Evaluation of Kangaroo Care on Newborn Thermoregulation
Evaluation of Kangaroo Care on Newborn Thermoregulation Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN Kangaroo Care Purpose of the research Evaluate the benefit of Kangaroo Care to the neonate Providing evidence-based research to provide
mothers and newborns a more natural birth experience Minimize separation of the maternal-infant couplet to enhance birth experience Provide cost effective care Problem Statement What does the literature say about kangaroo care (KC), also
known as skin-to-skin care, in the regulation of the thermoregulatory system of the neonate? PICO In term newborns born vaginally, will the axillary temperature remain within the normal range in infants placed skin-to-skin immediately after birth compared with infants placed within minutes of birth under a radiant warmer during the first hours of life?
Literature Eliminated Narrowing the Literature Critical evaluation of ten selected articles Articles were examined for appropriateness to the purpose statement, reliability, and validity (Nieswiadomy, 2008, p. 63) Qualifications of the researchers and the
ethical content was also analyzed (Nieswiadomy, p. 29) Articles not meeting criteria were eliminated Literature Eliminated A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation (Fardig, J., 1980). This was an outdated source
Keeping infants warm: Challenges of hypothermia (Mance, 2008). Involved preterm infants which did not meet the criteria set in the purpose statement Temperature variation in newborn babies: Importance of physical contact with the mother (Fransson, Karlsson, & Nilsson, 2005). Article did not discuss skin-to-skin content and the research did not start until four to eight hours after birth Literature Eliminated- continued
The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial (Ferber & Makhoul, 2004). Focused on infants neurological behavior with minimal discussion regarding temperature Kangaroo mother care: 25 years after (Charpak et al., 2005). Difficult to follow, and mainly pertained to the unhealthy newborn in underdeveloped countries with a minimal discussion regarding temperature
Early skin-to-skin contact for mothers and their healthy infants (Anderson, Moore, Hepworth, & Bergman, 2003). Article only consisted of one page and required advance knowledge of statistics in order to understand Literature Selected Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies Gretchen A. Dabrowski RN, BSN
Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies Qualitative evidence-based discussion Utilizes historical studies The articles findings provided evidence that newborns placed skin-to-skin with mothers
remained considerably warmer during the first three hours of life (Dabrowski, p. 66) Kangaroo Care at Birth for Full Term Infants: A Pilot Study Mary W. Walters, MS, RN. Kim M. Boggs, MSN, RN, BC. Susan Ludington-Hoe, PHD, CNM, FAAN. Kimberly M. Price, RN, IBBCLC. Barbara Morrison, PHD, FNP, CNM. Kangaroo care at birth for full term infants: A pilot study.
Level I qualitative research study Approval obtained from hospital review board All of the researchers practiced in women's health Clear purpose statement
Outlined clearly in a systematic process discussing the descriptive design Evidence-based Practices for the Fetal to Newborn Transition Judith S. Mercer CNM, DNSc Debra A. Erickson-Owens CNM, Ms Barbara Graves CNM, MN, MPH Mary Muford Haley CNM, MS Evidence-based practices for the
fetal to newborn transition Article listed additional findings to benefit
neonate. Clear summarization of articles reviewed Findings significant for the benefit of this intervention (p
Rintaro Mori, MD, PHD, MSc, FRCPCH Rajesh Khanna Debbie Pledge Takeo Nakayama Meta-analysis of physiological effects of skinto-skin contact for newborns and mothers Peer reviewed journal Recent publication 2010 Significantly related to the research question Directly evaluated physiological parameters affecting infants before-and-after the KC
intervention to evaluate safety Consisted of both systematic reviews and random-controlled trials Methods categorized Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers (contd)
Meta-analysis included 23 studies, consisting of 13 before-after studies, five randomized control trials, a cross-over trial, and four cohort studies Limitations of studies were acknowledged Confounding variables were eliminated to increase validity p value was < 0.05 making this study significant in findings Findings of this article showed an increase in body temperature during skin-to skin contact Barriers to the implementation
of Kangaroo Care Barrier The desire by the mother to allow visitors to hold the baby was reported (Anderson et al, 2003) Bridge
