PERAWATAN METODE KANGAROO MOTHER CARE (KMC) PADA BAYI BARU LAHIR RENDAH

Tujuan Pembangunan Berkelanjutan (SDGs) bertujuan untuk menurunkan Angka Kematian Neonatal setidaknya hingga 12 per 1.000 KH (Kelahiran Hidup). Menurut WHO menjelaskan bahwa sebesar 60–80% dari Angka Kematian Bayi (AKB) yang terjadi, disebabkan karena BBLR. Kangaroo Mother Care (KMC) merupakan perawatan untuk bayi berat lahir rendah atau lahiran prematur yang telah terbukti menjadi yang paling layak, tersedia, dan intervensi pilihan untuk menurunkan morbiditas dan mortalitas bayi baru lahir di negara berkembang. Tujuan literature review ini adalah mendeskripsikan perawatan metode Kangaroo Mother Care (KMC) pada Bayi Baru Lahir Rendah. Metode yang digunakan adalah tinjauan literature dengan mencari artikel yang diterbitkan dalam berbagai basis data termasuk Pub Med, Science Direct, Portal Garuda, Google Scholar menggunakan kata kunci yang sesuai (BBLR atau Low Birth Weight, Kangaroo Mother Care) dari Tahun 2017 sampai 2021. Hasil dari ulasan 5 artikel menunjukan perawatan metode Kangaroo Mother Care memberikan pengaruh terhadap respon fisiologis, meningkatkan kenaikan berat badan, rata-rata lama rawat 9 hari, tidak menemukan efek signifikan terhadap penilaian kognitif, bahasa, motorik dan sosio emosional. Kesimpulan berdasarkan tinjauan literature yang telah dilakukan adalah ada pengaruh metode Kangaroo Mother Care (KMC) pada BBLR.

Effects of Kangaroo Mother Care in the NICU on the Physiological Stress Parameters of Premature Infants: A Meta-Analysis of RCTs

Objective: The aim of this study was to analyze the randomised controlled trials that explored the effect of kangaroo mother care on physiological stress parameters of premature infants. Methods: Two independent researchers performed a systematic review of indexed studies in PubMed, Embase, CINAHL, Cochrane and Scopus. We included data from randomized controlled trials measuring the effects of kangaroo care compared to standard incubator care on physiological stress outcomes, defined as oxygen saturation, body temperature, heart rate and respiratory rate. The PRISMA model was used to conduct data extraction. We performed a narrative synthesis of all studies and a meta-analysis when data were available from multiple studies that compared the same physiological parameters with the kangaroo method as an intervention and controls and used the same outcome measures. Results: Twelve studies were eligible for inclusion in this meta-analysis. According to statistical analysis, the mean respiratory rate of preterm infants receiving KMC was lower than that of infants receiving standard incubator care (MD, −3.50; 95% CI, −5.17 to −1.83; p < 0.00001). Infants who received kangaroo mother care had a higher mean heart rate, oxygen saturation and temperature, although these results were not statistically significant. Conclusions: Current evidence suggests that kangaroo care in the neonatal intensive care unit setting is a safe method that may have a significant effect on some of the physiological parameters of stress in preterm infants. However, due to clinical heterogeneity, further studies are needed to assess the effects of physiological stress in the neonatal intensive care unit on the development of preterm infants.

Smart Incubator for Preterm Neonatal Using Kangaroo Mother Care

Kangaroo mother care is an apparatus that provides closed and controlled environmental for the preterm babies. A Preterm birth is commonly defined as any birth base 37 weeks completed weeks of gestation period. This paper deals with cost effective design of incubator that monitors parameters like pulse rate, temperature, humidity, child security and the readings will be continuously displayed In the LED screen and also monitoring the details to the corresponding doctor, nurse and parents by using GSM. The power failure problem is also eliminated by using solar panel. We also intimate the parents about feeding time, dressing time, ear check, eye check. But many of the existing system does not mentioned about above problem and have adopted only with humidity and temperature and also by manual control. So the main objective of this research is to overcome drawbacks and provide eco friendly service to all common people.

Effects of Intermittent Kangaroo Mother Care on Low-Birth-Weight Neonates: A Retrospective Before-and-After Study

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome. Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome. Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42). Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.

A Prospective Study on the Efficacy and Safety of Kangaroo Mother Care as an Alternative Means of Transport of Preterm and Term Small-for-Gestational Age Infants

Background. The unavailability of transport incubators in resource-limited areas increases the risk for hypothermia in low birthweight neonates requiring transfer to another hospital. The kangaroo mother care (KMC) position may be a better alternative than swaddling the neonates during transport. Objective. To determine the safety and efficacy of KMC as an alternative means of transport of preterm and term small-for-gestational age (SGA) infants who need to be transferred to a higher level of care. Specifically, it aims to establish if KMC is safe and efficacious in terms of thermoregulation during inter-facility transfers. It also aims to determine the impact of transport distance from the referring hospital, age of gestation, sex, birthweight, and Apgar score on the efficacy of KMC in preventing hypothermia. Methods. We did a prospective, single-blinded, parallel-randomized controlled trial from September 2016 to October 2017 from a community-based primary care facility to a tertiary government hospital. We included newborn preterm infants and term SGA infants weighing 1200–1800 grams, delivered at health centers, district and provincial hospitals who needed to be transferred for a higher level of care. Outcomes included physiologic variables such as temperature, heart rate, respiratory rate. We conducted statistical analysis using t-test, risk ratio, and multiple regression analysis. Results. Thirty-one neonates were randomized to KMC transport (n=15) and conventional transport (swaddled) (n=16). Fifty percent of the swaddled infants developed hypothermia against none in the KMC infants. The risk of hypothermia was reduced by 93.75% in the neonates transported in KMC. The gestational age, birthweight, sex, Apgar scores and distance travelled had no confounding effect on the neonates’ temperature during transport. Conclusions. Kangaroo mother care transport is a safe, effective, and low-cost alternative in inter-facility neonatal transport especially in limited-resource areas.

