after giving birth, mothers who practiced the Kangaroo method were more gentle with their children, and their six-month-old children were more high level mental and psychomotor development.

Babies born at term.

The use of the "Kangaroo" method for carrying full-term babies is mentioned in only a few articles. For example, Ferber et al. in 2004 studied the effect of the Kangaroo method on full-term babies. The study involved 47 healthy couples mother and child. Some of them used the "Kangaroo" method immediately after birth, others used the standard practice of caring for a newborn.

The mothers of the experimental group began to practice the "Kangaroo" method 15-20 minutes after giving birth for 1 hour. Observations were carried out continuously, starting from the fourth hour after birth. Multivariate analysis of variance of the results showed significant difference between the profiles of the two groups (F = 2.39; p = 0.02): infants to whom the Kangaroo method was applied slept longer, their sleep was calm. When studying tonic functions, they more often demonstrated flexion movement and less often extension.

The authors came to the conclusion that the use of the "Kangaroo" method for nursing full-term newborns allows you to quickly stabilize the physiological state of the body and provide the necessary physical activity. Huang et al. in 2006 found that the Kangaroo method promotes temperature adaptation in term newborns with hypothermia. The kangaroo method has a calming effect on learning plantar reflex(in the CM group, periods of crying and expressions of displeasure on the face of the newborn were reduced by 82% and 65%, respectively) (Gray et al., 2000).

Anderson et al. in 2003 found that the Kangaroo Method prolongs the duration of breastfeeding for term infants, promotes temperature maintenance healthy newborn within safe limits (provided that the child's body is dry, he is positioned correctly, his back is closed).

In another study, the Kangaroo method was found to significantly reduce the duration of crying in full-term babies 60 minutes after birth (Christenson et al., 1995). Studies have shown that when using the Kangaroo method, skin-to-skin contact had a massage effect, as opposed to simply being carried on the hands. As a result, preterm infants gained weight faster, and in term infants, circadian rhythms were established faster (Ferber et al., 2002a) and the required level of melatonin secretion (Ferber et al., 2002b).

Meyer et al. in 1999 studied the effects of the Kangaroo method on children who had problems with breastfeeding. The experiment involved three mothers who used the "Kangaroo" method for one hour before feeding. It was found that this method of nursing newborns can be recommended for breastfeeding.

POSITIVE EFFECTS FROM HANDLING

Simply carrying a newborn, even in the absence of skin-to-skin contact, also has a number of positive effects, including reduced crying and increased parental care. In a 1986 study by Hunziker et al., 99 pairs of mothers and infants took part. They were randomly divided into two groups: experienced parents they had to carry the child in their arms for at least three hours a day; during the control period, the time of carrying the child in their arms was not regulated. Peak at 6 weeks of age baby crying, infants in the experimental group, who were more often carried on their hands, cried and were nervous 43% less during the day and 51% less in the evening hours (from 4 pm to midnight).

Barr et al. in 1991 investigated the possibility of using the Kangaroo method to reduce the crying time of newborns with colic. This study included 66 mothers who had children aged 4 weeks or younger who complained of crying. They were also divided into two groups: mothers of the control were instructed to simply follow the recommendations of the pediatrician. In the experimental group, in addition, mothers were asked to increase the time of carrying a child in their arms by 50%. As a result, during the experiment, children in the experimental group were carried on their hands for about 6.1 hours a day, which was 2.2 hours a day more (by 56%) than it was done in the control group.

Throughout the experiment, scientists did not find any difference between the groups regarding the duration or frequency of crying and the condition increased nervousness in children. They concluded that the "Kangaroo" method is not effective in the treatment of children prone to colic. The results obtained are at odds with the effect that the Kangaroo method has on healthy children, which, in turn, can be explained by the peculiarities physiological state children with colic.

SOFT CHILD CARRIERS

Anisfeld suggested in 1990 that soft carriers could make it much easier for babies to carry. In his study, 49 pairs of mothers and newborns were randomly divided into two groups, one given a sling and one given a plastic carrier. The subjects were required to use them daily.

