KANGAROO MOTHER CARE

HISTORY, CONCEPT & PROCESS

Key Concept in KMC

Kangaroo Position

Continuous Kangaroo Position at Home

Continuous Kangaroo Position During Sleep

1990s Ambulatory KMC

1978-1996:From Practice to Science

Risk of death among LBW due to infection is
reduced by 50%
Significantly Less Hospital-acquired infections
Breastfeeding rates higher post-discharge
Cumulative mortality at follow-up visits, lower in
KMC but not statistically significant
Adequate growth especially Head Circumference
Mothers more sensitive and responsive to their
newborns and vice versa
KMC families scored higher environmental scores

1999-Present
Dr. Jose Fabella Memorial Hospital invited to
send two delegates to Colombia to train in
KMC
KMC Program was initiated in Aug 13, 1999
and prospectively evaluated systematically for
one year
The program was institutionalized in 2000
after demonstration of beneficial effects on
mortality and morbidity*

KMC : The Local Evolution

Incubator Care for Stable LBW

Stable LBW in KMC Position

Stable LBW Adapting to KMC

Kangaroo Mother Care Ward

HIGH-TECH NICU v.s. KMC?

KMC : Local Evidence (JFMH)

Significant reduction in proportion of
LBW deaths due to sepsis
Significant reduction in LBW mortality
Significantly increased breastfeeding
rates among KMC LBWs compared to
well term newborns up to 6 months postdischarge
Thermoregulatory effect equal to even
better than incubator
Significant economic benefits

KMC : Reaching Out to the Community 2004

Pilot in the community of Manila
Collaborated with the Manila Health
Department, MCH & Office of Midwifery
Services
Training of KMC Trainers
Implementation
Documentation & Evaluation
Institutionalization

KMC : A Global Program

KMC Around the Globe

KMC, Uppsala Sweden

NICU & KMC Around the Globe

Unidad de Uppsala, Sweden

Photos courtesy of KMC Uppsala University Sweden

Participation of the Father in NICU

Photos courtesy of Kangaroo Foundation, Bogota, Colombia

Parents Participation and empowerment

Photos courtesy of Kangaroo Foundation, Bogota, Colombia

The Evolving Potential : the micro Impact of KMC

Potential influence of the nociceptive stimuli (ex: sensoneural experiences)
on the structure and function of an immature brain

20 w

25w

35w
40.000 synapses per second

Neuronal migration
astrocytognesis

oligodendrognesis

axonal and dendritic development

synaptognesis

Programmed cellular death

Kangaroo Foundation, Bogota, Colombie

A. Sola 2000

Brain Development at Various AOG

12

19

26 wks

22

35 wks

Cross-section of Brain during Development

Macro
19

22

Macro
26

Macro
Macro
35

26 wks

Macro

33 wks
Macro

Critical Period of Brain Development

Premature brain (~24 weeks)

Brain of baby born at term

Kangaroo Foundation, Bogota, Colombie

Carmen Pallas 2005

KANGAROO MOTHER CARE

Allows the development of the immature
brain in a less stressful environment
Prepares the family for the care of this
frail infant

Kangaroo Foundation, Bogot, Colombia

K.Nyqvist. Unidad de Uppsala

Providing KMC and

success in breastfeeding
the premature infant is a
multidisciplinary work
between staff and family
and its time-dependent

Breastfeeding the LBW

Leche League

Development of Feeding Cues/Reflexes

9 family-baby rooms in the neonatal unit with a bed, a bathroom, a

monitor and the possibility to have a crib or an incubator. Parents
are stimulated to carry their infant in KMC 24/7 (Sweden)

Kangaroo Foundation, Bogota, Colombie

K.Nyqvist Unidad de Uppsala

KMC : The second Evolution

KMC is a comprehensive way of
transforming the manner in which we care
for our LBW infants.
KMC today, is no longer the poor mans
alternative.
KMC brings physiologically sound, humane
and emotionally appropriate intervention
to the NICU & complements neonatal care.

KMC Global
Guidelines
WHO 2003

KMC
EvidenceBased CPGs
Colombia

KMC : a concept, a method of care

For the baby/mother dyad & the Family

There is a
logical
progression
in the
implementation
of KMC

1-Skin to skin contact

a. Intermittent
b. Continuous
2-Breastfeeding the premature infant
3.Empowerment of the mother and the family
(KMC rooms)
4-Home discharge in kangaroo position

5- Appropriate growth & development

In a healthy environment

KANGAROO MOTHER CARE

RECENT DEVELOPMENTS

Kangaroo mother care vs conventional neonatal care:

OUTCOME: Mortality at discharge or 40-41 weeks PCA

Continuous KMC

With Continuous KMC,

the risk of dying is reduced by 40% (p= 0.03)
Conde-Agudelo The Cochrane Collaboration, 2014

Kangaroo mother care vs conventional neonatal care:

OUTCOME: Mortality at discharge or 40-41 weeks PCA

Age of KMC Initiation: <10 DOL

Age of KMC Initiation: >10 DOL

With KMC < 10 DOL, the risk of dying reduced by 44% (p= 0.01)
Conde-Agudelo The Cochrane Collaboration, 2014

Kangaroo mother care vs conventional neonatal care:

OUTCOME: Mortality at discharge or 40-41 weeks PCA

Low/middle-income countries

High-income countries

Reduction by 43%, risk of dying among LBW infants

in low-middle income countries
Conde-Agudelo The Cochrane Collaboration, 2014

Kangaroo mother care vs conventional neonatal care:

OUTCOME: Severe infection/sepsis at latest follow up

With KMC, the risk of sepsis is reduced by 44% (p= 0.0008)

Conde-Agudelo The Cochrane Collaboration, 2014

Kangaroo mother care vs conventional neonatal care:

OUTCOME: Weight gain at latest follow-up (g/day)

Significantly higher weight gain per day among KMC infants

Conde-Agudelo The Cochrane Collaboration, 2014

Among KMC babies

The earlier the initiation of KMC
The longer the KMC
The higher the chance of survival of LBW
infants
Especially in low to middle income countries
Risk of sepsis is reduced by 44%
Daily weight gain is significantly higher among
KMC babies
Conde-Agudelo The Cochrane Collaboration, 2014

KMC Benefits
Philippine Evidence

Weight
gain

Mortality

Hospital
Stay

Nursing
load

Hypoglycemia

Sepsis

hypothermia

By 50% duration of
CPAP and oxygen
support

exclusive
breastfeeding for first
6 months

PGH
Fabella
MMMMC

Increase prolactin
levels and breastmilk
production

Safe for
Transport
Both Intermittent &
Continuous KMC
beneficial

Global Call to KMC Acceleration

KMC Global Programs

KMC MAP OF THE PHILIPPINES

69 Health facilities
trained
All Regions of the
Country covered
13 Certified as KMC
Centers of Training and
Excellence
Care for the Small Baby
Package of Interventions

DOHs Care for the Small Baby

Package of Interventions:
1. Antenatal Steroids for mothers in preterm
labor
2. Essential Intrapartum care for the stable LBW
3. Basic Newborn Resuscitation
4. Kangaroo Mother Care