Background: Kangaroo Mother Care (KMC) is defined as skin-to-skin contact between a mother and her newborn baby, frequent and exclusive or nearly exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW) infants, and in response to problems of serious overcrowding in neonatal intensive care units (NICUs). KMC essentially uses the mother as a natural incubator. According to this principle, LBW babies are placed to the mother’s chest in an upright position, where maternal body heat can help control the baby’s body temperature. Although widely used in some parts of the world, this practice is not the norm in the Kingdom of Saudi Arabia (KSA). Aim: The aim was to assess the feasibility and acceptability of running a randomised controlled trial (RCT) to evaluate the effectiveness of KMC in LBW infants in KSA.Study Design: A pilot RCT with supportive qualitative interviews was conducted, underpinned by a post-positivist approach.Methods: This was a mixed methods study. Quantitative methods were used to measure the effectiveness of KMC, and qualitative methods were used to explore women’s and nurses’ experiences of a) KMC and b) trial processes. The study took place in two urban hospitals in Jeddah, KSA. Ethical approval was gained, and data were collected between March and May 2011.The quantitative element comprised a two-group, individually randomised controlled pilot trial with 20 mothers-and-babies per group. The randomisation sequence was computer-generated, and participants were randomised using consecutively numbered, sealed, opaque envelopes. Data were collected using routinely collected case records, specifically designed clinical data sheets and two questionnaires (validated maternal bonding scale and maternal breastfeeding experience questionnaire). For the latter questionnaire, the design was informed by an expectation-fulfilment model. The qualitative element comprised semi-structured interviews, within 48 hours of birth, with a sample of 20 mothers who participated in the pilot RCT and 12 nurses who were attending these mothers. All 40 mothers were also telephoned when their babies were 6 months old to ascertain their feeding method and exclusivity of feeding.Quantitative data were managed using SPSS and analysed descriptively to estimate confidence intervals and effect sizes. Statistical tests and regression models were used to explore associations with potential outcome measures, with findings interpreted with caution as hypothesis-generating rather than hypothesis-confirming, given the small sample size. Qualitative data were analysed manually, using the Framework Approach.Results: The pilot study confirmed that trial processes were efficient, the intervention was acceptable (to mothers and nurses) and that the outcome measures were appropriate; the percentage of women exclusively breastfeeding at 6 months was identified as the most appropriate primary outcome. A large scale trial of KMC would be feasible and acceptable in KSA. However, issues relating to religious and organisational culture would need to be resolved, including improving privacy in the NICU, addressing language issues arising from transcultural nursing and engaging with male partners. A unique finding was the effect of KSA culture on women’s mobility and the impact that this had on their ability to carry out KMC if they were personally discharged but their baby remained in the NICU. Conclusion: A large scale RCT comparing KMC with standard care in KSA is feasible, acceptable and recommended. However, prior to progressing to a large scale study, a thorough planning stage is necessary which considers cultural practices and ward environment. The understandings gained from this research will be transferable to other research within similar settings

ABSTRACT The purpose of this study was to understand the mothers lived experience and perception towards 24-hour Kangaroo Mother Care (KMC) during hospitalization of their preterm babies. A qualitative design was used and phenomenological methods used to collect data. Nine in-depth unstructured interviews were with purposely-selected participants. The meaning of their experience was analyzed using Collaizzi’s (1978) steps to phenomenological data analysis. Data analysis revealed major three themes: (a) “it is a bond between me and my child” (b) nurse-parent interaction, and (c) “it is tiring and exhaustive”. However, the study found that all the mothers in spite of exhaustion, reported some high level of satisfaction with KMC because it allowed them to be closer to their babies. hence giving them the opportunity to observe their growth and become fully involved in the care. KMC was additionally noted have provided a comforting and warm environment for the babies, thus enabling them to grow faster and this in turn increased maternal satisfaction. Recommendation was made regarding further research preferably quantitative study to establish relationship between production of breast milk and the use of KMC. The principle of 24-hour KMC should also be incorporated and emphasized in all levels of educational training as this practice has been found to have numerous benefits both to the mothers and to their preterm babies.

