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VOLUME 10 — ISSUE 6: TRANSCRIPT
Featured Cases: New Perspectives On Kangaroo Care
Our guest authors are Marilee C. Allen, MD, Professor
of Pediatrics, and Maureen M. Gilmore, Assistant
Professor of Pediatrics at Johns Hopkins University
School of Medicine in Baltimore, Maryland.
MEET THE AUTHORS
Marilee C. Allen, MD
Professor of Pediatrics
Johns Hopkins University
School of Medicine
Baltimore, Maryland
After participating in this activity, the participant will
demonstrate the ability to:
n Discuss the safety of kangaroo care, and barriers
to its implementation in tertiary care NICUs.
n Describe the impact of kangaroo care on the
parents and NICU team.
n Summarize the potential effects of kangaroo care
on preterm neuromaturation.
This discussion, offered as a downloadable audio file
and companion transcript, covers the important topic of
management of kangaroo care in the format of casestudy scenarios for the clinical practice. This program
is a follow up to the Volume 10, Issue 5 eNeonatal
Review newsletter— New Perspectives on Kangaroo
Care.
Unlabeled/Unapproved Uses
Dr. Allen and Dr. Gilmore have indicated that there will
be no references to unlabeled/unapproved uses of
drugs or products.
PROGRAM DIRECTORS
Edward E. Lawson, MD
Professor of Pediatrics
Chief, Division of
Department of Pediatrics
Johns Hopkins Children's
Center
Baltimore, Maryland
Maureen M. Gilmore, MD
Assistant Professor of
Pediatrics
Director of Neonatology
Johns Hopkins Bayview
Medical Center
Baltimore, Maryland
Maureen M. Gilmore, MD
Assistant Professor of Pediatrics
Johns Hopkins University
School of Medicine
Baltimore, Maryland
Faculty Disclosure
Dr. Allen and Dr. Gilmore have indicated that they
have no financial interests or relationships with any
commercial entity whose products or services are
relevant to the content of their presentation.
Release Date
April 30, 2015
Lawrence M. Nogee, MD
Professor
Department of Pediatrics –
Neonatology
Johns Hopkins University
School of Medicine
Baltimore, Maryland
Expiration Date
April 29, 2017
Mary Terhaar, DNSc, RN
Associate Professor
Director, DNP Program
Johns Hopkins University
School of Nursing
Baltimore, Maryland
Anthony Bilenki, MA, RRT
Director Respiratory
Care/ECMO Services
The Johns Hopkins
Hospital
Baltimore, Maryland
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PROGRAM BEGINS BELOW
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CME/CE INFORMATION
STATEMENT OF NEED
Nutrition
n Physicians may not be aware of recent evidence-based recommendations
on recognizing and treating GERD in neonates.
n Current neonatal nutritional management practices may be enhanced to
optimize and meet the specific needs of low birth weight preterm infants.
n Current neonatal nutritional management practices may be enhanced to
optimize and meet the specific needs of low birth weight preterm infants.
n Clinicians who treat neonates are uncertain of optimal strategies for
prevention and early recognition and treatment of necrotizing enterocolitis.
Respiratory-Related Issues
n Clinicians may be unfamiliar with some of the newest evidence-based
approaches for treating neonatal persistent pulmonary hypertension.
n Clinicians treating preterm infants may not be fully aware of the most recent
developments in optimal management of bronchopulmonary dysplasia and
respiratory distress syndrome.
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eNeonatal Review Podcast Transcript, Volume 10: Issue 6
eNEONATAL REVIEW PODCAST TRANSCRIPT
MR. BOB BUSKER: Welcome to this eNeonatal
Review podcast.
Today’s program is a follow-up to our newsletter
topic: New Perspectives on Kangaroo Care. With us
today we have Dr. Marilee Allen, Professor of
Pediatrics at the Johns Hopkins School of Medicine.
Also joining us is eNeonatal Review program director
Dr. Maureen Gilmore, Assistant Professor of
Pediatrics at Johns Hopkins.
eNeonatal Review is jointly presented by the
Johns Hopkins University School of Medicine and
the Institute for Johns Hopkins Nursing. This program
is supported by educational grants from Abbott
Nutrition, Ikaria, and Mead Johnson Nutrition.
Learning objectives for this audio program include:
n Discuss the safety of kangaroo care, and barriers
to its implementation in tertiary care NICUs.
n Describe the impact of kangaroo care on the
parents and the NICU team.
n Summarize the potential effects of kangaroo care
on preterm neuromaturation.
