MODULE 3: Kangaroo Mother Care

Overall Aim:

Acquire sufficient knowledge and demonstrate the skills to be able to initiate KMC among
LBW’s in the delivery room.

Overall Objective:

At the end of the workshop, participants should be able to:

1. Acquire sufficient knowledge and demonstrated the skills to be able to provide KMC
2. Demonstrate the capability to guide mothers how to provide KMC to their LBW babies
3. Been oriented to the standard forms and documents used in initiating KMC in the
delivery room
INTRODUCTION

A. KMC History
Kangaroo mother care started in 1978 in Bogota, Colombia by Dr. Rey and Martinez in
response to shortage of incubators and increasing rates of infection in the hospital. In the
Philippines, it was started in Dr. Jose Fabella Memorial Hospital upon the return of Dr. Socorro
Mendoza from the training on Kangaroo Mother Care at Fundacion Canguro (Colombia, 1999).
KMC was then institutionalized and adopted as the standard of care for all low birth weight
babies (babies weighing <2,500g) and cascaded to the local Manila Health Department involving
all lying-clinics in 2004. In order to cascade the implementation of KMC in other hospitals
nationwide, Dr. Mendoza established the Bless-Tetada Foundation in 2008 and later on
developed standardized protocols and procedures for raining, implementation, research,
monitoring and accreditation. The first hospital that underwent training, pilot implementation
and accreditation as KMC center of excellence was Mariano Memorial Medical center in Region
1 (2010-2011) followed by Eastern Visayas Regional Medical Center in 2012. There are now 144
hospital nationwide who has been trained on KMC and there are already accredited as Center
of Excellence in Training and Research.

Include hx/evolution of CSB

B. The low birth weight newborn

Birthweight is the first weight of the newly born obtained after birth, preferably within
the first hour of life or after the first full breastfeed of a healthy, vigorous, normal newborn.
Low birth weight is birth weight of less than 2,500 grams or 5 pounds 8 ounces. There are
several causes of low birth weight namely preterm birth, intrauterine growth retardation,
mother’s poor health, nutrition and illness during pregnancy, poor socio-economic status of the
family and poor pre-natal care. Birth weight can be affected by the following factors:

1. Fetal factors
a. Gender: for the same age of gestation , girls weigh less than boys
b. Birth order: first-born infants are lighter than subsequent infants
c. Multiple pregnancy: twins weigh less than singletons
d. Chromosomal aberrations
e. Renal function
2. Maternal factors
a. Mother’s diet from conception to delivery
b. Mother’s body composition at conception
c. Mother’s own fetal growth
d. Women of short stature
e. Residence in areas of high altitude
 f. Adolescent mothers have smaller babies
g. Mother’s lifestyle, illness, exposure
3. Intrauterine and extra-uterine environment
a. Placental and cord morphology and function
b. Uterine crowding from mass lesions
c. Socio-economic deprivation
d. Exposure to environmental toxins
e. Large families
Babies who are born with low birth weight are also at risk to develop the following
immediately after birth: hypothermia, hypoglycemia, hyperglycemia, hypocalcemia, feeding
problems, problems related to prematurity, polycythemia and anemia. Later during adulthood,
they are also at risk to develop the following long-term problems: poor growth during
childhood, higher incidence of adult diseases like Type II DM, hypertension, cardiovascular
diseases, neurodevelopmental problems and nutritional or feeding difficulties. (Barker
Hypothesis)

C. KMC Concepts

KMC is a comprehensive way of transforming the manner in which we care for our LBW
infants. It is now the standard of care for all low birth weight infants and is no longer the “poor
man’s” alternative. It brings physiologically sound, humane and emotionally appropriate
intervention to the NICU and complements neonatal care.

Four essential components of KMC

1. Kangaroo position
2. kangaroo feeding strategy
3. kangaroo early discharge
4. ambulatory kangaroo care

There is logical progression in the implementation of KMC which may start as

INTERMITTENT KMC where skin to skin contact can be done intermittently, with mother and
baby dyad in kangaroo position at least 2 hours continuously for a total of 8 cumulative hours
per day improving to CONTINUOUS KMC with the mother and baby dyad in kangaroo position
of at least 20 cumulative hours per day. Later on progressing to breastfeeding the premature
infant, empowerment for the mother and the family to take care of a very small baby,
continuing kangaroo position even after discharge and eventually having appropriate growth
and development in a healthy environment.

