A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants < 2000 g in Nigeria using continuous ambulatory temperature monitoring

Abstract

Although skin-to-skin contact (or kangaroo mother care, KMC) for preterm infants is a practical alternative to incubator care, no studies have compared these methods using continuous ambulatory temperature monitoring. To compare thermal regulation in low birthweight infants (< 2000 g) managed by KMC alternating with conventional care (CC) and to determine the acceptability to mothers of KMC, an experimental study with a crossover design with observational and qualitative data collected on temperature patterns and mothers attitudes to skin-to-skin care was conducted in the neonatal wards of three hospitals in Lagos, Nigeria. Thirteen eligible infants were nursed by their mothers or surrogates in 38 4-hour sessions of KMC and the results compared with 38 sessions of incubator care. The risk of hypothermia was reduced by > 90% when nursed by KMC rather than conventional care, relative risk (RR) 0.09 (0.03-0.25). More cases of hyperthermia (> 37.5 degrees C) occurred with KMC, and coreperiphery temperature differences were widened, but the risk of hyperthermia > 37.9 degrees C (RR 1.3, 0.9-1.7) was not significant. Micro-ambient temperatures were higher during KMC, although the average room temperatures during both procedures did not differ significantly. Mothers felt that KMC was safe, and preferred the method to CC because it did not separate them from their infants, although some had problems adjusting to this method of care. Where equipment for thermal regulation is lacking or unreliable, KMC is a preferable method for managing stable low birthweight infants.

Neonatal hypothermia in low resource settings: a review

“…Various interventions for prevention and management of hypothermia have been tested in community as well as hospital settings, and have added to the existing evidence base. 3,5,8,[89][90][91][92][93][94] Warm chain The 'warm chain' 32 is a set of 10 interlinked procedures to be taken at birth and during the following few hours and days to prevent hypothermia by minimizing heat loss in all newborns. Failure to implement any one of these procedures will break the chain and put the newborn baby at risk of hypothermia.…”

“…97 The practice of Kangaroo Mother Care in hospitalized LBW infants has been associated with a number of benefits, and is now considered to be at least as good as standard care with incubators. 89,91 Besides improved thermoregulation of the newborn, other potential benefits include improved maternal-infant bonding, more rapid transition to physiological stability following birth, reduced crying and longer periods of alertness, improved breastfeeding and growth, reduced incidence of serious bacterial infections and earlier discharge from hospital. 5 STSC was shown to be at least as effective as incubator care for the management of hypothermia in normal birth weight neonates in hospital settings.…”

Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India

“…The technique has found widespread acceptance for care of medically stable, hospitalized LBW infants weighing <2000 g. [2][3][4][5][6][7][8] The practice of KMC in hospitalized LBW infants has been associated with a number of benefits, and is now considered to be at least as good as standard care with incubators. 2 Potential benefits include improved maternal-infant bonding, more rapid transition to physiological stability following birth, reduced crying and longer periods of alertness, improved breastfeeding and growth, reduced incidence of hypothermia and serious bacterial infections, and earlier discharge from hospital.…”

An exploration of perceptions regarding the feasibility of implementation of kangaroo mother care in the maternity ward of Tsumeb district hospital, Namibia

“…A Nigerian experimental study on thermal regulations of infants weighing less than 2000 grams found that the risk of hypothermia was 90% reduced when baby is nursed in KMC compared to conventional care (Ibe et al, 2004).…”