Kangaroo Mother Care versus Prone Position in Preterm Neonates: A Non Randomised Clinical Study

Abstract

Introduction: One of the major problems of preterm neonates is immature alimentation. This may lead to inadequate weight gain, higher chances of sepsis and increased mortality. Positioning during and after feeding affects nutritional tolerance. Kangaroo Mother Care (KMC) is a method of skin-to-skin contact between mother and neonate, claimed to improve infant outcomes. Aim: To compare prone and Kangaroo Mother Care positioning of preterm neonates of 28 to 32 weeks gestational age during orogastric tube feeding. Materials and Methods: The study was a non-randomized crossover clinical study, carried out at Sick Newborn Care Unit and Neonatal Intensive Care Unit (NICU), Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata, India, from April 2020 to March 2021. The studied parameters included gastric residual volume (3 hours postprandial), vital signs like respiratory rate, heart rate, SpO2 level, body temperature, Capillary Blood Glucose (CBG), also comfort scores using a comfort scale. Total 110 preterm neonates of 28 to 32 weeks gestational age were sampled as per inclusion criteria and divided into two groups. Each group was fed by orogastric tube feeding in its respective position, in which they were kept for 3 hours. Vital signs, comfort scores and gastric residual volume were re-assessed. Groups were crossed over on the next day. Statistical analysis was done by t-test. Results: Of the total 110 neonates, KMC sample and prone position sample were compared after 3 hours. Heart rate was 147.5±4.3 and 151.08±9.1 beats per minute and respiratory rate 52.8±2.9 and 55.6±4.9 cycles per minute, which were lower in KMC than in prone position. There was better glycemic control {n=107 (97.27) and 80 (72.73) mg/dL}, higher comfort scores (11.2±1.1 and 10.1±2.0) and minimal to negligible gastric residuals (0.03±0.05 mL and 0.13±0.12 mL) in KMC position, when compared to prone position, respectively. Conclusion: Kangaroo mother care produced more stable physiological indices, and was more comfortable for preterm neonates and resulted in better feeding, absorption and metabolism.

Effect of lying position on gastric residual volume in premature infants: A systematic review

“…The primary results of the studies included in the systematic review are presented in Table 5. In the studies by Özdel and Sarı 18 , no significant difference was found between the prone position and kangaroo care in terms of mean gastric residual volumes, whereas the study by Naskar et al 25 found less stomach residual volume in kangaroo care compared with the prone position. In the study of Yayan et al, the stomach residual volume level was lower in the right lateral and prone positions than in the left lateral and prone positions 15 .…”

“…Also, considering that most studies 16,19–22,24 recommended the prone position for its effectiveness on stomach residual volume, it seems kangaroo care has an effect similar to the prone position with the infant's contact with the mother. However, in the studies of Naskar et al, the amount of stomach residual volume in kangaroo care was less than in the prone position with regards to mean gastric residual volumes measured 3 h after feeding 25 . This could be because the participants in the study by Naskar et al 25 were preterm newborns at 28–32 weeks of gestation compared with the sample group of Özdel and Sarı, 18 which included newborn infants at 28–36 weeks of gestation, possibly leading to different results.…”

“…In one study, 23 the daily feeding volume was 150 and 75–100 ml/kg/day in premature infants with a birth weight of ≤1500 g and a gestational age of ≤34 weeks. One study 21 reported that there was no statistically significant difference between premature newborns in terms of feeding volumes, and three studies 19,20,25 provided no information on feeding volume. In only Chen et al's studies, premature newborns were supported with invasive or noninvasive mechanical ventilation 16 .…”

“…Eight of the studies 15,16,18,[21][22][23][24][25] were single-center studies and two 20 were carried out in two centers. The 10 studies discussed here were performed in Turkey, 15,18,21,23 Iran, 19,20,24 Taiwan, and India.…”

“…The 10 studies discussed here were performed in Turkey, 15,18,21,23 Iran, 19,20,24 Taiwan, and India. 22,25…”