Kangaroo Care?

TiffyRN, BSN, PhD · Jun 14, 2006

Of course we never let any kid who is "unstable" do KC (occ. A&B's don't really count).

>1000grams: no md order needed but md can order KC if infant is

Umbilical lines: no, and no holding 5hrs after lines dc'd

Intubated: doable (but scary to me)

Privacy: yea right! Sometimes we put up a screen but if the kid is intubated or smaller; I feel the need to see him/her. Occasionally a big stable kid in for TTN or r/o sepsis we will let mom take to one of our pumping rooms and KC there. Though they are off the monitor it's acceptable (kind of like a day rooming in situation).

A&B's: they can have a history of them and even have them while KC'ing but they can't be getting worse or more frequent or KC is cancelled.

Length: generally we limit to 1hr or less if infant showing signs of distress. I know the research doesn't back up this time limit though. We certainly let the nurse use his/her judgement if the infant is acting stable.

BabyNurse513 · Jun 14, 2006

Obviously the baby needs to be stable. We prefer the babes to be over a kilo but there are always exceptions. We usually start with a one hour limit and go from there. As they get bigger and more stable we will let mom kangaroo for the whole time between care, 3-4 hours. We try to get PICC lines in and umbilical lines out asap so that usually isn't an issue. Again, as long as they are stable, we have no problems kangarooing vented babies. All our bedspots have curtains that can be pulled around the whole bedspot for privacy. A/B's are ok as long as they don't increase or worsen with KC. We try to encourage KC as much as possible.

Gompers, BSN, RN · Jun 15, 2006

What do you do with your babies and parents. Do you do Kangaroo Care with vent babies? Babies with UAC, UVC lines? How long can baby be on mom? One hour or several hours? What about A's and B's? How do you manage privacy, both for mom and babe and the babies close by in the nursery. HIPPA problems (we have small rooms, crowded at times).

We do Kangaroo Care with vented babies as long as they are stable on not constantly desatting or on 100%. We don't even let parents hold babies with umbilical or peripheral arterial lines whether they're vented or not, so definitely no Kangaroo Care there. We let the mom hold the baby as long as tolerated, but about four hours would be our max so that we can do a good assessment on the baby and so that mom can go drink some water, get some food, and pee!!! If a baby is being held, Kangaroo or not, and is having some pretty decent bradys or desats, they need to go back to bed.

We have the moms bring a big button-down shirt (usually one of dad's) and we'll keep it in a plastic bag at the bedside. This is so mom doesn't have to plan her outfits around Kangaroo care. She'll go change into the shirt, and will discreetly unbutton it as we prepare the baby. She'll open her shirt for a second while we place the baby inside, then we'll cover the baby with the shirt and also a warm blanket. If there are a lot of people around, we might get the screen for the few minutes we're getting the baby into or out of the shirt, but usually it's so quick that one one can see anything. We do not allow them to have screens up while they're holding the baby, though, because we want to keep an eye on them, especially if the baby is vented. But the blanket mom is holding over her chest provides more than enough coverage.

ETA: We actually encourage Kangaroo Care for babies under a kilo. If the baby is stable enough to be held, we'd rather them be Kangaroo-ed by mom or dad instead of being wrapped up in a blanket with hat. The babies seem to keep their temps MUCH better if they are skin to skin, plus they just seem to enjoy being held more in that situation. And for a parent with a baby under a kilo, to be able to hold them skin-to-skin, it seems to help them more psychologically than to just hold the kid swaddled up. Maybe it's because they can't really focus on the tubes and stuff since they can't really look down? They just feel their hot little baby against them. I love seeing it.

wee one rn · Jun 15, 2006

what do you do with your babies and parents. do you do kangaroo care with vent babies? babies with uac, uvc lines? how long can baby be on mom? one hour or several hours? what about a's and b's? how do you manage privacy, both for mom and babe and the babies close by in the nursery. hippa problems (we have small rooms, crowded at times).
this is something we do occasionally, now we are working on a policy. i would appreciate any help you could give us.

kangaroo care is something that we encourage for all parents as soon as the baby is stable. we ask that they do it for at least 1-2 hours to give the baby time to really settle in before it's time to move back into the isolette, as the transfer is generally the most stressful part for the staff, parent, and baby. we have also found that after the longer kangaroo times, the babies generally settle in more easily and sleep better once back in the isolette. (to help with this, i do my care right before i take the baby out so hopefully they won't have to stop kangarooing due to a needed diaper change or suctioning and then once back in the isolette the baby can settle in again and sleep for a while before it's time for hands on.)

now for the requirements:

-we are required to have an order

-no size limit, but they have to be stable

-stable pattern of as/bs/ds, if they significantly increase or require frequent intervention then we return them to their isolette. (some kids show a decreased number of as/bs/fio2 during and after kangaroo care!)

-vents are ok, a little scary the first couple times, but have all your lines and wires organized and make sure they'll reach, then have one person transfer the baby while the other nurse/rt handles the vent tubing. we then tape the tubing to the parent and/or chair to stabilize the tube.

-lines are fine, except art lines, uvcs generally aren't an issue because we have piccs in before the baby would be stable enough to kangaroo

-feeds are fine, we just ask that the parent hold for at least 20 mins after the feed is done running in

-vitals off the monitor- temp, hr, rr, pox, fio2, before starting and then q15mins

-as for frequency, they have to remain stable during and after their kangaroo care and show a consistent pattern of weight gain. we generally start with isolette changes (q1-2 weeks) and then increase it as tolerated, every 3 days, every other, etc. for simplicity, we have it coincide with weights so the baby is taken out of the isolette as little as possible, especially if they are small or slow to gain weight.

-we have the parent wear a button down, or give them a patient gown and then cover the baby with the shirt/gown and a blanket. we do all kangarooing behind a screen (we also have close quarters, try turning the isolette to make more room) and the monitors are high enough to see over the screen so you aren't hovering over the parent but can still see all of the baby's vitals and check in as needed.

-last but not least, we turn down the lights to help provide a more relaxed environment, the parents really seem to appreciate this but understand that it isn't always possible depending on what's happening with the other babies in the room.

i hope this helps! it really seems to be a good thing for most of our parents and babies, especially the babies that are mid-20 weekers and finally stable but are still looking at quite a long stay with us.

Mimi2RN, ASN, RN · Jun 15, 2006

These will really help. It's good to get information from the nurses who are actually know what works.

Thank you! :yeah: :balloons:

Sweden · Jun 15, 2006

We encourage kangaroo care and have increased the use of it during the last couple of years.

We have a written policy:

Intubated (for the first time or if something new has happend), children with umbilical lines, unstable,

A´s and B´s are not a hinder for KMC. Unstable vent babies are held all the time and they don´t seem to be more unstable doing kangaroo care compared to lying in bed.

Usually it´s at least one hour of KMC (KangarooMotherCare) but parents are encouraged to do it as much as they want and can. Some babies are only held a few hours each day and others are held 6-8 hours (mum and dad just switch places). Parents are encouraged to be active with transferring baby (carrying baby/tubing) and we think we have reach our goal (well, at least one) when parents do everything around KMC and we´re only there to support them.

My personal record is getting a 480 gram baby out to mum when baby was only 12 hours (vent, umbilical lines, GA 24+1). It was only for an hour but both mum and baby loved it!

Preterm babies >32 weeks can actually be held in kangaroo position directly from birth at our unit. Those babies never use a isolette or bed, they stay on mum or dad in private rooms 24/7 until discharge. Almost all care can be done with baby still on parent (bililights, feedings, bloodsamples and so on).

Anna (from Sweden):)