Dr. Allen and Dr. Gilmore have both indicated that
they have no financial interests or relationships with
a commercial entity whose products or services are
relevant to the content of their presentation. They
have also indicated that there will be no references to
unlabeled or unapproved uses of drugs or products.
MR. BUSKER: I’m Bob Busker, managing editor of
eNeonatal Review. Dr. Allen, thank you for joining us
today.
DR. MARILEE ALLEN: Thank you for inviting me.
This is an important topic.
MR. BUSKER: And thank you as well, Dr. Gilmore.
And welcome to the program.
DR. MAUREEN GILMORE: Thank you, Bob, I’m happy
to be with you today.
MR. BUSKER: I think all of our listeners would agree
that care in the NICU demands more technology than
most other areas of the hospital. Now I don’t think it’s
possible to imagine a lower-tech intervention than
kangaroo mother care — and it may seem out of place
in a high-tech NICU environment. But the evidence
presented in the newsletter describes the benefits of
kangaroo care, and talks about the need to translate
those findings into practice. So let’s do some of that
right now, by looking at some patient situations. Dr.
Gilmore, start things off for us, if you would, please.
DR. GILMORE: We had a 980 gm male who was
delivered by C-section at 27 weeks gestation for
preterm labor and fetal distress. His mom was a 35year-old gravida II, para 0-0-1-0 with a prior 20-week
loss. During the mother’s current pregnancy, the baby
was noted to have ascites and supraventricular
tachycardia was diagnosed. This SVT and symptoms
resolved with maternal digoxin treatment.
At delivery the baby required intubation and
ventilation, and his APGAR scores were 4, 5, and 7 at
1, 5, and 10 minutes. In the NICU he was extubated by
about 12 hours of age to a nasal cannula, and he had
no evidence of effusions, ascites, or SVT. His
echocardiogram revealed just a small PDA and good
biventricular function.
MR. BUSKER: So what we have here is a baby who
had been in trouble and now seems to be recovering
fairly nicely. What was the family’s role in all this?
DR. ALLEN: His mother visited him at about 14 hours
after birth, and she needed encouragement to touch
him. She returned the following day and cried when
she held him for the first time. She began to produce
some breast milk. Then he was started on some
trophic gavage feedings. Fortunately, he remained
physiologically stable, and the following week his
parents were able to begin kangaroo care. His mother
held him skin to skin between her breasts, with
a blanket covering them both.
MR. BUSKER: Dr. Allen, let me turn to you.
Precautions to provide adequate warmth to this very
preterm infant — what were the considerations there?
DR. ALLEN: Kangaroo care originated in Colombia
and other parts of South America. A mother would
continuously hold her baby, meaning 24 hours a day,
7 days a week, skin to skin, upright between her
breasts, with a wrap around both her and the baby.
And this proved to be quite safe and efficacious in
providing warmth and care to stable preterm infants
eNeonatal Review Podcast Transcript, Volume 10: Issue 6
1
and allowed hospitals with limited resources to free
up isolettes for sicker neonates.
Studies have consistently demonstrated that kangaroo
care not only provides adequate warmth to maintain
stable temperatures of preterm infants, but some have
shown that there is less variability in a preterm
infant’s temperature than in an isolette. Unlike the
continuous kangaroo care originally designed in
Colombia, most studies of preterm infants in tertiary
care NICUs have reported kangaroo care being
provided by mothers and/or fathers for varying length
of time, from 20 minutes to 13 ½ hours.
The 2011 study by Blomqvist and Nygvist from
Sweden reviewed in the newsletter is unique in that it
reports on mothers’ experiences providing continuous
24/7 care to their preterm or ill neonates in a tertiary
care NICU from admission to discharge, as opposed
to intermittent care.1
MR. BUSKER: I want to ask you about the safety of
kangaroo care. Things like apnea, infection, poor
growth from increased energy requirements. What
are the actual risks of kangaroo care? Dr. Gilmore?
DR. GILMORE: Many studies, including the one by
Carbasse, et al. which was reviewed in our newsletter,
demonstrated good physiological stability with
kangaroo care compared to preterm infants in
isolettes, including, for example, the same or
improved heart rate, improved respiration, improved
oxygen saturation, temperature, etc.2 Dr. Allen?