Using the analysis of transition probabilities of the experimental data, by the third month of the study, mothers wearing slings responded better to the baby's voice signals. When the babies reached the age of 13 months, the Ainsworth Strange Situation experiment was conducted, during which it was found that the children in the experimental group pressed closer to the mother's body. The authors concluded that when using slings, the mother becomes more responsive, and the child is better fixed.

Waltrud et al. in 2002 studied the safety of slings in a three-stage crossover experiment. This study involved 24 premature and 12 full-term newborns. They were under constant surveillance. In the experimental group, children were carried horizontally or vertically in a sling; in the control group, a stroller was used to move.

In 90% of cases, the difference between the confidence interval of the oxygen access indicator when the child is in a sling in a vertical or horizontal winding and the average value this indicator when moving a child in a wheelchair was 2%.

CONCLUSIONS

As a result of the analysis, the safety of all methods of carrying newborns (Kangaroo method, carrying on hands and in a sling) was proved. There is strong evidence that the Kangaroo method has a positive effect on premature babies, which is to reduce hospitalization time, reduce morbidity, increase the number of children exclusively breastfed and increase the duration of breastfeeding, increase weight, increase the body's ability to self-regulate, and as well as increased maternal affection.

For full-term children, actual data on the benefits of the "Kangaroo" method were obtained, including an improvement in the general condition of the body, increased motor activity, improved temperature self-regulation of the body, and an analgesic effect. There were no reports of any serious adverse effects. Carrying on the hands without using the Kangaroo method leads to a decrease in the level of crying. When using slings, the attention of the mother to the requirements of the child increases, and the child is securely fixed. There are many benefits to physical contact between mother and child, so it is important to note the importance of using the kangaroo method, carried in the arms or in a sling.

The considered methods of carrying children can be recommended as necessary and natural ways care of newborns (both premature and full-term).

The birth of a premature baby is a big stress for the family. Sometimes premature generic activity starts unexpectedly. In some cases, it is necessary to artificially induce labor ahead of time or perform an operation caesarean section. Indications for this are certain complications of pregnancy. In any case, a lot of negative experiences fall upon the family: a sense of guilt for what is happening, pain, fear for the baby, a feeling of insecurity in one's abilities, a feeling of hopelessness from the current situation.

How less term gestation on which the child was born, the more time he will be forced to spend outside the walls of the house: in the neonatal intensive care unit or in the department of nursing premature babies. Not all hospitals allow mothers to lie with their children. Sometimes they visit their babies only 1-2 times a day. This separation from the child further exacerbates the anxiety of mothers for their condition. Therefore, in nursing premature babies, it is very important to create an atmosphere of unity between mother and baby, even for several hours, which will improve their psycho-emotional connection, as well as the overall health of the crumbs. IllnessNews explains what the kangaroo method is in preterm care and how it is applied.

What is the kangaroo method?

Caring for a premature newborn baby using the "kangaroo" method involves the baby being at the naked mother's (or father's) breast in an upright position, which ensures that the skin of the child is in contact with the skin of one of the parents. The main goals of the method are to adapt the newborn to extrauterine life conditions as soon as possible, to give him the opportunity to recover faster and fully develop among his family members.

Why is this interesting name- Kangaroo method? Let's turn to nature. The female kangaroo bears her baby for a very short time, only 30-40 days. Then he is born very tiny, 2-3 cm in length. He cannot live separately from his mother and is very dependent on her. Immediately after giving birth, the baby kangaroo climbs into the bag on the mother's stomach and spends about seven months in it. There he is in warmth and security, eats mother's milk and growing. Only having become big enough and independent, the kangaroo leaves its cozy home and begins to live its own life.

A bit of history

It is interesting how this method of nursing premature babies appeared in modern medicine. 37 years ago in Colombia, Dr. Edgar Ray and his partner Hector Martinez first applied the method of nursing premature babies on the mother's breast in the face of a shortage of incubators for children. Mom gave the child the warmth of her body, which was simply necessary for a premature baby. The results of this experience shocked everyone: the children gained weight faster, got better, they had fewer problems with breathing and feeding.

