Running head: KANGAROO MOTHER CARE 1

Kangaroo Mother Care

Shannon Vandenberg
Ferris State University








Kangaroo Mother Care 2

Abstract
A clinical situation about low birth weight neonates associated with an increased rate of
mortality and/or morbidity is approached by conventional neonatal care that is expensive and
complex. This limits the care for developing countries because of the scares resources available
raising the issue of an alternative practice. Kangaroo Mother Care is a skin-to-skin contact
intervention found as an alternative through evidence-based research at high levels of evidence.
Specific methodology is chosen for available evidence and article critiques performed to
interpret the research findings. Evidence findings are integrated to support the quality and safety
of the available resources to provide significance for nursing decisions.














Kangaroo Mother Care 3

Introduction
The purpose of this paper is to be able to develop clinical questions based on the
interpretation of research findings by using evidence-based research. This assignment is to
enhance the nursing processes and gain nursing knowledge to implement in the professional
practice and for personal advancement. The clinical question developed is, In low birth weight
neonates in health facilities, is Kangaroo Mother Care more effective than conventional care in
reducing mortality and/or morbidity.
Clinical Question
Low birth weight is the major contributor to infant mortality and morbidity. According to
Conde-Agudelo & Daz-Rossello (2014) a low birth weight is accounted for nearly 60%-80% of
neonatal deaths and about two-thirds of infant deaths. Authors Conde-Agudelo & Daz-Rossello
(2014) define low birth weight as, weight at birth of less than 2500 g irrespective of gestational
age (Conde-Agudelo & Daz-Rossello, 2014, p. 2). To approach the high-risk neonates requires
complex quality of care, high technology, and financial stability. In low income countries, the
resources are scares and the technology is not available (Nirmala et al., 2006). The neonatal
morbidity and mortality rates among low birth weight complications are a major concern in these
developing countries. To address this issue, an alternative method is to be developed to provide
the appropriate care for high-risk neonates.
An alternative that is becoming recognized as being the quality advancement to this issue
is a skin-to-skin contact intervention known as Kangaroo Mother Care (KMC). This involvement
is between the mother and the infant where they are positioning in a skin-to-skin contact with no
barriers of clothing (Nirmala et al., 2006). The benefits of this method are to provide the
opportunities for personal attachment, exclusive breastfeeding, and health stabilization (Samera
Kangaroo Mother Care 4