DR. ALLEN: A Cochrane review of 18 studies looked
at kangaroo care in NICUs. In 16 of the studies the
infants were stabilized, as in the case we were just
talking about. Thirteen of the studies provided
intermittent kangaroo care, and five provided
continuous care.
The studies found overall that there was a decreased
mortality rate in the infants who got kangaroo care,
decreased rates of infection or sepsis, decreased
episodes of hypothermia, and a shorter length of stay.
What was interesting was that they also found
increased rates of breastfeeding and improved gains
in the infant’s weight, length, and head circumference,
which may well have led to a shorter length of stay.
Other studies of cortisol levels in infants who received
kangaroo care found that infants who got the
kangaroo care had lower cortisol levels, which
certainly suggests a reduced amount of stress in those
infants. Another Cochrane study that looked at
painful procedures in the NICU, for example, heel
sticks, and found fewer signs of pain on pain scores
and shorter duration of crying in neonates who
received kangaroo care.
So overall the evidence shows the safety of kangaroo
care for preterm infants in a NICU and may even
improve their level of stress and response to pain,
which I think can be quite beneficial.
MR. BUSKER: The criteria for selecting infants for
kangaroo care in the NICU — what should clinicians
be aware of? Dr. Allen?
DR. ALLEN: I think this is fairly controversial. A
number of reports in the literature on the safety and
efficacy of kangaroo care in a NICU report a variety
of criteria for which NICU infants were selected for
kangaroo care in their unit. The Carbasse 2013 study,
reviewed in the newsletter, is very interesting because
they demonstrated the safety of kangaroo care for
infants born at 24 to 33 weeks’ gestation, including
intubated infants, as long as they required less than
50% oxygen and their ventilator rate was less than
50.2 They also couldn’t have any persistent pulmonary
hypertension, respiratory events requiring
intervention in the previous 12 hours, sepsis, or
intraventricular hemorrhage.
But of the infants studied, 18% of them were
intubated, 30% were on CPAP, and as many as 11%
of them still had umbilical venous catheters in. Do
you have anything to add, Maureen?
DR. GILMORE: Kangaroo care in extremely preterm
infants and infants requiring respiratory support
definitely requires skilled NICU staff who have
experience with moving intubated preterm infants
and those with continuous cardiorespiratory
monitoring, and close staff observation of how the
babies are doing.
MR. BUSKER: Talk to us a little bit, if you would,
about the barriers to implementing kangaroo care in
a tertiary care unit.
DR. ALLEN: Before kangaroo care can be
implemented in a NICU, protocols must be
established for selection criteria, transfer to and from
eNeonatal Review Podcast Transcript, Volume 10: Issue 6
2
kangaroo care, nursing and respiratory care,
monitoring, and procedures to follow if the infant is
unstable. This is a totally new approach to caring for
preterm infants in the NICU, and it requires the
education and training of all NICU providers.
The Hendricks-Munoz paper reviewed in the
newsletter and the Mayers paper describing a nursing
simulation training program for kangaroo care
showed that the NICU nurses’ perception of, comfort
with, and competency in providing kangaroo care
benefited from those steps.3
Kangaroo care also requires a commitment from
the family, which is the other major obstacle,
because it takes a lot of their time and they need
to be participating in their infant’s care. Nonetheless,
I think kangaroo care should be viewed as an essential
component of family-centered care of the NICU
infant, and it should involve fathers as well as
mothers.
Ideally, implementing kangaroo care requires
assessing a family’s strengths and challenges,
discussing the benefits and risks of kangaroo care,
helping parents understand the degree of
commitment it entails, teaching them how to monitor
their infant, educating them about how to recognize
and respond to their infant’s cues, and partnering
with them to provide a safe and nurturing
environment for the infant.
MR. BUSKER: The infant we started out discussing —
He had a social smile, and he was very vocal and
interactive, a delightful infant.
On exam he did have some neuromotor abnormalities
which are very common, and they included some
asymmetries and some increased tone. We gave the
parents some recommendations for positioning and
working with him and felt he needed some ongoing
physical therapy.
During the clinic visit, though, his mother became
quite tearful when describing how anxious she had
been about his survival during the last six weeks of
her pregnancy when she was taking the digoxin, and
for his first several weeks in the NICU. She reported
that when she had her daughter who died at 20 weeks’
gestation, she never had the opportunity to see or
hold her daughter. For this second pregnancy of hers,
for her son, his NICU nurses encouraged her and
supported her and helped her hold him and
participate in his care, and they helped her with the
kangaroo care. She felt that they’d given her a gift of
hope. Now that he’s home, she’s taken an extended
leave of absence from work, and she remains
committed to breastfeeding him.