In the future, such innovations in nursing premature babies began to be used in other countries where it was not easy with specialized equipment (poor countries in Africa and Asia). It also came in handy in refugee camps and military hospitals. Despite the complexity of nursing conditions, it was possible to go out even deep premature babies(weight less than 1000 g). The reason for such success was noted thanks to the "kangaroo" method.

Gradually, the whole world, including developed countries, began to use the "kangaroo" method in practice. To date, sufficient experience has been gained in the application of this method, studies have been carried out with stunning results, and excellent success has been achieved in nursing thousands of premature babies.

In hospitals where premature babies are cared for, hospital staff creates the necessary conditions to apply the kangaroo method. It is most convenient if special hours are allocated for this according to the operating mode of the department. The main appointments and manipulations must be completed by this time so that the parents present in the department do not distract doctors and nurses. They, in turn, try not to touch the child once again and not to distract him from communicating with his parents.

Most often, the kangaroo method is performed with mom, although there are no contraindications for doing this with dad (except for the presence of acute diseases from him, which can be transmitted to others). The parent sits on a chair or a special chair and takes a comfortable position. Then the nurse puts the naked baby (only in a diaper, socks and cap) on the mother's or father's chest. Usually the child is laid belly down (the “frog” position) or on the side. From above they are wrapped with a blanket and left for a while. It can be several minutes or even hours, depending on the condition of the baby and the established rules in the department.

All this time, a nurse is watching the child. This is not difficult to do, because special sensors are installed on the child’s skin that record his heart rate (HR) and the degree of blood oxygen saturation. When rejected important indicators from the norm, the equipment will emit a sound signal, which will notify the medical staff of the danger. It will be possible to stop this procedure and provide assistance to the child if necessary.

Mom and dad during physical contact with the child can gently stroke his head and back, sing songs to him, tell stories, dream and even tell how they will live together at home when the baby gets better. Thoughts are material, so it is very important to tune in to a good mood and constantly pronounce your desires.

What does the "kangaroo" method give for the baby?

Why is the kangaroo method so good? What does he give for the baby?

The child gradually becomes familiar with outside world, leaving the space of the incubator (incubator). Acquaintance with him takes place next to relatives who love him and are waiting for a speedy recovery.
The skin and mucous membranes of the child are populated by the microflora of the parents, which serves as an excellent fight against nosocomial infections. It is a mistake to think that parents should not touch a premature baby in the hospital, so as not to "bring dirt to him." It is their flora that is the most native and useful for the child.
The baby is warmed by the most natural warmth - the warmth of the body of the mother and father. It will quickly form and mature the thermoregulation system.
The child hears the beat of the mother's or father's heart, feels their rhythmic breathing. It is very helpful for premature babies. Especially for those children who often experience respiratory arrest and slow heart rate due to the immaturity of their nervous system.
The baby inhales the native smell, hears familiar voices, touches the body of mom or dad with his fingertips, he develops a sense of the spatial position of the body. That is, all the senses are gently stimulated. A sense of attachment to mother and father is formed.
Babies who are nursed using the kangaroo method gain weight faster, eat more readily, and retain feeding better. First, you can feed the baby with expressed breast milk through a tube, then start applying it to the breast. The more time the baby spends with the mother, the faster breastfeeding will be.
The child's perception of pain during painful manipulations and interventions decreases.
Terrible figures of infant mortality and morbidity of children, as well as the number of complications from their diseases, are decreasing. This allows premature babies to be sent home earlier.

