Skin-to-Skin (Kangaroo) Care for Preterm and Ill Infants in the Neonatal Intensive Care Unit (NICU)

The World Health Organization (WHO), the United Nations Children’s Emergency Fund (UNICEF), the U.S. Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), Baby-Friendly USA, and every professional and non-profit organization that deals with maternal-infant health issues, recommend skin-to-skin (S2S) care for all infants, whether healthy or ill in an intensive care unit. Healthy infants should have skin-to-skin contact immediately after vaginal birth, for at least 1-2 hrs or as long as the family wishes. For infants born by cesarean section, skin-to-skin care should commence as soon as mother is alert and responsive. Infants requiring resuscitation, or mothers with complications requiring intensive monitoring may need to wait until both mother and infant are stable to do kangaroo care.

Skin-to-skin care has been shown to be safe and effective in promoting physiologic stability and breastfeeding in preterm infants. It is the first step towards a mother being comfortable holding her preterm or ill infant for feeding. S2S care has benefits for both mother and infant, which are especially important for the preterm or ill infant in the NICU.

What is Skin-to-Skin (Kangaroo) Care?

For healthy babies, S2S care is placing a just born, naked infant, onto the chest of the mother and covering both with a warm blanket. The infant may be dried briefly (especially the hair and scalp) on the mother’s chest before the blanket is placed. For a premature or ill infant, the baby is usually dressed in just a diaper and a hat, and placed upright between mother’s breasts, against her bare skin. Mothers’ clothing is then closed around the baby and a blanket placed on top. The mothers’ body temperature will adjust to cool or warm the infant as needed. Fathers and other adult family members may also do S2S care, but mothers do it most often because of the increased chance for breastfeeding.

What are the benefits of Skin-to-Skin (Kangaroo) Care?

For the baby, S2S care stabilizes vital signs, including temperature, heart rate, breathing pattern, and oxygen saturation. It decreases crying and stabilizes blood sugar. S2S care decreases pain from blood-drawing and other painful NICU procedures. It is also associated with fewer infant infections, better weight gain, earlier discharge home, and improved neurologic development. Babies who are engaged in kangaroo care sleep more deeply, using all their energy to grow.

For the mother, S2S care has been shown to increase maternal breastmilk production and lengthen duration of breastfeeding both in the NICU and after discharge. S2S care stimulates the release of the hormones prolactin and oxytocin (the love hormone) which foster parental relaxation, minimize stress and promote parental attachment and bonding. Practicing S2S care also enhances parental confidence and competence in caring for a sick or preterm infant. Most importantly, S2S care reduces infant infections by colonizing the infant’s gastrointestinal system with normal maternal bacteria (microbiome) to develop the infant’s immune system. It enhances the maternal enteromammary immune system in which mothers’ breastmilk is enriched with antibodies and activated immune cells to fight pathogens in the infant’s environment.

When can my NICU baby do S2S care?

NICU infants can do S2S care when they are stable enough to be moved from their isolette or warmer to their mother’s chest. Many babies are off the ventilator, but some are not. Some babies may have too many tubes or lines to be moved safely until some of the lines are removed. A nurse, and sometimes a respiratory therapist, will need to help move the infant safely. Since the hardest part is moving the infant out and then back into the NICU bed, parents should plan to spend at least an hour (more is better) doing S2S care with their infants each time. Most heart and oxygen monitor leads will remain on the baby during kangaroo care. The baby’s temperature will be checked periodically, but most babies get warmer, not cooler. Mothers can feel their baby’s breathing and other movements, learning his/her likes and dislikes quickly.

What do mothers and fathers need to do?

Parents of NICU infants should ask to do kangaroo care with their infant. A routine daily bath or shower is important to protect your baby. Parents should wear clothing that opens in front, or change to a hospital gown with the opening in the front. Nurses will help parents find a comfortable chair, blankets, and a privacy screen if requested.

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