His father had also provided kangaroo care in the
NICU, and in follow-up clinic he participated in
answering a lot of the questions about his son’s
feedings, behavior, and development, which I think is
very telling and much more engaged than we usually
see when it comes to fathers’ participation.
Dr. Gilmore, what can you tell us about his follow-up?
MR. BUSKER: Dr. Allen, let me ask you to continue
to our follow-up clinic. We knew in the NICU he’d had
some complications of prematurity including some
mild RDS, a PDA, some gastroesophageal reflux, and
anemia. Overall, though, he did very well, and he was
discharged home at ten weeks and ad lib
breastfeeding. His parents brought him back to the
NICU follow-up clinic at four and a half months old
with a corrected age of one and a quarter months for
his prematurity.
DR. ALLEN: Kangaroo care requires a substantial
commitment of both time and effort of the parents.
This was especially the case for the mothers of the
preterm infants in the NICU in the paper from
Sweden that was reviewed in the newsletter.1 These
parents provided continuous kangaroo care from
admission to discharge 24 hours a day, seven days
a week.
DR. GILMORE: We had this 27-week baby come back
Dr. Allen, I understand that you were able to see this
baby and his family in follow-up clinic. Can you tell us
a little bit more about your interactions with them?
DR. ALLEN: He was doing quite well. He had some
reflux but had been feeding and growing very well.
and tell us more about the effects of kangaroo care on
the parents.
Kangaroo care gives parents the opportunity for and
empowers them to parent their preterm infant from
the beginning instead of just passively watching as the
NICU staff provides the care. Kangaroo care does a
good job supporting a mother’s efforts and encourages
determination to breastfeed by providing stimulation
eNeonatal Review Podcast Transcript, Volume 10: Issue 6
3
for her breast milk production. Studies have
demonstrated that kangaroo care increases the
likelihood a mother will breastfeed and increases milk
production duration of breastfeeding, even after
discharge from the NICU.
MR. BUSKER: And how has kangaroo care been
shown to influence the parents’ subsequent care of
their infant?
DR. ALLEN: I think during their infant’s time in the
NICU, kangaroo care reassures parents that their
infant is growing and maturing, and they learn how
to recognize and respond to their infant’s cues and
needs. By the time of NICU discharge, parents know
their infant very well, and they become more
confident of their ability to care for their child once
they take the child home.
Studies of kangaroo care have demonstrated an
increase in measures of parental bonding and
involvement of fathers. Additional studies have
demonstrated a decrease in measures of maternal
depression and stress with kangaroo care of their
preterm infant in a NICU.
MR. BUSKER: Dr. Gilmore, you’re a director of a
NICU. Tell us about the impact kangaroo care may
have on the staff.
DR. GILMORE: Parent education and initiation of
kangaroo care with careful transfer of fragile infants
and placement on the parents’ chests definitely
requires substantial time investment from the NICU
staff, especially the NICU nurses and respiratory
therapists. It’s important that NICU staff continue
to monitor the infant during kangaroo care and be
available to the parents if they have any questions
or concerns.
As the infant grows and parents become accustomed
to their role, they can assume some of the
responsibilities of their infant’s care with consultation
with the NICU staff as needed. And we’ve certainly
seen, as parents have performed kangaroo care,
they do become a little bit more comfortable with
it over time.
Parents usually are quite appreciative of the
opportunity to provide kangaroo care and are grateful
for the support they receive while their infant is in the
NICU. This positive feedback from families can have
a powerful influence on NICU staff and provide
incentive to support the next infant’s family in
kangaroo care.
MR. BUSKER: Thank you, doctors, for bringing us
that case and discussion. And we’ll return, with Drs.
Allen and Gilmore, in just a moment.
DR. MAUREEN GILMORE: Hello. I’m Maureen
Gilmore, assistant professor of pediatrics and director
of neonatology at Johns Hopkins Bayview Medical
Center. I’m one of the program directors of
eNeonatal Review.
eNeonatal Review is a combination newsletter and
podcast program delivered via email to subscribers.
Newsletters are published every other month. Each
issue reviews the current literature in areas of
importance to neonatologists, respiratory therapists,
neonatal nurses and nurse practitioners, and other
health care practitioners whose work/practice
includes treating neonates.