The application of the "kangaroo" method gives a woman the opportunity to psychologically "bring" this child and smoothly "complete" her pregnancy, which ended so quickly.
Prolonged physical contact with the baby stimulates lactation in the mother. This is very important for the baby. After all, to maintain lactation, being in such life situation, very difficult: no on-demand breastfeeding, which naturally increases breast milk supply.
The developing reflex of oxytocin contributes to a faster contraction of the uterus.
Attachment to the child is established, which may not immediately be established after premature birth.
A woman ceases to feel guilty, because now there is simply no time for this. You need to think about how to help the baby, focus on nursing him.

Who can do the kangaroo method?

The kangaroo method can be used with all newborns, even full-term ones. You can learn this in a hospital and continue to do it at home, using, for example, a sling. The most important thing in using the kangaroo method is the stability of the child's condition. He may even be on a ventilator, receive intravenous infusions or tube feeding and not be interrupted from such important procedures.

The task of the staff is to make the mother and father understand the importance of this procedure and that without the participation of the parents, nursing their baby would not be so successful. That is, it is the parents who play a key role in the development of their baby. Doctors and nurses only help to cope with life-threatening conditions, guide parents and teach them how to care for their child.

The readiness of the child to conduct the "kangaroo" method is assessed comprehensively. If his condition is unstable or worsens after skin contact with parents, then it is worth postponing the use of this method for more favorable period. It is not recommended to use the "kangaroo" method with severe oxygen dependence, the presence of difficultly fixed venous catheters (there is a risk of damaging or pulling them out), with severe infectious diseases, with intraventricular hemorrhages of 3-4 degrees and some other diseases and conditions.

The issue of the possibility of using the "kangaroo" method is decided individually for each child. Even if now his condition does not allow physical contact with his parents, after a short time the situation may change in the other direction.

Today, the "kangaroo" method is an important part of the early rehabilitation of premature and seriously ill newborns. Kangaroo refers to close physical skin-to-skin contact between infants in their first weeks of life and their parents. The essence of the method lies in the fact that children are laid out daily, from one to several hours a day, on the open surface of the breast of mom or dad. To reduce heat loss, cover the baby on top with a warm diaper or blanket, and you can put a hat on the head.

Why is skin-to-skin contact called "kangaroo"?

The name "kangaroo" was born by analogy with the method of carrying a kangaroo cub observed in nature, which, when born, barely reaches a length of 2.5 cm, and its body has not even been completely formed yet and it spends the first months in skin fold- the pouch on the belly of the mother kangaroo. This is a natural way, prompted by nature itself, to keep warm, and hence the life of our premature babies. The term "kangaroo" is clear to absolutely everyone and has long been included in the lexicon.

When did they start talking about "kangaroo" as a way to nurse premature babies?

The history of the "kangaroo" began about 30 years ago, when in Colombia, due to a lack of incubators, pediatricians Edgar Rey and Hector Martinez tried to use the heat of the mother's body to prevent the death of premature babies from hypothermia. This experience turned out to be successful and began to be applied initially in the poorest countries of Africa and Asia, in refugee camps, in hospitals in zones of military conflicts. There have been reports that thanks to the use of "kangaroo" even premature babies with a birth weight of less than 1000 g were able to exit in the absence of special medical equipment. Somewhat later, "kangaroos" began to be actively used in neonatal departments in "developed countries". Today, more and more people turn to this simple method nursing newborns, because the "kangaroo" not only replaces the incubator, but can give much more than medicines and modern medical equipment.

What is the meaning of "kangaroo"?

The "kangaroo" method perfectly combines various influences, and its influence occurs quite naturally, as if in the background.

The effect of soft stimulation of all the senses of the child. The child feels strokes, touches, hears the heartbeat and the voice of the mother, catches the smell mammary gland, breast milk , body odors. It also stimulates a sense of balance, a sense of body position in space and movement.
The perception of pain by a premature baby is reduced so much that he may practically not respond to a skin puncture when taking a blood test.
Helps to establish a relationship between the child and native family, fosters a sense of parenthood and affection for the child.
Helps maintain breastfeeding
Increases self-esteem and confidence of parents that they are able to help the baby.
Gives a time of calm and silence, gives the effect of relaxation and restoration of psychological balance after a severe injury caused by premature birth.
Increased awareness of parents in the care and treatment of premature babies.
The level of trust and interaction of parents with the medical staff of neonatal departments is increasing.