Definition of Terms:

1. Kangaroo position (KP)

 The LBW is placed in a vertical position on mother’s chest, in between her breasts, in
skin to skin contact and held using an expandable shirt or clothing.

2. Kangaroo mother care method (KMCM)

Standardized and protocol-based system of caring for the preterm and/or LBW
which includes:

a. Kangroo position
b. Breastfeeding
c. Mother and family assumes responsibility for the care of the LBW

3. Kangaroo mother care intervention (KMCI)

Series of steps that are applied thoroughly and systematically following the
kangaroo mother care method. It includes:

a. KMC method
b. Early discharge
c. Ambulatory KMC

Benefits for the LBW and family:

1. Better weight gain

2. Decreased risk for infection
 Protective maternal flora acquired from skin-to-skin contact
 Protection from breastfeeding
 Decreased risk of nosocomial infection due to early discharge
3. Improved maternal/family and infant bonding
 4. Increased and sustained breastfeeding post-discharge
5. Better neurodevelopmental outcome
6. Maternal and family empowerment
7. Decreased cost of care (early discharge) and health maintenance
(breastfeeding)

4. Kangaroo mother care program

Group of activities aimed at implementing the KMCI with an adequately-trained and

organized health care team within a specific administrative and physical structure.
Essential components:
a. KMCI
b. KMC team
c. Administrative structure

Benefits to the hospital and nation:

a. Decreased neonatal morbidity and mortality to help achieve MDG 4

b. Improved breastfeeding rates post-discharge, key indicator for sustaining
MBFHI accreditation
c. Appropriate catch-up growth rates and neurodevelopment of the LBW
d. Decreased incidence of adult diseases among LBW, contributing to a
healthier and productive population

D. KMC Benefits: Philippine Evidence

1. decrease in
a. mortality rate
b. sepsis rate
c. duration of CPAP and oxygen support
d. hypoglycemia
e. hypothermia
f. hospital stay
g. nursing load
2. safe for transport
3. increase weight gain
4. increase prolactin levels and breastmilk production
5. both intermittent and continuous KMC are beneficial
E. Levels of KMC implementation
 KMC SCORPIO

Overall Aim:

Acquire sufficient knowledge and demonstrate the skills to be able to initiate KMC among
LBW’s in the delivery room.

Overall Objective:

At the end of the workshop, participants should be able to:

4. Acquire sufficient knowledge and demonstrated the skills to be able to provide KMC
5. Demonstrate the capability to guide mothers how to provide KMC to their LBW babies
6. Been oriented to the standard forms and documents used in initiating KMC in the
delivery room

A. SCORPIO STATION

KMC Initiation and Documentation

Aim: This station aims to demonstrate the Kangaroo Position and Transport in KMC

Objectives:

At the end of the station participants should be able to:

1. Enumerate criteria for eligibility of babies and mothers to be in KMC

2. Demonstrate kangaroo position
3. Monitoring KMC mother-baby dyad while in the DR until transport to hospital/room
4. Documentation of KMC initiation
 Who are eligible to start KMC?

Eligibility criteria:

Maternal:

1. Freedom from any active, communicable disease

2. Willingness to lactate & breastfeed

3. Emotional/psychological stability

4. Commitment to the KMC technique

Neonatal:

1. Weight at enrolment <2,500gm

2. Clinical stability for holding with or without feeding

3. Prior to transfer to room/ward, ability to breastfeed in a coordinated fashion

 Where can we start KMC?

KMC can be started immediately after the delivery of the LBW in the delivery. They can also be
initiated once they fulfill the criteria at the NICU, in the wards or at the out patient department.

How is the process of initiation of KMC?

1. Inform the Mother/Father prior to initiation

and determine acceptability/willingness

2. Satisfaction of selection criteria

3. Written order in chart by the attending MD

4. Informed consent

5. Intermittent KMC

6. Continuous KMC

7. Educating & training the Mother & baby

8. Completion of documents for initiation

Education and Training the KMC dyad

1. Holding the LBW neonate

2. Placing the baby in kangaroo position

3. Taking the baby out of the kangaroo position

4. Feeding the LBW

5. Maintenance of cleanliness & hygiene

6. Recognizing signs of instability or illness

7. Exercise & relaxation in KMC

Holding and Positioning baby in KMC

Documentation

There are prescribed documents that are being used by hospital trained and currently implementing the
KMC program. If your hospital is still in the process of training or is yet to train, we recommend to use
the following documents/forms in documenting KMC initiation.

A. Initiation form
B. Mother-baby dyad monitoring sheet