Bimonthly podcasts are also available as
downloadable transcripts, providing case-based
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Subscription to eNeonatal Review is provided without
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Continuing education credit for each issue, and each
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eNeonatal Review without charge, and access backissues, please go to our website;
www.eneonatalreview.org. Thank you.
MR. BUSKER: And welcome back to our eNeonatal
Review discussion: New Perspectives on Kangaroo
Care. Our guests are Dr. Marilee Allen and
Dr. Maureen Gilmore from the Johns Hopkins School
of Medicine. And we’ve been discussing how some of
the information presented in our last newsletter issue
can be translated into practice in the NICU. So to
continue, if you would please, Dr. Gilmore, describe
another patient for us.
DR. GILMORE: A 35-year-old mother was hospitalized
at 30 weeks’ gestation for preeclampsia, and she
eNeonatal Review Podcast Transcript, Volume 10: Issue 6
4
underwent an emergency C-section because of vaginal
bleeding and possible abruption. The 1440 gm baby
responded very well to routine care in the delivery
room. In the NICU he developed some respiratory
distress requiring some SiPAP support, but he was
weaned off support by three days, and his parents
were then able to hold him for the first time.
He began some gavage feedings, advanced to full
nipple and breast feedings, and having done well,
was discharged home by five weeks. Unfortunately,
kangaroo care was not routinely practiced at that
time and was never offered to his parents.
Dr. Allen, can you tell us more about the mother?
DR. ALLEN: This mother was unable to visit her
son for 24 hours because her treatment for
preeclampsia. When she first saw him in the NICU,
she cried seeing how scrawny and small he was,
crying all alone in the isolette. His mother is a
neurodevelopmental pediatrician and she worried
that the NICU care that was saving his life was not
providing the nurturing that she knew he also needed.
She felt helpless and worried that his nurse knew
more about him than she did.
Maureen, do you want to talk about he did after
discharge?
DR. GILMORE: As you mentioned, his mother was
a developmental pediatrician and she, of course,
followed him very closely. He had some mild language
delays, which improved by 15 months of age. By
preschool he had good growth and fine motor skills
and excellent visual perception with age-appropriate
language skills.
By age seven he had some difficulty learning to
read, and his parents were concerned. At that point
reading learning disability as well as some features
of attention deficit disorder were diagnosed.
Fortunately, he responded well to medications and
tutoring.
In high school, with follow-up evaluations,
dyslexia was confirmed, and he benefited from
accommodations in the classroom. He went on to
graduate from high school and go to college. Marilee?
DR. ALLEN: His astute mother, whom I know very
well, in conversation with me wondered about
whether kangaroo care, had it been available, might
have influenced his development and if so how it
might have. Clinically we recognize that formerly
preterm adolescents, including those who do not
develop major disabilities, still have higher rates of
learning disability, attention deficit, executive
dysfunction, and school and behavior problems than
control infants who are born at term.
MR. BUSKER: There seems to be a kind of general
opinion that kangaroo care is likely to positively
influence neurodevelopmental outcomes. Dr. Allen,
what’s the evidence basis behind that?
DR. ALLEN: One randomized trial of kangaroo care
in preterm infants assessed them at 12 months,
corrected for their degree of prematurity. The
investigators found that infants who received
kangaroo care had a 3.7 point higher cognitive
score than controls, and there was some evidence
of possible neuroprotection with kangaroo care in
a subset determined to be at higher risk for
neurodevelopmental disability at birth, based on
a need for resuscitation at birth or neuromotor
abnormalities when they were seen at six months.
In 2014, as discussed in the newsletter, Feldman
conducted a nonrandomized study of 73 preterm
infants who were provided continuous kangaroo
care for 14 consecutive days compared to 73 preterm
control infants.4 They found that as these children
were growing up, the group that received kangaroo
care had significantly higher cognitive scores at 6, 12,
and 24 months, but not at 5 and 10 years. However,
they had higher scores on tests of executive function
at 5 and 10 years.
(For those of you who don’t know about executive
function, executive function is the way that we
organize ourselves, the way we determine what kind
of task or problem we’re trying to solve, the strategy
we’re going to use, assess how we are doing along the
way, and make modifications so that we’re able to
successfully accomplish it.)
Another study, in a small study in Colombia in 1994 of
adolescents who were born preterm, used transcranial
magnetic stimulation to assess cerebral motor
function and found that these adolescents who had
received kangaroo care had faster conduction times
and inhibition.