Many may object: “Why did they start talking about a new method, because in our neonatal departments it was always allowed for parents to take their children in their arms, talk to them, caress, but this has never been called the term “kangaroo method” before? About the application of the “kangaroo” method they say when this phenomenon is integrated into daily work and becomes an inseparable part of the process of physical and psychological adaptation of a premature baby to life in a family.This is achieved through parental education, professional training of pediatric nurses, social and emotional support.

Can "kangaroo" worsen the condition of the child? Is there a danger of sudden cooling?

Scientific studies carried out in different countries over the past 30 years have not revealed a single fact when the use of the "kangaroo" method caused any harm to the child or mother. The child not only does not cool down while on the mother's chest, but its temperature even rises, and cardiac activity and respiration remain stable.

Does "Kangaroo" really have a beneficial effect or is it a myth?

In large scientific studies, it has been shown that with "kangaroo" nursing in premature babies, episodes of apnea decrease, they gain weight somewhat faster, begin to breastfeed earlier, they have less respiratory diseases in the first 6 months of life. In departments where "kangaroo" is practiced, there is a lower incidence of hospital infections in newborns. The mothers who participated in the "kangaroo" breastfeed their children for longer, are more respectful of the work of doctors and children's nurses. Scientific research is currently ongoing and concerns the study of the effect of "kangaroo" on physiological changes in the child's body, on neurological and emotional development children and parent-child relationship. Other aspects are also being explored, even economic viability and the impact of kangaroos on phenomena such as cruel attitude to children, homelessness and orphanhood.

When is the kangaroo method contraindicated?

Despite the popularity of "kangaroo", this way of caring for premature babies cannot be used routinely, without taking into account the state of health, the characteristics of the child's response and the attitude of parents. Contraindications can be, for example, severe sepsis, fresh intracranial hemorrhages of 3-4 degrees, the need to breathe oxygen with a concentration of more than 40%, difficult fixation of a venous or arterial catheter. As a rule, "kangaroo" is allowed only after a stabilization period. It is absolutely wrong to make the "kangaroo" method dependent only on the body weight and age of a premature baby or, for example, on the need for mechanical artificial ventilation of the lungs. It would be expedient each time to resolve this issue strictly individually.

How is kangaroo done in practice?

With stable general condition of a premature baby, the doctor has the right to offer parents such a method, which is not quite usual for our hospitals. But a number of conditions must be met.