Provide education and encouragement to mothers regarding what KC is and the benefits KC has been shown to provide Barrier The attitude of health care providers is noted to be a barrier to KC. This may be due to a
lack of knowledge regarding the benefits of KC or fear of a change in practice Bridge The provision of adequate education to both healthcare providers and patients, including their families, is a potential way to solve these barriers
(Dabrowski, p. 65) Patient preference Patient preference is an important aspect of implementing any evidence-based nursing practice (Nieswiadomy, 2008, p. 8) Nurses should provide education and support for kangaroo care, but allow patients to express their preference about the utilization of kangaroo care
Application of the Evidence The evidence highly supports a change in practice, encouraging skin-to-skin contact at birth
The evidence correlates well with the expectations of evidenced-based medicine research Each of the articles selected clearly defines the purpose of the study All of the selected articles are rated as level I or Level II, with the exception of one article, according to hierarchy of evidence The articles chosen contain recent findings, with the oldest article being from 2007 Skin-to-Skin Contact Summary
Birthing units that separate mothers and babies with the intention of preventing cold stress unwittingly increase the risk of cold stress, and at the same time deprive the pair of intimacy and bonding while delaying breastfeeding initiation (Mercer et al., 2007, p. 267) The evidence suggests that skin-to-skin contact should be the mainstay of newborn thermoregulation (Mercer et al., 2007, p. 267)
The benefit of increasing fetal well-being is the primary focus in these studies Summary (contd) Initiation of skin-to-skin contact immediately after birth is an evidence-based nursing practice More effective than the use of radiant warmers
Has many other benefits Cost effective and more natural extension of the birth process Recommendation References Anderson, G., Shiu, S., Dombrowski, M., Swinth, J., Albert, J., & Wada, N. (2003). Mother-newborn contact in a randomized trial of kangaroo (skin-toskin) care. JOGNN: Journal of Obstetric,
Gynecologic & Neonatal Nursing, 32(5), 604-611. doi: 10.1177/0884217503256616 Anderson, G. C., Moore, E., Hepworth, J., and Bergman, N. (2003). Early skin-to-skin contact for mothers and their healthy newborn infants. Birth, 30(3), p. 206207. doi: 10.1046/j.1523536X.2003.00247.x Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., and Worku, B. (2005),
Kangaroo mother care: 25 years after. Acta Pdiatrica, 94(5), p. 514522. doi: 10.1111/j.16512227.2005.tb01930.x Dabrowski, G. (2007). Skin-to-skin contact: Giving birth back to mothers and babies. Nursing for Women's Health, 11(1), p. 6471. doi: 10.1111/j.1751-486X.2007.00119.x Fardig, J. A. (1980). A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation, Journal of Nurse-Midwifery, 25(1), p. 1928. doi: 10.1016/0091-218(80)90005-1
Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. Pediatrics, 113, 4. p.858(8). Retrieved from: http://www.pediatrics.org/cgi/content/full/113/4/858 Ford, L. C. (2010). Evidence based nursing practice project: NURS 350 Research in nursing. Retrieved from Ferris State University School of Nursing, Ferris Connect website: http://myfsu.ferris.edu/webct/urw/lc1399024356061.tp14061160860 31/displayContentPage.dowebct?
pageID=1463932005011&resetBreadcrumb=false&displayBCInsideF rame=true Fransson, A., Karlsson, H., Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Archives of Disease in Child: Fetal Neonatal Edition, 90(6), p. F500504. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721966/ doi:10.1136/ adc.2004.066589 Galligan, M. (2006). Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN: The American
Journal of Maternal Child Nursing, 31(5), 298-306. Retrieved from: http://www.nursingcenter.com/_PDF_.aspx?an=00005721200609000-00007 . Mance, M. (2008) Keeping infants warm: Challenges of hypothermia. Advances in Neonatal Care, 8(1), 6-12. doi:10.1097/01.ANC.0000311011.33461.a5 Mercer, J. S., Erickson-Owens, D. A., Graves, B., Mumford Haley, M. (2007). Evidence based practices for the fetal to newborn transition. Journal of Midwifery &
Womens Health, 52(3), p.262-272. doi:10.1016/j.jmwh.2007.01.005 Mori, R., Khanna, R., Pledge, D. and Nakayama, T. (2010). Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatrics International, 52(2), p. 161170. doi: 10.1111/j.1442200X.2009.02909.x Nieswiadomy, R. (2006). Foundations of nursing research. (5th ed.). Upper Saddle, New Jersey: Pearson Prentice Hall.
Walters, M. W., Boggs, K. M., Ludington-Hoe, S., Price, K. M., Morrison, B. (2007). Kangaroo care at birth for full term infants: A pilot study. The American Journal of Maternal/Child Nursing, 32(6), p. 375-381. doi:10.1097/01.NMC.0000298134.39785.6c
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