Advances in Neonatal Care:
Letter From the Editor
Witt, Catherine L.
This month we are pleased to include in this journal supplement “A Clinical Guideline for Implementation of Kangaroo Care With Premature Infants of 30 or More Weeks' Postmenstrual Age” by Susan M. Ludington-Hoe, PhD, CNM, FAAN, Kathy Morgan, RN, CNNP, and Amel Abouelfettoh, PhD, RN. This article provides an extensive review of current research regarding the benefits of kangaroo care in the preterm infant. The authors have provided a helpful guide for neonatal intensive care units (NICUs) that are either currently doing kangaroo care or planning to begin the practice. The article provides information on the benefits of kangaroo care and offers practical suggestions for how to institute the practice safely.
Kangaroo care first originated in Bogota, Columbia, in response to the high mortality in preterm babies, reaching nearly 70%.1 This high mortality was due partly to a shortage of isolettes, which required placing more than 1 infant in the same bed, thus increasing the infection rate. In addition, the high mortality contributed to a lack of maternal attachment, resulting in abandonment of many preterm infants. Researchers found that infants who were held close to their mothers' bodies for large portions of the day not only survived but also thrived. Rates of maternal abandonment decreased as well.2 As news of the success of the program spread in the 1980s and 1990s, the practice was adopted in many NICUs in the United States. Although the rationale for adopting kangaroo care in modern NICUs is different, many of the benefits are the same.
Evidence suggests that there are many emotional and physiologic benefits to kangaroo care.3 In infants, the practice produces increased sleep time, decreased purposeless motor activity, and decreased crying, to list only some of the noted benefits. Improved weight gain, increased alertness, and decreased length of stay have also been noted.4 Emotional benefits for parents include enhanced parent–infant bonding, lower rates of depression, and greater confidence in caring for their preterm baby.4
Despite evidence of benefits to providing kangaroo care, many nurses and NICUs are reluctant to institute the practice, particularly with infants requiring mechanical ventilation, umbilical catheters, or other supportive technology. There are many reasons for this, including lack of support from leaders in the institution, staff workloads, and lack of education and protocols.5 Concerns about safety and risk are also cited by staff reluctant to implement kangaroo care. All nursing practices must consider the benefits and risks of the kangaroo care. In this supplement, the authors address many of these concerns and provide information on how to assess infant and parent readiness. They also pose practical questions to determine if individual NICUs are ready to institute this practice.
The mission of Advances in Neonatal Care is to “advance the art and science of newborn care through the publication of scientifically sound and clinically relevant articles that enhance interdisciplinary care.” Carefully reviewing the research and providing practical ways to translate research into clinical practice are important ways to advance newborn care. This supplement is an excellent example of how to apply research to the care of infants and families.
1. Eichel P. Kangaroo care: expanding our practice to critically ill neonates. Newborn Infant Nurs Rev. 2001;1:224–228.
2. Anderson GC. Kangaroo care of the premature infant. In: Goldson E, ed. Nurturing the Premature Infant: Developmental Interventions in the Neonatal Intensive Care Nursery. New York: Oxford University Press; 1999;131–160.
3. McGrath JM, Brock N. Efficacy and utilization of skin-to-skin contact in the NICU. Newborn Infant Nurs Rev. 2002;2:17–26.
4. Feldman R, Eidelman A, Sirota L, Weller A. Comparison of skin–skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics. 2002;110:16–26.
5. Chia P, Sellick K, Gan, S. The attitudes and practices of neonatal nurses in the use of kangaroo care. Aust J Adv Nurs. 2006;23(4):20–27.