et al. 2013). According to Thurkral et al. (2008), the list of physiological benefits of KMC are,
Heart and respiratory rates, respiration, oxygenation, oxygen consumption, blood glucose, sleep
patterns and behavior observed in preterm/LBW infants held skin-to-skin tend to be similar to or
better than those observed in infants separated from their mothers (Thurkal et al., 2008, p.4).
KMC is an inexpensive and simple approach that can be applied to the units experiencing scares
resources. The tremendous list of benefits can only motivate for the implementation of this
intervention to advance the care and improve the issue.
The clinical question is undertaken to determine if KMC reduces the morbidity and
mortality in low birth weight infants and provide valuable resources for the current practice.
Conventional care for the issue requires great expenses and professionals trained and
experienced to support the logistics of this condition (Conde-Agudelo & Daz-Rossello, 2014).
In developing countries that dont have these resources available could then use KMC as an
alternative to meet the same components of conventional neonatal care. The intervention of the
developed KMC can supply nutrition and maintain the infants body temperature to allowing the
specific demands necessary to meet the infants physical and emotional needs (Conde-Agudelo
& Daz-Rossello, 2014).
Methodology
Once a clinical problem was identified the development of a PICOT question was
developed. In low birth weight neonates in health facilities, is Kangaroo Mother Care more
effective than conventional care in reducing mortality and/or morbidity. This curiosity was
obtained through a personal experience in the Obstetrics unit when a couple from India requested
to practice the method of Kangaroo Mother Care. This spark of interest leads to the creation of
the PICOT question.
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The database of CINAHL and PubMed were utilized to search for the evidence available
based on the nursing problem identified. Obtained knowledge from class was used to effectively
search for articles that were related and had the most supporting evidence. To search for criteria
with the most reliable evidence was formulated in the advance search option. Available options
were chosen for inclusions such as in the title, peer-reviewed, five year periods, and full text.
Some findings had to come from available sources that were outside of the five year period
which became a threat to validity. The findings were still used for purposes of background
knowledge of the issue, however results were excluded. The main purpose of this course was to
find nursing research which became a challenge. According to Nieswiadomy (2012), in the book
Foundations of Nursing Research states, Using this definition, nursing research includes all
studies concerning nursing practice, nursing education, and nursing administration
(Nieswiadomy, 2012, p. 3). This helped include sources that werent particularly by nurses, but
involved in other aspects. Keywords used to obtain findings included kangaroo mother care, low
birth weight, neonates, morbidity, mortality, nursing, and skin to skin contact. Findings that were
used were related to the PICOT question developed and provided with the most support to the
practice.
The attempt for the highest level of evidence was achieved upon the result of a systemic
review from 2014. The level of evidence for the article was placed at the level C stated as,
Qualitative studies, descriptive or correlational studies, integrative reviews systematic reviews,
or randomized controlled trials with inconsistent results (Armola et al., 2009). The lowest level
of evidence found was Level D because criteria lower than a Level D was excluded from the
findings. The purpose was to find the highest level of evidence to support accurate findings and
defend the threats to validity.
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Discussion of Literature
Article One
A recommendation, based on the systemic review of Kangaroo Mother Care to Reduce
Morbidity and Mortality in Low Birthweight Infants written by Conde-Agudelo and Daz-
Rossello, should include a policy change considering low birth weight neonates in health care
facilities to reduce the neonatal morbidity, mortality, and costs using kangaroo mother care as an
alternative to conventional neonatal care. The source of the article is from The Cochrane Library
and upon visiting the home page of the website found that the publication was peer-reviewed.
The authors are affiliated with National Institutes of Child Health, Human Development, and
Human services. The main subject of this article is about the alternative intervention of
Kangaroo Mother Care to address the issue of low birth weight neonates developing risks and
declining survival rate. The problem investigated in the study is the need to determine which
intervention is the more effective practice for low birth weight infants. The purpose of the article
is on page 3 stating, To determine whether there is evidence to support the use of KMC in LBW
infants as an alternative to conventional neonatal care before or after the initial period of
stabilization with conventional care (Conde-Agudelo & Daz-Rossello, 2014). It was easy to
identify and understand the purpose because it was clearly stated and supported several times
throughout the study.
The sample for this crossover designed study was selected to ensure consistency of data
collection including low birth infants regardless of gestational age. The population sample
instituted inclusions and exclusions to decrease threats to validity. On page 5-7 provides several
domains that were considered as the risk of bias during the treatment such as random sequence
generation, allocation concealment, and binding of participants and personnel (Conde-Agudelo
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& Daz-Rossello, 2014). Using the AACN level of evidence (2009), the level of evidence chosen
for this systemic review is Level C stated as, Qualitative studies, descriptive or correlational
studies, integrative reviews systematic reviews, or randomized controlled trials with inconsistent
results (Armola et al., 2009). The statistical analysis used for the data are interval level or
higher because they used risk ratio and mean difference both with 95% confidence intervals. On
page 21 the authors state, The results of this updated review indicate that, currently, there is
sufficient evidence to support the use of KMC in stabilized LBW infants as an alternative to
conventional neonatal care in resource-limited settings (Conde-Agudelo & Daz-Rossello,
2014). The majority of the results concluded that it reduces the incidence of respiratory tract
infections and decreases the rate of nosocomial infections. The conclusions were consistent with
other findings, clearly stated, and seemed valid because it answered the identified question.
Based on the results of this study, more research would be more helpful with a larger sample size
and strong study design. Based on the current policy which is the conventional neonatal care,
should be open to offering the alternative of Kangaroo Mother Care to reduce morbidity and
mortality in low birth weight infants.
Article 2
A recommendation, based on the article of Effect of Intermittent Kangaroo Mother Care
on Weight Gain of Low Birth Weight Neonates with Delayed Weight Gain written by
professionals affiliated with pediatric departments and institutions, should include a policy
change considering the use of Kangaroo Mother Care as an alternative to standard care for low
birth weight neonates in health care facilities. The source of the article is from The Journal of
Perinatal Education where peer-reviewed journals are published according to the homepage of
the journals website. The background on page 194 supports the need for the study because it
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provides the low level of evidence. The main subject of the article is intermittent Kangaroo
Mother Care intervention promotes breastfeeding and becomes a practical method to regain birth
weight for infants. The issue is found on page 195 stating, Weight gain problems represent
about 25% of cases in our neonatal intensive care unit (NICU) (Samra et al., 2013). To reduce
morbidity and mortality rates, implementing the method of Kangaroo Mother Care versus the
standard care to effectively improve this issue. The purpose of this article is found on page 195
stating, The aim of this study was to examine the effectiveness of intermittent KMC with
increased opportunities to breastfeed on weight gain in LBW neonates who did not start to gain
weight after Day 7 (Samra et al., 2013). The purpose was easy to locate and understand because
it was clearly stated near the beginning of the study.
The study is a non-randomized controlled, quasi-experimental design with a sample
selected to ensure consistency of the data collection. The authors stated on page 198, We
designed the inclusion and exclusion criteria to limit to the utmost extent of the influence of
confounding variables on our results (Samra et al., 2013). This provides evidence that the
authors instituted these types on inclusions and exclusions to decrease threats to validity. Using
the AACN level of evidence (2009) , the level of evidence for selected for this design would be
Level C stated as, Qualitative studies, descriptive or correlational studies, integrative reviews
systematic reviews, or randomized controlled trials with inconsistent results (Armola et al.,
2009). The chi-square test was used as the statistical analysis at interval level or higher. The
results for the study was that intermittent Kangaroo Mother Care had effective results for weight
gain in neonates with delayed weight gain. However, there wasnt a significant among of birth
weight gained between the two interventions. Only mean daily weight was higher for Kangaroo
Mother Care. The conclusions were consistent with other findings, clearly stated, and seemed
Kangaroo Mother Care 9

