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When to initiate Kangaroo Care?

When to initiate Kangaroo Care?

A controversy about Kangaroo Care is how soon to start, and who is eligible, especially those in intensive care units.

According to the Rey & Martinez model that is described in the WHO guidelines,[1] the infant should be stable to "tolerate skin-to-skin contact".[2] [3] However, every hospital has a different definition of "stability".  Some consider unstable a baby that is intubated.  Some hospitals have a policy of separating the babies from their mothers until they achieve a certain gestational age, certain days after birth, or a specific weight.  Others take the time to systematically implement kangaroo care mitigating the risks to the point that they consider a baby in oscillator to be stable for kangaroo care. 

From a biological and neuroscience perspective, others argue that it is separation from mother that causes the instability.[4],[5],[6] 

Dr. Bergman suggests that instead of asking "how is the baby tolerating kangaroo care?" we should ask, "how is the baby tolerating not being in kangaroo care?"

Should Neonates sleep alone? 
"Maternal-neonate separation is associated with a dramatic increase in Heart Rate Variability power, possibly indicative of central anxious autonomic arousal. Maternal-neonate separation also had a profoundly negative impact on quiet sleep duration. Maternal separation may be a stressor the human neonate is not well-evolved to cope with and may not be benign."
Article "Should Neonates sleep alone?" was published in Biological Psychiatry November 2011.

Comment below what is your opinion, your experience, or your hospital policy? 


[1] WHO. Kangaroo mother care - a practical guide. Geneva, Switzerland: WHO; 2003.
[2] Charpak N, Ruiz-Pelaez JG, Figueroa dC. Current knowledge of Kangaroo Mother Intervention. Curr Opin Pediatr 1996 April;8(2):108-12
[3]Charpak N, de Calume ZF, Ruiz JG. "The Bogota Declaration on Kangaroo Mother Care": conclusions at the second international workshop on the method. Second International Workshop of Kangaroo Mother Care. Acta Paediatr 2000 September;89(9):1137-40.
[4] Bergman NJ, Linley LL, Fawcus SR. Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatr 2004 June;93(6):779-85
[5] Bergman N. The neuroscience of birth - and the case for zero separation. Curationis 2014;37(2):1-4
[6] Phillips R. The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth. Newborn and Infant Nursing Reviews 2013;13(2):67-72.

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Comments (2)

Joanna Bradshaw

As a nurse in a neonatal intensive care unit who is very much in favour of skin to skin I do sometime s ask myself if I sometimes am going to far. For example a very stable 24 weeker weight 740grams. On day four remains ventilated but doing very well and may even come off it soon, and onto cpap. Is day four too early to come out. Although very stable I often wonder about the other systems such as the blood pressure (all well on this baby). But they are not very good at auto regulating them selves and how does their vestibular system cope should I take this day 4, 24 weeker out for skin to skin?
Thank you

Yamile J.

My son was born weighing 906 grams and I kangarooed within 24 hours. It was good for him and for me, and I truly believe it did wonders for our relationship. There was nothing else I needed most than to show him that he was not alone and that I loved him. With tools like The Zaky ZAK, babies can be secured and positioned midline on the mom/dad, and foster their relationship and no-separation while providing the best possible care.

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