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A review of the literature, however, concludes that
there’s insufficient evidence to determine the effect of
kangaroo care on neurodevelopmental outcome and
preterm survivors with any degree of certainty. Clearly
more research is needed.
DR. GILMORE: Marilee, how can kangaroo care
influence preterm neuromaturation while the infant
is still in the NICU?
DR. ALLEN: Let’s first talk about how current
standard neonatal intensive care for preterm infants
differs from the intrauterine environment. There’s
immediate and prolonged separation from the
mother, bombardment of the preterm nervous
system with meaningless sensory stimuli, limited
opportunities for human touch, multiple painful
stimuli with no or limited analgesia, restricted
kinesthetic and olfactory stimulation, and interactions
that are not related at all to the infant’s cues or state
of alertness.
Kangaroo care provides physiologic stability for one
thing, allowing for undisturbed neuromaturation,
and it provides continuous skin contact and exposure
to the mother, a parent’s smell and taste; and the
parental movement while providing kangaroo care
provides some gentle kinesthetic stimulation. All
of these are good experiences for a developing
nervous system.
Kangaroo care can also shield the infant from
extraneous light and noise and provide appropriate
cue-based exposure to the parent’s face and speech.
If the baby’s sleeping, of course, the exposure would
be minimized. But if the baby is awake and in a quiet,
alert state, that’s the perfect time for the parent to
start talking to the infant. Kangaroo care has also
been shown to be an effective analgesic for painful
stimuli, reducing both the intensity of the infant’s
pain response and time to recovery.
Probably more important, kangaroo care gives
parents an opportunity to learn to recognize and
appropriately respond to their infant’s cues.
MR. BUSKER: Dr. Allen, one final question on this
patient. What are the measurable physiological effects
of kangaroo care on neuromaturation?
DR. ALLEN: Several studies have shown that infants
who receive kangaroo care had more quiet sleep and
longer sleep cycles. As in the Feldman trial reviewed
in the newsletter, there are more organized
sleep/wake cycles than in control preterm infants.4
Some studies have demonstrated lower cortisol levels,
lower stress reactivity, and higher oxytocin levels in
preterm infants who receive kangaroo care. In the
2014 study by Welch, et al reviewed in the newsletter5,
they obtained EEGs during sleep at 35 and 40 weeks
postmenstrual age in preterm infants who had
received their family nurture intervention which
included kangaroo care. They found increased frontal
brain activity with neuromaturation, which was not
found in the control preterm infants.
Other studies have showed that increased brain
activity, especially in the frontal region, has been
associated with lower risk of attention deficit,
executive dysfunction, and mental health problems,
which I find very intriguing.
MR. BUSKER: Doctors, thank you both for today’s
cases and discussion. I’d like to go to a more general
question now— and that’s to ask you what areas of
kangaroo care do you think most require further
research? Dr. Gilmore?
DR. GILMORE: It seems that safety as well as the
physiological stability of infants with kangaroo care
have been very well supported and defined in the
literature. In addition, I think the efficacy of kangaroo
care in pain control has also been pretty nicely
documented. The remaining question, then, is
neuromaturation.
Literature reviews conclude that there’s still at this
point insufficient evidence to determine the effect of
kangaroo care on preterm neuromaturation or on
neurodevelopmental outcome in preterm survivors.
Marilee, other thoughts?
DR. ALLEN: Intriguing data support our current
understanding of preterm neuromaturation and
recovery for preterm brain injury, suggesting a
beneficial and/or neuroprotective effect of kangaroo
care. In light of the persistent neurodevelopmental
difficulties that children born preterm and their
families face, I think the data are compelling enough
to support ongoing investigation of the effect of
kangaroo care on preterm development.
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MR. BUSKER: Thank you for those thoughts,
doctors. Let’s wrap things up now by reviewing
today’s discussion in light of our learning objectives.
So to begin: the safety of kangaroo care and the
barriers to its implementation in tertiary care NICUs.
Dr. Gilmore?
DR. ALLEN: Thank you for this opportunity. It’s been
a pleasure to talk about such an important topic.
important points. Kangaroo care has been shown
to be safe and efficacious for preterm infants born at
24 to 33 weeks’ gestation. Kangaroo care has also
been associated in numerous studies with physiologic
stability. We’ve touched on the fact that NICU staff as
well as providers lack some familiarity with the
benefits of kangaroo care, but this can be overcome by
an education program and some simulation training.
please take the post-test at
www.eneonatalreview.org/test.