valid because it answered the identified question. Based on the results of this study, more
research would be more helpful with a larger sample size and strong study design. Based on the
current policy to use standard care for low birth weight infants, should be open to offer the
alternative of intermittent Kangaroo Mother Care to low birth weight neonates with delayed
weight gain.
Article 3
A recommendation, based on the article of Kangaroo Mother Care: Effect and perception
of mothers and health personnel written by health professionals, should include a policy change
to Kangaroo Mother Care as a cost effective alternative to implement for low birth weight
neonates versus the current policy of conventional care. The source of this article is found in The
Journal of Neonatal Nursing. Upon locating the home page of the journals website found
published peer-reviewed journals were offered. The review of literature on page 178-179
supports the need for the study because of the low level of evidence. The main subject of this
article is found on page 178 about the approach for high-risk newborns being effective through
the combination of socio-cultural, economic, and professional conditions along with a well-
developed structure (Nirmala et al., 2006). The problem investigated in the article is to determine
between kangaroo Mother Care and routine care as the most effective and safe implementation
for areas with limited resources. The purpose of this study is found on page 178 stating, Hence
it was intended to determine whether the heart rate, temperature, respiration rate and oxygen
saturation of LBW neonates nursed in the NICU and Obstetric (OB) ward differed significantly
or not during Kangaroo Mother Care and routine care (Nirmala et al., 2006). The purpose was
easy to find and recognized because it was clearly stated throughout the study.
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This study is a time-series quasi-experimental design with a convenient sample of
mothers. The sample selected for this data was based on specific criteria to enhance the purpose
of the study. The authors state, KMC has been suggested as an alternative that is appropriate,
and affordable yet of a high quality, that could be easily implemented with no exclusion criteria
for all premature babies (Nirmala et al., 2006). However, the study was done in 2006 which is a
threat to validity for using this study for current research and is now considered exclusion
criteria. Using the AACN level of evidence (2009), the level of evidence for selected for this
design would be Level D stated as, Peer-reviewed professional organizational standards, with
clinical studies to support recommendations (Armola et al., 2009). Repeated measures
multivariate analysis of variance (RMANOVA) was the statistical data used at an interval level
or higher. The results of the findings were found on page 182 concluding no significant
differences (Nirmala et al., 2006). However, the Kangaroo Mother Care is a safe and resourceful
alternative to implement that only requires a supportive environment and motivated health
personnel. The conclusions of the results were consistent with findings from similar studies. The
results seemed to be valid and clearly stated throughout the study. Based on the results of this
study, more research would be more helpful with a larger sample size and strong study design.
Based on the current policy of routine neonatal for low birth weight infants, the alternative of
Kangaroo Mother Care should be implemented as an acceptable and practical practice when
resources are limited.
Significance to Nursing
The significance of the evidence findings was that it can be integrated into practice to
improve the quality and safety by using new methods through research. KMC would not have
been implemented if the practice was not identified through evidence-based research. As a nurse,
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the quality and safety of the patient is the most important practice to maintain. By integrating
new research findings it allows the removal of any barrier and benefits with supporting evidence
in nursing decisions. Integrating evidence and research findings into practice, according to the
ANA Scope and Standards of Practice (2010), states the registered nurses, Incorporates
evidence when initiating changes in nursing practice (ANA, 2010, p. 58). It is a part of the
nursing process to protect the patient by initiating in evidence research before advancing a
nursing practice.
Evidence findings can impact quality and safety because it provides additional
support when educating the patient. For the nursing issue related to low birth weight infants, a
standard practice needed to be implemented. The significance of this practice was to have an
alternative method to conventional care for low-resource countries. According to The Quality
and Safety Education for Nurses, current evidence that affects the values for optimal health care
can be defined as Value the concept of EBP as integral to determining best clinical practice
(Pre-licensure KSAS, 2014).. The availability of resources when making a clinical decision can
be utilized with evidence findings. Through research, KMC was created as an alternative method
to impact the relevant health care policy of conventional care and reflect on available resources.