Aim: The aim of the study was to compare knowledge and attitudes towards Kangaroo Mother Care (KMC) among neonatal unit staff at two neonatal units 2008 and 2010. Method: Members of staff from two neonatal units completed a questionnaire with 22 statements and an open-ended question in 2008 and 2010. The data were analysed with Mann-Whitney U test and content analysis. Results: There were significant differences between unit A and unit B in both the 2008 survey and the 2010 survey, showing better knowledge of KMC and a more positive attitude to KMC in unit A. Content analysis of responses to the open-ended question revealed concerns in unit B that its care environment was not suitable for KMC. Conclusions: Hypothetically, the fact that staff in unit A work in facilities designed to facilitate KMC, receive training in KMC and practice continuous KMC in intensive care as well as in intermediate care, has resulted in good knowledge of KMC and a general improvement of staff attitudes to KMC.

Infants in the NICU undergo many painful procedures and literature supports KMC as an effective intervention to diminish pain however, it is not used routinely in NICUs. The purpose of this qualitative study is to provide NICU nurses an opportunity to describe their experience of utilizing KMC for pain, and to interpret this experience with the goal of generating patterns that explain this understanding. The findings can be used to formulate interventions that foster the use of KMC. Using Interpretive Description as a philosophy of inquiry and research methodology, 8 NICU nurses were interviewed and participated in a focus group. Four patterns emerged: (1)”Seeing is Believing”; (2) Human Heartedness: “It’s the Least I can do”; (3) Playing it Safe; and (3) Creating the Possibility within Constraints.

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

The implementation of developmental care in South Africa seems problematic. As an effective care approach, developmental care (DC) reduces short- and long-term sequelae for pre-term and sick infants. This study therefore investigates and documents how DC can be implemented successfully in a South African context. The research design chosen, intervention design and development, has six phases: problem analysis and project planning, information gathering and synthesis, design, implementation, evaluation and advanced development, and dissemination. The sixth phase fell outside this study’s scope. Phase One, problem analysis and project planning, involved analysing and describing the level of DC practiced at the research site before implementation, and planning the implementation of DC in a South African public NICU. Planning involved consulting relevant literature and the multidisciplinary team of the NICU. Phase Two, information gathering and synthesis, consisted of identifying the factors involved in DC implementation from national and international examples of such implementation in neonatal intensive care. These factors were derived from available literature and other resources, including institutions where DC and kangaroo-mother care have been implemented, to provide a contextual framework for the intervention plan. The intervention plan for DC implementation at the research site was designed in Phase Three, based on the information gathered in Phase Two. The plan consisted of descriptive representations of the realities of clinical practice combined with applicable theoretical perspectives on the practice of DC. Guidelines for implementing DC were established as part of the plan. Phase Four involved the execution of the intervention plan in a South African public NICU, with participation from members of the multidisciplinary team. The intervention plan was refined and developed further in Phase Five, through monitoring and evaluating DC principles in the NICU. The guidelines were validated by an expert group. The study used Lincoln and Guba’s model (1985: 305) to ensure trustworthiness. No experimental and control groups were used as DC was implemented uniformly in the NICU, with all infants receiving this care. Harm or damage to research participants were not expected, as DC implementation benefits them and improves their working environment. Confidentiality was ensured for all participants and institutions involved. Informed consent for participation was obtained from individual members of the multidisciplinary team. Clearance was obtained from the ethics committee of the University of Pretoria, and institutional consent was obtained from the necessary organisations. This intervention study targeted the multidisciplinary team where medical, nursing, allied health profession and non-medical support personnel were involved in implementing DC. Phase One’s targets and goals included improving the quality of care rendered at the research setting, reducing developmental delays for preterm and sick infants and improved the working environment for the multidisciplinary team. Personnel targets were increasing the staffs’ knowledge and skills, and improving staff morale and job satisfaction. These targets and goals were achieved. / Thesis (PhD (Nursing Science))--University of Pretoria, 2006. / Nursing Science / unrestricted

