angaroo mother care (KMC) is a nursing method that involves skin-to-skin contact between a mother and her newborn to help establish bonding and meet the baby's biological and emotional needs. It's a simple way to care for low birth weight infants (LBWIs), who are born with a weight below 2500 grams, and is especially important because 20 million LBWIs are born worldwide each year.
4. Background (1/2)
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• The global prevalence of low birth weight (LBW) is
15.5%, which amounts to about 20 million LBW infants
born each year (WHO, 2003).
• Among which, 96.5% occur in developing countries.
5. Background (2/2)
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• Globally, low birth weight (LBW) contributes to
60% to 80% of all neonatal deaths.
• Preterm birth and small for gestational age is
the most common direct cause of newborn
mortality, is one of the reason for low birth
weight.
• Prematurity is the primary cause of newborn
death accounting to 31% (NENAP, 2016).
6. What is Kangaroo Mother Care?
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• Kangaroo Mother Care (KMC) is care
of newborn infants secured skin-to-skin
to the mother
• KMC is a powerful and easy to use
method to promote the health and well-
being of
o Low birth weight (LBW) - infants
with birth weight below 2500g
o Preterm infants – infants with
gestational age less than 37 weeks
o Full term infants
7. Reasons why KMC was implemented (1/2)
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• In 1979, while working in hospital of Bogota,
Colombia, Dr. Edgar Rey & Hector Martinez,
found out that:
• Large numbers of LBW & preterm infants were
delivered because of:
oPoor Antenatal Care attendance
oHigh incidence of toxaemia of pregnancy,
anaemia & infections
oShortage of staff & inadequate equipment
8. Reasons why KMC was implemented (2/2)
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• High infection & mortality rate because of
overcrowding
• Large numbers of infants who were abandoned by
their mothers
9. KMC Practice in Colombia
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• Maternal-infant skin-to-skin contact was
introduced to stable LBW infants surviving the
first few weeks of life
• Exclusive breastfeeding was encouraged
• As long as infants could feed and were gaining
weight, they were discharged, regardless of
weight
10. • This practice resulted in:
o Improved outcome for LBW infants
o Decreased hospitalisation time
o Less overcrowding
o Less abandoned infants
o Improved staff morale
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12. Why is it called Kangaroo Mother Care?
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• A newborn baby kangaroo (joey) is very immature at birth
and very small in size.
• The mother kangaroo’s pouch provides warmth, safety and
a constant supply of food (milk) to the joey.
13. Similar to kangaroo care giving the human infant is also
immature and especially the LBW infant benefits from
skin-to-skin care because it provides warmth, safety and
food.
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14. Additionally…
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• As incubators and radiant
warmer are expensive, require
skilled staff and reliable electric
power, many hospitals do not
have them or not enough.
• Babies born in hospitals who
need incubators or radiant
warmer to keep them warm
often have to share them.
15. • Sharing incubators is
risky because if one
baby becomes ill he can
easily pass the infection
to the other baby.
• KMC was developed
as a way to maintain
the normal body
temperature of low birth
weight and premature
babies born in hospitals
that do not have
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16. Types of KMC
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1. Continuous KMC or full KMC
2. Partial or intermittent KMC
17. Continuous KMC
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• When KMC is practiced ideally for 24 hour
except cleaning the diaper, or breast feeding.
• At least 18 hours is compulsory.
• KMC may discontinue for very short periods
when the mother has to bathe or attend to other
personal needs.
• It requires support from the family members,
including the husband.
18. Partial or intermittent KMC
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• Less than 18 hours but it should not be less than 3
hours a day.
• The duration of
condition of the
mother.
intermittent
infant and
KMC depends
the availability
on the
of the
19. Components of KMC
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• Continuous skin to skin contact between baby’s front
and mothers chest.
• Exclusive breastfeeding.
20. 1. Continuous skin to skin contact
between baby’s front and mothers chest
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• Place the baby between the mother’s breasts in
an upright position
• Continuous or intermittent
21. Eligibility Criteria for KMC: Baby
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• All stable low birth weight babies are eligible for KMC.
• Sick babies needing special care should be cared
under radiant warmer initially.
• KMC - started after the baby is hemodynamically
stable.
• HEMODYNAMICALLY STABLE: IS A MUST!!
22. Guidelines for practicing KMC according
to weight
allows initiation of KMC.
• Birth weight >1800 g: These babies are
generally stable at birth. Therefore, in most of
them KMC can be initiated soon after birth.
• Birth weight 1200-1799 g: It might take a few
days for stabilization before KMC can be
initiated.
• Birth weight <1200 g: Frequently, these
babies develop serious prematurity-related
morbidities often starting soon after birth. It may
take days to weeks before baby's condition
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23. Eligibility Criteria for KMC: Mother
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• Willingness
• General health and nutrition
• Hygiene
• Supportive family
• Supportive community
24. 2. Exclusive Breastfeeding
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• The kangaroo position is ideal
for breastfeeding.
• The cloth that wraps around
the mother and baby is
loosened to breastfeed.
• Initially tube or cup feeding
before breastfeeding is
established.
