If babies have a UAC/UVC, then no holding at all. The only exception to that that I have seen is when it's a term kid (usually glucose issues...) who only has a UVC b/c they had no PIV access... on those occasions we have let mom hold.
As far as being vented - we let moms and dads kangaroo (or hold normally) as long as the baby is stable enough to do so. It is up to the nurse who has the baby at the time, so there are some times where a family gets upset because they were told that they could hold/kangaroo later on that day - and then the current nurse says otherwise. However, that nurse calmly explains to the family the reasons for not being allowed to kangaroo/hold at this time, and the family usually understands. Once the realize that not holding is in the best interest of the baby at that current moment, they're fine with it. It's only when we get the parents who are more concentrated on their own best interests, and not their babies', that we have some problems.
Nov 10, '07
We do have a Kangaroo Care policy in my facility. The policy states that vented babies are permitted to kangaroo, however babies with umbilical lines are not. In some cases they may be held swaddled with lines secured to the diaper and blankets.
Did you have specific questions about breastfeeding policies?
Nov 12, '07
Per my facility, Kangaroo Care Policy:
A. Parents must have clean, dry skin with no abrasions, rashes or open wounds.
B. Any infant stable enough to tolerate routine cares.
1. Any intubated infant who is clinically stable.
2. Any infant on oxygen through NCPAP, nasal cannula/prongs, or oxyhood that is clinically stable.
3. If there are any questions about infant eligibility consult the neonatal nurse practitioner or neonatologist.
C. Exlcusion Criteria
1. Any infant clinically unstable (frequent or prolonged apneic episodes, frequent ventilator adjustments, desaturation with traditional cares).
2. Any infant with chest tubes."
Notice nothing mentioned about umblilical lines. This is per the nurse's discretion. Most nurses will allow kangarooing w/the UAC/UVCs only a few are not comfortable with allowing kangarooing with lines.
What questions do you have about breastfeeding? Our lactation consultant has recently implemented moms to pump for 5 min. prior to breastfeeding so infants will receive hindmilk. We do not have a specific POLICY for breastfeeding, not even in PP or NBN.
Nov 12, '07
We're terrible about holding/kangarooing/breastfeeding. I can't imagine them implementing a policy on our unit allowing an intubated baby to be held. It's funny because we're so very very proud of the way we tape our ET tubes and how very very secure they are. When we do it on the practice doll you're supposed to be able to pick it up by the tube without it slipping. A very few nurses will let a baby with a UVC to come out, but I'm pretty sure no one is comfy enough with UAC's to do it.
Before anyone gets cranky at me, I'm not saying I agree with this, just reporting how it is on my unit.
Nov 18, '07
I work in a level 3 NICU. My unit's kangaroo care policy is a lot like csm08mms's unit policy. The only exception is babies under the bililights or babies under oxyhoods cannot be held. All parents get a kangaroo care packet in their admissions folders. Nurses are supposed to ask the parents about wanting to kangaroo care if the baby is able to. We ask the mothers to wear buttoned down shirts and no bra so that the baby gets complete skin-to-skin contact. Parents must hold the baby a minimum of 1 hour so that the kangaroo care is effective. We limit kangaroo care to only 2 people for each baby due to infection control issues. My unit has a great kangaroo care policy and Child life will bring a selection of beautiful, hand-made kangaroo care blankets that the parents can choose from and a mirror to better see the baby.
The majority of the babies in the level 3 NICU don't get breastfed because they are too tiny, not stable enough, or just have chronic issues and can't tolerate it. If the baby can be breastfed, we need to have orders first. It can get tricky sometimes because it can be difficult to measure breastfeed intake. Sometimes we ask the mother how much she usually pumps, and then after breast feeding, she will pump and we will estimate how much the baby swallowed by the amount the mother pumped (LOL the leftovers) and how empty her breasts feel. Then we will just gavage the amount of milk we think the baby needs to get a full feeding. Breastfeeding is really rare in level 3 though. One of my babies was allowed to nipple feed as tolerated and I had to sneak over to level 2 to grab bottles and nipples because I couldn't find any on my side of the unit!
Nov 19, '07
Is it possible to get a copy of your Kangaroo Care Policy??? Does it have evidence -based practice??? I'm trying to get an offical policy going. I'm doing my Lactation Consultant course next year so I'm very interested in this area ( also Breastfeeding Policy).