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References
American Nurses Association (ANA). (2010). Nursing: Scope and Standards of Practice (2010th
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Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., &
Heafey, C. A. (2009, August). AACN Levels of Evidence: Whats New?. In Critical
Care Nurse. Retrieved July 16, 2014, from Critical Care Nurse (10.4037/ccn2009969).
Conde-Agudelo A., & Daz-Rossello JL. (2014, April 22). Kangaroo mother care to reduce
morbidity and mortality in low birthweight infants. In The Cochrane Library. Retrieved
July 2, 2014, from The Cochrane Library (10.1002/14651858.CD002771.pub3).
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed., p. 3). Boston: Pearson.
Nirmala, P., Rekha, S., & Washington, m. (2006, September 7). Kangaroo Mother Care: Effect
and perception of mothers and health personnel. In Journal of Neonatal Nursing.
Retrieved July 25, 2014, from CINAHL (10.1016/j.jnn.2006.07.008).
Pre-licensure KSAS (2014). In QSEN Institute. Retrieved August 4, 2014, from
http://qsen.org/competencies/pre-licensure-ksas/#evidence-based_practice
Samra, N. M., Taweel, A. E., & Cadwell, K. (2013, October). Effect of intermittent kangaroo
other care on weight gain of low birth weight neonates with delayed weight gain. In The
Journal of Perinatal Education. Retrieved August 3, 2014 (10.1891/1058-
1243.22.4.194).
Thukral, A., Chawla, D., Agarwal, R., Deorari, A. K., & Paul, V. K. (2008). Kangaroo Mother
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