27. Support to the mother
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• Health care staff support in hospital
o Emotional support – The mother needs
encouragement if she is to give KMC
o Teaching mothers the skill to take care of
their LBW infants
o After discharge infants need regular follow-
up to check satisfactory weight gain at
clinics close to home
• Support from the family at home to help mother
take care of her infant and practice KMC at
home.
29. Early discharge and follow up
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The mother continues to practice KMC after the
infant is discharged.
Eligibility criteria for discharge:
• Baby’s general health is good and there is no
concurrent disease such as apnoea or infection
• Feeding well, and is exclusively or
predominantly breastfed
30. • Follow-up visits ensured
• Gaining weight (at least 15g/kg/day for at least three
consecutive days)
• Temperature is stable in the KMC position
• Mother is confident
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31. Benefits of KMC
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• To the baby
• To the mother
• To the hospital
• To the nation
32. Benefits to the baby
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best
• Baby kept warm 24 hours as mother is the
incubator
• Breathing becomes regular as it reduces apnoea
• Breastfeeding better and gains weight faster
• Infants are much less stressed and this provides
neurological protection to the infant
• Better organized sleep patterns
33. Benefits to the Mother
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• Confidence in caring for her infant is boosted
• Improved bonding between mother and infant
due to the physical closeness between them
• Mothers are empowered to play an active role in
their infants care
• Mothers are enabled to become the primary care
giver of their infants
• Breastfeeding is promoted
34. Benefits to the Hospital
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• Significant cost-savings as well as better
outcomes
o Less dependence on incubators
o Less nursing staff necessary
o Shorter hospital stay
• Improved morale & quality of care
• Better survival
35. Benefit to the Nation
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• KMC result in healthier and more intellectual babies
and thus adds to the nation wealth.
• Decrease neonatal mortality and morbidity.
• Simple and applicable everywhere and cost effective.
36. Preparing for KMC (1/4)
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• Initiation of KMC
• Counselling
• When baby is ready arrange a time that is
convenient to the mother and baby
• Demonstrate her KMC procedure in a caring,
gentle manner with patients
37. Preparing for KMC (2/4)
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• Answer her all her queries and allay her anxieties
• Allow her to bring other family members during this
time
o It helps in building positive attitude of the family and
ensuring family support to the mother which is
particularly crucial for post-discharge home-based
KMC.
o It is helpful if the mother starting KMC interacts with
someone who is already practicing KMC.
38. Preparing for KMC (3/4)
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• Mother's clothing
KMC can be provided using any front-open, light dress
as per the local culture. KMC works well with blouse and
sari, gown.
• Baby’s clothing
Baby is dressed with cap, socks, nappy, and front open
sleeveless shirt, Bhoto in winter.
39. Preparing for KMC (4/4)
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• Supporting garment
▶ To carry the baby in kangaroo position – KMC sling or
3.5 meter cloth that will allow the mother or the father
or the relatives to sleep with the baby in that position.
40. Time of Initiation
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• KMC can be started as soon as the baby is
stable.
• Babies with severe illnesses or requiring special
treatment should be managed according to the
unit protocol.
• Short KMC sessions can be initiated during
recovery with ongoing medical treatment (IV
fluids, Oxygen Therapy).
41. Procedure of KMC
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privacy: Since it requires some
▶ Provide
exposure of mother culturally acceptable
privacy should be given in nursery, wards and
NICU.
42. Kangaroo Position (1/2)
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• Baby should be placed between mother’s
breast in upright position.
• Head should be turned to one side in slightly
extended position. The slightly extended
head keeps the airway open and allows eye
to eye contact with mother.
43. Kangaroo Position (2/2)
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• Hips should be flexed and abducted in a “frog”
position and arms should also be flexed.
• Baby’s abdomen should be at the level of mother’s
epigastrium. Mother’s breathing stimulates the baby
thus reducing apnoea.
• Support the baby’s bottom with a sling/binder.
44. Feeding
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• Explain about breastfeeding while in KMC
• Can give express breast milk cup/spoon, orogastric
tube
45. Monitoring
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• Important especially in early stage
• Make sure neck in slightly extended position
• Airway clear
• Regular breathing
• Pink in colour
• Temperature normal
46. Can the mother continue KMC during sleep
and resting?
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• The mother can sleep with baby in kangaroo
position in reclined or semi recumbent position
about 30 degrees from horizontal.
• This can be done with an adjustable bed or with
pillows on an ordinary bed.
• A comfortable chair with an adjustable back
may be used for resting during the day.
47. When to stop KMC?
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• Till baby finds it comfortable and cosy
• Once baby’s weight >2500gm and gestation >37
weeks
48. Post-Discharge Follow-up (1/2)
Close follow up is a fundamental pre-requisite of KMC practice. Baby is
followed once or twice a week till 37-40 weeks of gestation or till the baby
reaches 2.5 – 3 kg of weight.
Thereafter, a follow up once in 2 – 4 weeks
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may be enough till 3 months of post-
conception age.
• Later, the baby should be seen at an interval of
1-2 months during first year of life.
49. Post-Discharge Follow-up (2/2)
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• The baby should gain adequate weight (15-20
gm/kg/day up to 40 weeks of post-conception age and
10 gm/kg/ day subsequently).
• More frequent visits should be made if the baby is not
growing well or his condition demands.
