Page 305 - Encyclopedia of Nursing Research

272 n KANgAROO CARE (SKIN-TO-SKIN CONTACT)

with gastric reflux, adoptive parents, and a the funded trial, late preterm infants (32 36
–
mother who felt depressed during early post- weeks) began KC by 30 minutes after birth,
K partum (Anderson, Dombrowski, & Swinth, continued 84% of the time, had remarkable
2001). Other journals that frequently publish behavioral organization, began breastfeeding
KC articles include Acta Paediatrica, Journal of exclusively by 2 hours, and were breastfeed-
Obstetric, Gynecologic, and Neonatal Nursing, ing competently by 24 hours. Importantly,
Neonatal Network, and Journal of Neonatal two infants developed respiratory distress
Nursing. (grunting) before KC began, but this disap-
KC is safe and has health benefits based peared quickly while the infants remained
on evidence (Nyqvist et al., 2010a, 2010b). In in KC and received warmed humidified oxy-
the United States, nurses have done most of gen via oxyhood; the warmth and humidity
this research. Findings included adequate are essential (Ludington-Hoe et al., 1999).
warmth, energy conservation, regular heart Randomized trials in developing countries,
rate and respirations, fourfold decrease in Europe, and Taiwan have also been done.
apnea, adequate oxygenation, more deep Although fully implemented in some
sleep and alert inactivity, less crying, less hospitals, use of KC generally remains scat-
cranial deformity, no increase in infections, tered. The method is not allowed in some
fewer days in incubators, greater weight hospitals and might not last in others because
gain, earlier discharge, and increased and of resistance from some hospital staff with
longer lactation and breastfeeding. Morelius, resultant variable support for parents. An ele-
Theodorsson, and Nelson (2005) found that gant model for introducing the method and
maternal salivary cortisol, which was high at effecting desired change and implementation
baseline, decreased during the initial KC ses- is described by Bell and Mcgrath (1996). KC
sion and decreased further across repeated benefits are surely dose related. Thus, paren-
sessions. KC was also analgesic for infants, tal burdens (e.g., transportation needs, time
provided mothers felt relaxed (gray, Watt, & required, fatigue, discomfort, concern about
Blass, 2000). Fathers also gave KC effectively, home-related responsibilities, stress, anxi-
as did grandparents, young siblings, and ety) warrant creative initiatives, including
selected important others. Parents feel more broad social services to facilitate relaxation
fulfilled, become deeply attached to their and extend caregiving to the mother’s home
infants, and feel confident about caring for (Anderson et al., 2003).
them even at home. Cost-effectiveness and Other trends in KC include increasingly
improved long-term outcomes are apparent rigorous research, federal funding, publica-
but not yet evidence-based. tion of detailed guidelines (e.g., World Health
The National Institute of Nursing Organization, 2003), conferences devoted to
Research has funded nurses to conduct at KC, increased networking (Ludington, 2010),
least six randomized trials with preterm KC routinely provided to more vulnerable
infants and KC interventions. Five trials have infants and to full-term infants and pro-
been conducted by Ludington: three were vided by selected family members or friends,
with infants in open-air cribs, in incuba- a new focus on late preterms (Raju, Higgin,
tors, and on mechanical ventilation, one on Stark, & Leveno, 2006), consumer awareness
sleep and brain development measured by of and desire for KC, and increased use of
electroencephalogram, and one on blunting KC to facilitate lactation and breastfeeding
of pain measured by heart rate variability especially for dyads having breastfeeding
(Ludington-Hoe, 2010; http://report.nih.gov). difficulties. The new realization that very
The sixth trial was with 32- to 36-week infants early KC can help stabilize some preterm
beginning KC on average 4.5 hours after birth infants and even prevent NICU admission
(e.g., Anderson et al., 2003). In a pilot trial for has increased interest in giving KC as soon