The rooms should be spacious enough. Next to the incubator or crib, you need to place a comfortable chair in which the back allows you to take a reclining position. This is necessary so that the mother does not experience inconvenience, because the "kangaroo" can last more than one hour. In a multi-bed ward, a secluded corner where mother and baby will be located can be separated with a screen. The approach to the incubator must be kept free, and medical equipment, breathing hoses, system lines, firstly, should not impede access to the child, and secondly, provide sufficient freedom of movement.
The day when you plan to invite your mother needs to be well planned so that no planned diagnostic and healing procedures did not disturb the peace. Most convenient time evening or evening. Taking blood for analysis can be performed during the "kangaroo", but this is not recommended so that the child does not experience an unpleasant painful experience at the time of communication with his mother.
Before starting the "kangaroo" mom should get in an accessible form full information about the health status of the child and the ongoing treatment. It is imperative to tell what apnea is and what help is provided in this case. It is necessary to explain the purpose of the pulse oximeter, what indicators it displays and the normal range of their changes.
It may take some effort at first to overcome the feeling of fear and fear of inadvertently harming such a fragile and delicate creature that is a premature baby. This is where support from parents who already have a positive kangaroo experience will help a lot.
In the role of "kangaroo" can be not only mom or dad, but also other family members, including older brothers and sisters, if their presence does not contradict the internal routine of the hospital. The only condition is that all visitors must be healthy.
In the department of newborns, it is necessary to observe elementary hygiene requirements. The strictest is washing and sanitizing hands.
Mom is advised to wear a shirt or blouse that can be easily unbuttoned at the front.
Recommended for varicose veins compression stockings or an elastic bandage, and during the "kangaroo" - an elevated position of the legs.
A premature baby is usually kept completely naked for direct skin-to-skin contact. You can leave only a diaper and a hat on the head.
Most difficult moment- this is the transfer of the child from the incubator to the mother's chest. This procedure will require at least two people. In the beginning, it is necessary to assess the child's behavior and his readiness for interaction. Before laying out of the incubator, you need to attract the attention of the child. To do this, gently touch it with your palm, let you feel your presence. Wait for a response. This is how we communicate that something is about to happen. Next, the child is carefully moved, turned over on the tummy and laid vertically on upper part mother's breasts, check the position of the sensors of the tracking equipment, if any, and cover.
For the first time, the presence of a pediatric nurse is required during the entire kangaroo session. A child in need of respiratory support can receive oxygen through a mask, nasal prongs. Hardware artificial ventilation lungs is also not an obstacle if the frequency of mandatory respiratory cycles is not more than 25 and the oxygen concentration is not more than 40%. When conducting a kangaroo session with a ventilated patient, the utmost attention and readiness for emergency assistance is necessary. A tracheal intubation kit and experienced staff should be available.
It takes at least an hour for the child to fully adapt, so the "kangaroo" usually lasts from one to 3-4 hours.
It may be that the first kangaroo session, and most of the time thereafter, is deeply premature baby will only sleep and show no activity. But sooner or later, the baby on the mother's breast instinctively begins to make movements in search of the nipple. This behavior is observed even in premature babies with a birth weight of less than 1000 g. If the baby begins to try to find the breast, grabbing the nipple is great! It is necessary to encourage his efforts by feeding, even if the baby is still feeding through a tube. Moreover, breastfeeding is also possible. At the first sucking attempts, a small premature baby will only feel the taste and smell of milk without receiving any significant amount of food (such sucking is called non-food), but this has a significant impact on the development and consolidation of the reflex and is the first step for breastfeeding.

When should a kangaroo session be terminated?

"Kangaroo" is stopped when the child shows excessive anxiety, when the mother gets tired, when a significant deviation in the child's pulse rate and breathing from the norm and an increase in the need for oxygen breathing are noticed. It is also necessary to show understanding when staff asks to interrupt the "kangaroo" during a period of intense work in the department, for example, when it turns out emergency help to another patient.

How long can the "kangaroo" nursing last?

Many parents continue to "kangaroo" at home, after discharge from the hospital, when they feel a mutual need for such contact. But the child grows, he becomes less dependent on his mother and the need for a "kangaroo" will disappear by itself.

Articles used in the preparation of the publication:

Conde-Agudelo A, Diaz-Rossello JL, Belizan JM Kangaroo mother care to reduce morbidity and mortality in low birthweight infants (Review) Copyright 2007 The Cochrane Collaboration
Heather Harris A little help from my friends: caring for premature babies in a war zone International Breastfeeding Journal 2007, 2:3

Frühgeborene und ihre Eltern in der Klinik. Bundesverband "Das frühgeborene Kind" e.V.
Frühgeborene in den ersten Lebenswochen. Bundesverband "Das frühgeborene Kind" e.V http://www.fruehgeborene.de
Hector Martinez The mother kangaroo method

Skin-to-skin contact helps babies overcome the effects of preterm birth

How earlier kid came into being, more problems with health. He has an unstable heart rate, breathing, digestion, he cannot eat on his own. A whole arsenal is intended for nursing such babies. medical preparations and ultra-modern equipment... However, all the achievements of science are not able to replace maternal caress.

Benefits of close proximity

In 2003 World Organization Healthcare has released an amazing recommendation for the care of premature babies. Contrary to the sterility requirements of incubators and departments for newborns, infants with extremely low weight were proposed to be worn around the clock in a special sling, providing close skin-to-skin contact between mother and child. The method was called the kangaroo method - this is how marsupials "carry out" their cubs, who are born into the world completely unviable.

