Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

Abstract

Background: Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs). Methods: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents' knowledge and experience of KMC provision was administered to parents providing KMC. Results: One hundred thirty-five preterm infants received KMC, 21.2% of all preterm infants discharged. 65.2% of those who received KMC were below 32 weeks GA, 60.7% had a birth weight below 1500 g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA < 28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants. Conclusions: After advocacy, training and promotion, intermittent KMC was initiated on more immature and highrisk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia

“…A study from the United States found that the average gestational age of infants who received KMC was around 33 weeks, with KMC being performed when the infant was in a stable condition [18]. However, another study that included infants in a NICU with a gestational age less than 32 weeks found that KMC could be initiated after several days once the infant was considered to be in stable condition by a neonatologist [19,20]. Infants with a gestational age less than 32 weeks generally have a longer stay in the NICU, leading to more anxiety among the infant's family members, which could lead to a longer period of more intense KMC education during the infant's hospitalization [19].…”

“…However, another study that included infants in a NICU with a gestational age less than 32 weeks found that KMC could be initiated after several days once the infant was considered to be in stable condition by a neonatologist [19,20]. Infants with a gestational age less than 32 weeks generally have a longer stay in the NICU, leading to more anxiety among the infant's family members, which could lead to a longer period of more intense KMC education during the infant's hospitalization [19]. This can provide an opportunity for more successful KMC for very preterm infants.…”

“…The results of a 2002 hospital survey from the United States showed that around 67% of infants in a level 3 NICU received KMC, although more up-to-date data are required [25]. If an infant who was initially treated in the NICU improves, and the family is educated about KMC while the infant is being treated and willing to perform KMC, then KMC can be performed [19,20].…”

“…Furthermore, longer and more intensive KMC education during hospitalization could improve the willingness of mothers to perform KMC as well as their confidence. This could minimize the likelihood of missing the window for providing KMC to eligible infants [9,19,22]. Health workers, especially nursing staff, play a vital role in promoting KMC due to their role in caring for infants, educating mothers about infant care, and performing daily monitoring of infants [29].…”

Implementation experience of a 12-month intervention to introduce intermittent kangaroo mother care to eight Chinese neonatal intensive care units

“…Adequate spacing, equipment and human resources are key points to successful KMC implementation. Due to the practice of restricting parental access to NICUs in China, the KMC protocol developed was for intermittent KMC [ 8 , 9 ]. Despite the improved service capacity, we did not observe an increase in KMC coverage, which is contrary to the perspective that hospital infrastructure is the main barrier to KMC implementation.…”