Kangaroo Mother Care

1. DEFINITION

Definition: Care method for preterm/LBW infants involving continuous Skin-to-Skin (STS) contact with mother/caregiver to ensure optimum growth and development.
Status: Standard of care for LBW infants in all settings (WHO).
Goal: Promote thermal control, breastfeeding, and bonding while reducing mortality.

Kangaroo Position (Skin-to-Skin Contact):
- Vertical Position: Infant placed between mother's breasts under clothes.
- Posture: Hips flexed and abducted ("frog position"); head turned to one side/extended for airway patency.
- Maternal Position: Semi-reclining to prevent gastric reflux in the infant.
Exclusive Breastfeeding:
- Direct suckling or expression of milk while in position.
- Promotes higher rates and longer duration of lactation.
Early Discharge:
- Safe discharge from facility once stable and mother is confident.
Continued Follow-up:
- Regular monitoring of growth (weight/neurodevelopment) after discharge.

Based on Duration:
- Intermittent: For unstable babies or initial adaptation (short sessions).
- minimum session should be one hour
- Continuous: Ideally >20 hours/day (minimum 8 hours/day for benefit). Interrupted only for diapers.
Based on Timing:
- Late/Conventional: Initiated after hemodynamic stability (off respiratory support).
- Immediate (iKMC): Initiated within 24 hours of birth, even if on non-invasive ventilation (CPAP/HFNC).
Based on Setting:
- Facility-based: Initiated in NICU/Postnatal ward.
- Home-based: Continued care in the community post-discharge.

Indication: All preterm and LBW neonates.
Stability: Hemodynamically stable (no shock/vasopressors).
Permitted Support: Can be done with IV fluids, Orogastric tube, or Non-invasive ventilation (CPAP).
Apnea: Not a contraindication (KMC reduces apnea episodes).
Contraindications: Hemodynamic instability (shock), invasive ventilation (some protocols allow), active seizures, severe jaundice requiring intense phototherapy.

Willingness: Mother must be counseled and motivated.
Health: Free from serious illness or active infections.
Hygiene: Daily bath, clean clothes, short fingernails.
Support: Family members (father/grandparents) needed to relieve mother for breaks.

Infrastructure: Reclining chairs, open visitation policy, "Mother-NICU" beds.
Staff: Trained to support positioning and breastfeeding.

Mortality Reduction: Reduces neonatal mortality by ~40% (22% even with immediate initiation).
Survival: Significant survival benefit irrespective of birth weight or setting.

Hypothermia: Reduces risk by ~68% (Mother acts as a heat source).
Sepsis: Significant reduction in severe infections/nosocomial sepsis.
Apnea: Reduces episodes by 60% due to sensory stimulation and upright posture.
Stability: Improved heart rate and oxygen saturation stability.

Physical Growth: Better daily weight gain (15-20 g/kg/day), length, and head circumference.
Breastfeeding: Higher rates of exclusive breastfeeding at discharge.
Neurodevelopment: Reduced school absenteeism and behavioral problems (hyperactivity/aggression) at 20 years of age.
Analgesia: Reduces pain scores during minor procedures (e.g., heel prick).
Reduced stress - reduced cortisol levels

Weight Gain: 15–20 g/kg/day for 3 consecutive days.
Thermoregulation: Maintains temperature at room temperature for 3 consecutive days.
Feeding: Accepting breast milk well (direct/spoon/paladai).
Confidence: Mother confident in handling the baby.