Sammanfattning För att ge förutsättningar till optimal tillväxt och utveckling vårdas idag, tillsammans med andra behandlingar, prematura barnen på neonatalavdelningar hud mot hud. Vård hud mot hud av det prematura barnet sker oftast på mammas eller pappas bröst och forskning visar att detta är en gynnsam miljö för barnets utveckling och hälsa. Det har också en positiv inverkan på föräldrarnas anknytnings process. En otrygg anknytning kan leda till ohälsa längre fram i livet och det är därför viktigt ur ett folkhälsoperspektiv att det finns forskning som visar hur personalen ska gå till väga för att ge stöd och hjälp till föräldrar att vårda sitt barn hud mot hud. Syftet med denna undersökning var att ta reda personalens uppfattning och erfarenheter av att vårda barn hud mot hud. För att undersöka detta genomfördes sju semistrukturerade intervjuer med barnsjuksköterskor och barnsköterskor på en neonatalavdelning på ett sjukhus i mellan Sverige. Materialet som intervjuerna gav analyserades genom kvalitativ innehållsanalys. I resultatet framkom tre kategorier: personalens syn på sin roll, barnperspektiv och föräldraperspektiv. Kategorierna resulterade i temat ”motstridiga känslor hos personalen”. Detta framkom genom att personalen i sin roll och med sin kunskap om hud mot hud även behöver förhålla sig till barnets behov och barnets rätt till bästa vård samt föräldrarnas behov och svårigheter. Sammanfattningsvis framkom att kunskap, kunskapsöverförande samt att ge föräldrar praktisk hjälp är viktiga för att öka antal timmar barnet vårdas hud mot hud.

