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					“Kangaroo” Mother Care
          OUTLINE

Background
Program Description
Research Outcome
Summary
KMC History
Philippines : Livebirths 2000




       >2500 gm   <2500 gm   unknown
Perinatal Deaths




  Maternal     Infant
  Stillbirth   NeoTetanus
40000

30000

20000

10000

    0
        1994   1995   1996       1997    1998    1999

                Dr. Jose Fabella Memorial Hospital
               MORTALITY     MORBIDITY   TOTAL LIVE BIRTHS
2500

2000

1500

1000

500

   0
       1994   1995       1996      1997    1998    1999



                      TERM      PRETERM   TOTAL DEATHS
                     Dr. Jose Fabella Memorial Hospital
10000

8000

6000

4000

2000

    0
        1994   1995     1997      1998      1999


                      PRETERM    <2001   <2500
               Dr. Jose Fabella Memorial Hospital
JFMH Kangaroo Mother Care Program

     KMC team composed of:
        Pediatricians
        Nurses
        Midwives
        Social Workers
     Administrative Support
FAMILY SUPPORT
LOCAL STUDIES
        RATIONALE
Six –year neonatal statistics
consistently showed preterms
constituted 75% of deaths

Survival rates did NOT vary
significantly during the same period
of time
  “Kangaroo” Mother Care
         Program
    Objectives               Outcome Measures
To provide a               Effective thermoregulation
   “technology” that can       of the LBW
   substitute for the
   incubator
To promote maternal-       Decreased child
   infant bonding             abandonment
To promote and sustain     Improved breastfeeding
   breastfeeding of the       rates post-discharge
   preterm and low birth
   weight
 “Kangaroo” Mother Care
        Program
    Objectives                 Outcome Measures

To promote maternal         Maternal acceptance of the
   empowerment in the          KMC technique
   care of the sick LBW

To improve resource         Improved staff:patient ratio
   personnel allocation        in the NICU
   and utilization in the
   NICU
The Effect of “Kangaroo” Mother Care on the
Physiologic & Behavioral State of LBW Neonates



   Osia, M. Martin, L. Nerona, A. De Leon-
                Mendoza, S.
                 RESULTS
Axillary and rectal temperatures significantly
  higher during kangaroo care.
Heart and respiratory rates were not
  significantly different before and during
  kangaroo care.

Behavior state scores were significantly lower
  during kangaroo care than before kangaroo
  care.
Physiologic parameters significantly lower and
  less variable in maternal vs. paternal kangaroo
  care except axillary temperature.
      Objective # 3

To improve and sustain
breastfeeding rates after
discharge of preterm and low
birth weight infants
              Results

100

 80

 60

 40                       Well Babies
                          KMC Babies
 20

  0
       1     3      5
      mo.   mos.   mos.
         Conclusion
Breastfeeding rates among KMC dyads
are significantly increased compared to
the well babies followed-up at the
outpatient department up to 5 months
post-discharge.
      Objective # 5

To improve resource and
personnel allocation in the
NICU
       Staff : Patient Ratio
              at NICU
             Level III   Level II

Before KMC   1:10-15     1:30-40

KMC Program 1:8-10       1:15-20
Impact of Kangaroo Mother
Care on the Survivability of LBW
Neonates

     September 1999 - August 2000
         RESULTS

Population   KMC    Control
<1000         184   179
1001-1250     228   209
1251-1500     397   317
1501-1750     657   530
1751-2000    1216   820
Total        2682   2055
            Results
Survivors   KMC (%)       Control(%)
<1000       16 (8)        4 (2.2)
1001-1250   58 (25.4)     32 (15.3)
1251-1500   122 (30.7)    76 (23.9)
1501-1750   343 (52.2)    244 (46.0)
1751-2000   834 (68.6)    554 (67.5)
Total       1373 (51.2)   910 (44.3)
   70

   60

   50

   40

   30

   20

   10

    0
                                                                  SURVIVAL C
     1
<100         1-125
                  0            0
         100          1251-150             01-17
                                                 50           0
                                        15            1751-200

                                   SURVIVAL C SURVIVAL K
       SURVIVABILITY OF LBW’S IN KMC

                                    Odds ratio (95%CI)
 KMC, overall


     1751-2000

1501-1750


   1251-1500


  1001-1250

             1000



      0.75     0.80   0.85   0.90   0.95    1.0   1.05   1.10   1.15
SURVIVABILITY OF LBW’S IN KMC FIVE YEAR DATA

                                   Odds ratio (95%CI)
                                                        KMC, overall

                                                         1751-2000

                                                         1501-1750


                                                         1251-1500


                                                         1001-1250

                                                           1000




       0.75   0.80   0.85   0.90   0.95   1.0   1.05    1.10   1.15
  Proportion of Deaths due to
Sepsis Among Preterm Neonates
          (1998-2004)
                     Death      Life

 No KMC (’98)        506        968

 With KMC (99-04) 2608          8250

        P       = 0.000009
        RR      = 0.75 (0.66-0.84)
          Conclusion
Sufficient local evidence to support the
attainment of KMC program’s
objectives

Improved survivability among LBW’s in
general and preterms diagnosed to
have sepsis neonatorum
INTERNATIONAL
   STUDIES
Meta-analysis of 3 RCTs commencing
     KMC in the 1st week of life
               n = 988

major reduction in neonatal deaths for
babies <2000gm (RR 0.49,95%CI 0.29-
                0.82)

       International Journal of Epidemiology
                 2010:39,i144-i154
         Meta-analysis
 3 observational studies n= 8257

- reduction in neonatal mortality in
babies <2000 g, which was slightly
 smaller than that observed in the
randomized trials (RR 0.68, 95% CI
             0.58–0.79)

      International Journal of Epidemiology
                 2010:39,i144-i154
          Meta-analysis of 5 RCTs
                 n = 1520

  - KMC was associated with a reduction in
 serious neonatal morbidity (RR = 0.34, 95%
                CI 0.17–0.65)
  Morbidity was defined as severe infection
such as sepsis, necrotizing enterocolitis and
             severe pneumonia

         International Journal of Epidemiology
                   2010:39,i144-i154
              SUMMARY

•Breastfeeding rates among KMC dyads are
significantly increased

•KMC Improved survivability among LBW’s
 and preterms diagnosed to have sepsis neonatorum

•KMC reduced neonatal morbidities and
mortality among neonates <2000gm especially if
 KMC was started in the first week of life
  Implementation of
Essential Newborn Care
 Protocol : Early KMC

				
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