The initiative looked risky, but it immediately had an effect - the babies recovered faster and gained weight, their thermoregulation and sleep improved, they began to breastfeed. The mother's heart rate and breathing calmed the babies, helped them to "ripen".

Israeli scientists decided to clarify how long the supporting effect of "kangaroo therapy" lasts and for 10 years observed the growth and development of 146 premature babies, half of whom were nursed using the "skin to skin" method, and the other - in the old fashioned way, in couveuses. And it turned out that those children who literally did not get away with it in the first two weeks of life are far ahead of their comrades. They sleep better, study better, suffer less heart rhythm disturbances, and build better relationships with parents and peers. Maternal warmth turned out to be saving for them.

In addition to premature babies, psychologists recommend "kangaroo therapy" for debilitated, small newborns and for adopted babies who are alternately carried by mother and father. This helps the imprinting (imprinting) of parents, the emergence of a connection with the child.

The path of the gypsies

Skin-to-skin contact is known to be essential for a primate calf. All monkeys carry babies on themselves in the first year of life, warm with the heat of their body and feed on demand. Experiments set by zoologists in the middle of the last century proved that monkeys that were fed and groomed, but deprived of contact with the mother's body, were unable to communicate with each other and raise their young.

Primitive tribes also carry babies on themselves, however, to free their hands, they have been using slings for many thousands of years. The child does not part with his mother, eats and sleeps, feeling the warmth of her body, and the woman at this time gets food and does housework. Special baby carriers are included in National Costume Gypsy and Bedouin beauties.

Over the past 20 years, the sling has evolved from an exotic toy into a fashion accessory. Madonna, Julia Roberts, Britney Spears and Brooke Shields walked around with a bright sling in which the baby comfortably settled down.

There are several types of slings - long elastic scarves modeled on African ones, which are wrapped around the body and scarves with rings or gypsy-type knots. Both have their own advantages. A baby in a sling can lie face to face, as in a cradle, sit on the hip, or settle down facing forward, as in a baby carrier.

Pros and cons

The sling is suitable for most parents with babies. A comfortable sling increases the mobility of a young mother, allowing "without leaving the child" to do housework, go shopping or take a walk, without worrying where to leave the stroller and how to lift it. With the help of a sling, a young father gets a great opportunity to help his wife in caring for a newborn - in the bosom of the father, the children doze just as willingly as in the mother. Heart and breathing rhythms soothe babies, and close contact with the baby improves lactation.

There are few contraindications for wearing a baby in a sling, but they do exist.

The first is the dissatisfaction of the baby. If, after a few weeks of wearing, the baby still cries when trying to arrange it in a rag bag, it is better to postpone the experiments for a few months or even for good.

If the child suffers from a curvature or hernia of the spine, dislocation or dysplasia hip joints, torticollis and others orthopedic problems, you should consult with your doctor if sling is allowed at all.

In the first year of life, as well as if rickets is suspected, it is better not to keep the baby in a sling for more than an hour and a half without a break. If there is a need for longer journeys, you need to take the child out from time to time, let him lie down or crawl.

It is better not to wear impressionable, poorly sleeping and very young children in a sling with their backs to their mother's belly - an excess of impressions is not in the best way affect their nervous system.

Babies suffering from lung diseases and a severe runny nose should not be left wrapped in a sling facing their mother's belly for a long time, especially in warm, stuffy rooms.

Moms have more restrictions. This is the first three months after a caesarean section, suturing the cervix or perineum (you can sit with a sling in a rocking chair or move around the house, but not walk down the street). You should not use a sling for osteochondrosis, sciatica, spinal hernia, and other back problems, uterine bleeding, in the first and especially in the third trimester of a new pregnancy. With epilepsy, a tendency to fainting and dizziness, loss of coordination of movements, it is also better not to risk it.