Philosophiae Doctor - PhD (Nursing) / The number of healthcare institutions that has embraced Kangaroo Mother Care (KMC) as an effective and efficient method of neonatal care especially in Edo State, Nigeria has not multiplied even after more than a decade of its recommendation by the World Health Organisation (WHO) in 2003. Nigeria ranks seventh among the ten African countries where newborns have the highest risk of dying with over 700 newborn deaths per10, 000 live births. This is worrisome because Edo State is one of the 36 states in Nigeria that contribute about 6,700 neonatal deaths to the 255,500 mortality rate recorded in Nigeria annually. This has led to a concern about the knowledge and attitude of the key drivers in neonatal care of simplified methods aimed at reducing neonatal mortality despite previous training efforts. The development of a strategy to enhance the early implementation of the WHO KMC guidelines in all healthcare facilities across the state was therefore conceptualized. Strategies to increase implementation are considered important to the success of KMC because reducing neonatal mortality rate is contextual. This research aimed to explore and describe the application of the KMC guidelines by the nurses, administrators and parents of preterm infants in the care of premature babies and to develop strategies to enhance its early implementation in healthcare facilities in Edo State, Nigeria.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-06-15T18:02:17Z No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5) / Made available in DSpace on 2016-06-15T18:02:17Z (GMT). No. of bitstreams: 1 Laysa Gabrielle Silva Medeiros.pdf: 1788729 bytes, checksum: e020ca14a18dbb540c4e2962dcd57577 (MD5) Previous issue date: 2016-02-23 / Introduction: Every year, 20 million of newborns born with low weight mainly as a result of premature births. This fact represents an important public health problem that reflects in high rates of neonatal and maternal morbimortality. Scientific advances in neonatal intensive care have contributed significantly to reduce perinatal mortality rates promoting an increase in the survival chance of newborns with low weight and the emergence of perinatal care models that improve the quality of care. One of the most important actions is the Kangaroo Method. Objective: Analyze the perceptions of mothers with preterms and/or low weight newborns about the second phase of Kangaroo Method and the coping strategies adopted in a public maternity in the interior of Paraíba. Methodology: A qualitative research was developed and were interviewed, from May to August 2015, ten mothers that were hospitalized in a Kangaroo Mother Accommodation experiencing the second stage of the method in integral way with their babies. The Data Saturation criteria was used to limit the number of participants. The data were collected using semi-structured interviews and were analyzed through Bardin's Content Analysis, from which emerged three categories: Baby hospitalization and maternal feelings; Kangaroo Mother Accommodation: maternal experiences; Experiencing the Kangaroo Mother Care. Results: With a hospitalized baby, mothers face a period a disturbance period involving suffering, fear, sadness, despair, fault and anger, resulting in impairment on their self confidence and self-esteem. However, despite these feelings, mothers can confront the difficulties through religious and/or family support. About to being close to the baby in the Kangaroo Method and deliver the her care, the mothers reported being happy and satisfied, emphasizing the child's improvement after the use of the method. To the mothers, this method was an opportunity to have a more intimate contact with the baby, but also brought difficulties such as distance and the missing of the family. In a general way, the mothers expressed to be satisfied as to the assistance given, the environment and operation, highlighting the role of staff, which contributed to the development of maternal safety. Final considerations: This study helped in understanding the maternal experiences and coping strategies within the Kangaroo Method, highlighting the necessity for reflection on the role of mothers in the context of the method, considering their entirety and individuality. / Introdução: Em todo o mundo, nascem anualmente 20 milhões de recém-nascidos de baixo peso, em consequência principalmente de partos prematuros. Tal fato configura importante problema de saúde pública refletido nas altas taxas de morbimortalidade neonatal e materna. Os avanços científicos, empregados à terapia intensiva neonatal têm contribuído significativamente para redução das taxas de mortalidade perinatal, promovendo um aumento da chance de sobrevida dos recém-nascidos de baixo peso e o surgimento de modelos de assistência perinatal voltado para a melhoria da qualidade do cuidado. Dentre essas ações, destaca-se o Método Canguru. Objetivo: Analisar as percepções das mães de recém-nascidos pré-termo e/ou baixo peso sobre a segunda etapa do Método Canguru e as estratégias de enfrentamento adotadas por elas, em uma Maternidade Pública no interior da Paraíba. Metodologia: Trata-se de uma pesquisa qualitativa, na qual foram entrevistadas, no período de maio a agosto de 2015, dez mães que estiveram internadas no Alojamento Mãe Canguru, vivenciando a segunda etapa do método de forma integral junto com seus bebês. Para delimitação do número de participantes foi utilizado como critério a saturação dos dados. Os dados coletados por meio de entrevista semiestruturada, foram analisados através da Análise de Conteúdo de Bardin, na qual emergiram três categorias: Hospitalização do bebê e sentimentos maternos; Alojamento Mãe Canguru: experiências maternas; Vivenciando o Método Canguru. Resultados: Com a hospitalização do bebê, as mães enfrentam um período que envolve sofrimento, medo, tristeza, desespero, culpa e raiva, resultando no comprometimento da autoconfiança e autoestima. Entretanto, apesar desses sentimentos, as mães conseguem lidar com as dificuldades, através da religiosidade e/ou apoio familiar. Quanto a estar junto ao bebê no Método Canguru e realizar os cuidados com ele, as participantes relataram estar felizes e satisfeitas, enfatizando a melhora do filho após o uso do método. Para as mães, o método foi uma oportunidade de ter um contato mais íntimo com o filho, mas que também trouxe dificuldades, como a distância e saudade da família. De forma geral, as mães expressaram estar satisfeitas quanto à assistência prestada, o ambiente e funcionamento, com destaque para papel da equipe, que contribuiu para o desenvolvimento da segurança materna. Considerações Finais: Este estudo auxiliou na compreensão das experiências maternas e estratégias de enfretamento no âmbito do Método Canguru, destacando a necessidade de reflexão sobre o papel das mães no contexto do método, considerando-as em sua integralidade e individualidade.

<p>Aim: To examine the reaction of extreme preterm infants with regarding to body temperature and transepidermal water loss during skin-to-skin care according to Kangaroo Mother Care (KMC) during the infant’s first week of life. Method: This was a descriptive quantitatively designed study, which was a pilot study within the framework of a larger project. Nine children, with a median gestational age of 24.91 weeks, were examined by measuring body temperature (axilla and skin temperature) as well as transepidermal water loss before, during and after KMC. Results: The study showed that skin temperature tended to rise during KMC, especially for those children who were nursed with KMC for more than 60 minutes. Eight out of nine children had, after completing KMC, a normal axilla temperature. As was expected, transepidermal water loss was elevated when measured both pre and post test. Despite this, the children showed normal body temperature. Conclusion: The results of the study support that KMC can create a micro-climate that, for at least one hour, makes it possible for even extreme preterm infants to maintain a body temperature within the normal range during their first week of life.</p>