DR. GILMORE: We’ve touched on a couple of
MR. BUSKER: Dr. Allen, our second learning
objective: the impact of kangaroo care on the parents
and the NICU staff.
DR. ALLEN: Kangaroo care may have direct effects
for parents, including decreased stress and decreased
maternal anxiety and depression. Kangaroo care
strengthens maternal-infant bonding, facilitates
breastfeeding, and can help parents feel more
competent when caring for their infant.
For the NICU staff, a comprehensive educational
program, coupled with simulations, was very effective
in improving staff perception, comfort, and
competency in kangaroo care.
MR. BUSKER: And finally: the effects of kangaroo
care on preterm neuromaturation. Dr. Allen?
DR. ALLEN: Kangaroo care certainly provides
physiologic stability and can influence preterm
neuromaturation while the infant’s still in the NICU,
as in the associated increased frontal lobe activity
during sleep which was demonstrated in the
Welch study.5
We also discussed studies that provide examples of
how kangaroo care may have an impact on longer
term neuromaturation after a NICU discharge and
into early childhood, as in the Feldman study.4
Clearly, more work is needed in this area.
MR. BUSKER: From the Johns Hopkins School of
Medicine, Dr. Marilee Allen, Dr. Maureen Gilmore,
thank you for being part of this eNeonatal review podcast.
DR. GILMORE: Thanks, Bob, for inviting me to
participate in today’s podcast on kangaroo care.
I really appreciate the opportunity.
MR. BUSKER: To receive CME credit for this activity,
This podcast is presented in conjunction with
the eNeonatal Review Newsletter,
a peer-reviewed literature review certified for
CME/CE credit, emailed monthly to clinicians
treating patients in the NICU.
This activity has been developed for neonatologists,
respiratory therapists, neonatal nurses, nurse
practitioners, and other members of the NICU team.
This activity has been planned and implemented in
accordance with the Essential Areas and Policies of
the Accreditation Council for Continuing Medical
Education, through the joint sponsorship of the Johns
Hopkins University School of Medicine and the
Institute for Johns Hopkins Nursing. The Johns
Hopkins University School of Medicine is accredited
by the ACCME to provide continuing medical
education for physicians.
The Johns Hopkins University School of Medicine
designates this enduring material for a maximum of
0.5 AMA PRA Category 1 Credit(s).™ Physicians
should claim only the credit commensurate with the
extent of their participation in this activity.
The Institute for Johns Hopkins Nursing is accredited
as a provider of continuing nursing education by the
American Nurses Credentialing Center’s Commission
on Accreditation.
For nurses, this 0.5 contact hour Educational Activity
is provided by the Institute for Johns Hopkins
Nursing. Each podcast carries a maximum of
0.5 contact hour.
This educational resource is provided without charge,
but registration is required. To register to receive
eNeonatal Review via email, please go to our website:
www.eneonatalreview.org.
eNeonatal Review Podcast Transcript, Volume 10: Issue 6
7
The opinions and recommendations expressed by
faculty and other experts whose input is included in
this program are their own. This enduring material is
produced for educational purposes only.
Use of the names of the Johns Hopkins University
School of Medicine and the Institute for Johns
Hopkins Nursing implies review of educational
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This program is copyright with all rights reserved by
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eNeonatal Review Podcast Transcript, Volume 10: Issue 6
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REFERENCES
1. Blomquist YT, Nygvist KH. Swedish mothers' experience of continuous Kangaroo Mother Care. J Clin Nurs.
2011 May;20(9-10):1472-1480.
2. Carbasse A, Kracher S, Hausser et al. Safety and effectiveness of skin-to-skin contact in the NICU to support
neurodevelopment in vulnerable preterm infants. J Perinat Neonatal Nurs. 2013;27(3):255-262.
3. Hendricks-Munoz KD, Mayers RM. A neonatal nurse training program in kangaroo mother care (KMC)
decreases barriers to KMC utilization in the NICU. Am J Perinatol. 2014;31(11):987-992.
4. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic
organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014;75(1):56-64.
5. Welch MG, Myers MM, Grieve PG, et al; FNI Trial Group. Electroencephalographic activity of preterm infants
is increased by Family Nurture Intervention; a randomized controlled trial in the NICU. Clin Neurophysiol.
2014 Apr;125(4):675-684
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