A Randomized Controlled Trial of Intermittent Kangaroo Mother Care versus Conventional Care in Increasing the Rate of Weight Gain among Low-Birth-Weight Neonates

Objective. To determine the effectiveness of Kangaroo Mother Care (KMC) in increasing the rate of weight gain and decreasing hypothermia, apnea, and sepsis rate, and shorten hospital stay among low-birth-weight infants. Methods. Very low birth weight (VLBW) infants (≤1500 grams) were randomized to either the KMC or conventional care group. KMC provided skin-to-skin contact at least 6 hours per day while the conventional group received the usual care in the newborn intensive care unit (NICU). Daily weight measurements and weekly measurements of length, head, and chest circumference were recorded until discharge. Occurrence of hypothermia, apnea, sepsis, and length of stay was noted. Results. KMC group had a higher mean weight gain per day (p=0.0102). There was no difference in the length, head, and chest circumference between the two groups. Sepsis and apnea rates were not significant between the two groups. Significantly more neonates experience hypothermia in the control group (p<0.0069). Conclusion. KMC is effective in increasing the weight per day compared with the control group. KMC protects the neonates against hypothermia. There is not enough evidence to show a difference in the incidence of sepsis, apnea, and the length of hospital stay between the two groups.

A Meta-analysis on the Effect of Kangaroo Mother Care on Preterm Mortality

Background. Kangaroo mother care (KMC) is a low-cost but high-impact intervention for preterm and low birth weight (LBW) infants. Objectives. To determine the effect of KMC on in-hospital mortality among preterm and LBW infants, taking into consideration their gestational age, birth weight, income category of the country of birth, and medical stability. Materials and Methods. A comprehensive search of several databases, as well as local listings of research papers, was performed to look for randomized controlled studies with KMC as intervention, and mortality and length of hospitalization as outcome measures. The risk of bias and publication bias was assessed. We did subgroup analyses based on income category of the country of birth, gestational age, birth weight, and medical stability of the infants. Results. Sixteen randomized controlled trials (RCTs) with 1738 infants in the KMC group and 1674 infants in the control group were included. Based on the GRADE approach, although all the studies were RCTs, the evidence is assessed as moderate certainty due to the nature of the intervention (KMC) that prevented blinding. There was a 41% reduction in risk of dying among preterm and low birth weight infants who received KMC compared to conventional medical care (3.86%% vs 6.87%; RR = 0.59, 95% CI 0.44, 0.79; I2 = 0%; number needed to treat for additional benefit (NNTB) = 34; 16 RCTs; 3,412 infants). Furthermore, there were also reductions in the risk of dying among infants who were <34 weeks AOG (KMC: 4.32% vs CMC: 8.17%, RR = 0.55, 95% CI 0.38, 0.79; I2 = 0%; NNTB = 26; 10 RCTs; 1795 infants), with birthweight of >1500 g (KMC: 3.97% vs CMC: 6.83%, RR = 0.60; 95% CI 0.45, 0.82; I2 = 0%; NNTB = 35; 10 RCTs; 2960 infants), and born in low- and middle income countries (LMIC) (3.77% vs 6.95%; RR = 0.57, 95% CI 0.43, 0.77; I2 = 0%; NNTB = 32; 14 RCTs; 3281 infants). There was a significant reduction in mortality (KMC: 11.05% vs CMC: 20.94%; RR = 0.54; 95% CI 0.34, 0.87; I2 = 0%; NNTB = 11; 5 RCTs; 387 infants) even among medically unstable infants who received KMC compared to those who did not. The length of hospitalization did not significantly differ between the KMC and the control groups. Due to high heterogeneity, subgroup analyses were performed, which showed a trend towards a shorter length of hospital stay among preterm infants <34 weeks AOG, with birthweight ≥1500 g, medically unstable during admission, and belonging to LMIC but did not reach statistical significance. Conclusion. There was moderate certainty evidence that KMC can decrease mortality among preterm and LBW infants. Furthermore, KMC was beneficial among relatively more premature, bigger, medically unstable preterm infants and born in low to middle-income countries.

Effect of Continuous versus Intermittent Kangaroo Mother Care on Weight Gain and Duration of Hospital Stay among Low-Birth-Weight Admitted at a Level II NICU: A Randomized Control Trial

Background. The Neonatal Intensive Care Unit (NICU) admission at the Philippine General Hospital (PGH) exceeds total bed capacity. Decreasing admissions to the NICU would prevent overcrowding of patients, improve patient care, reduce hospital stay, and reduce predisposition to hospital-acquired infections. Objective. To determine the effect of continuous versus intermittent Kangaroo Mother Care (KMC) on weight gain and duration of hospital stay among low birth weight (LBW) neonates weighing 1,800 - 2,220 grams. Methods. Forty-six (46) stable LBW were randomized to either continuous (≥12 hours in the maternity ward) or intermittent (≤6 hours in the NICU step-down unit) KMC groups. Daily weight and weekly length, head and chest circumference until discharge, and duration of hospital stay were measured. Data were analyzed using the Mann-Whitney U-test and Fisher's exact test. Results. Infants in continuous KMC had an average weight gain of 50 grams/day (p=0.509) and had an average duration of hospital stay of 3 days (p=0.218). Results were not statistically different from intermittent KMC. Conclusion. There was no evidence to show that weight gain and duration of hospital stay among infants in continuous KMC were significantly different from those in the intermittent KMC group.