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.

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

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.

Magister Public Health - MPH / Background: Every year, about 20 million infants are born with low birth weight globally, putting a heavy burden on health care and social systems, especially in developing countries as they are often understaffed and/or lack optimally functional equipment. In 1978, Dr E. Rey proposed the Kangaroo Mother Care (KMC) programme which was further developed by coworkers at one of the largest obstetric facilities in Santa Fe de Bogotá, Colombia. KMC was introduced as an alternative to the expensive and seldom used traditional methods to care for low birth weight infants. KMC is currently not practised at Tsumeb district hospital despite many infants born with low weight in the district. Aim: The aim of the study was to explore perceptions regarding the implementation of Kangaroo Mother Care in the maternity ward of Tsumeb district hospital. Study design: This was a qualitative exploratory study. Study population and sampling: The study population are doctors and nurses working in Tsumeb district, the Chief Medical Officer (CMO) as well as the health programme administrators in the family health division of the Ministry of Health and Social Services (MOHSS), Oshikoto region. Purposive sampling was used to select participants. Results: Perceptions were grouped into three main themes namely the parent-related, health worker-related and baby-related. Parent-related perceptions include self-trust, increased competency, less frustration, and active involvement of parents in baby care, which are similar to the literature and regarded as benefits of KMC. Health worker-related perceptions included both reduced workload and an increased workload. Baby-related perceptions are reduced morbidity, increased bonding and improved care. The study also revealed the barriers to KMC implementation as well as factors that can make KMC implementation a success. Conclusions: Three broad themes emerged from the study, parent-related, health worker-related and baby-related. Most of the health workers’ perceptions are similar to the benefits of KMC found in the literature but, some health workers have negative perceptions regarding KMC.

Tio procent av alla barn som föds i Sverige vårdas på neonatalavdelning. Där arbetar barnsjuksköterskor med särskild kompetens inom barn- och barnsjukvård med en viktig roll att stärka barns rätt till hälsa och föräldrarnas delaktighet i vården. Hud-mot-hud är en omvårdnadsmetod som har visat sig ge många fördelar för barnen. Samtidigt har utmaningar identifierats kring hur hud-mot-hud kan genomföras på bästa sätt och att barnsjuksköterskors uppfattningar och attityder kan påverka resultatet. Syftet med studien var att beskriva barnsjuksköterskors uppfattningar om och attityder till att vårda hud-mot-hud på neonatalavdelning. Sex intervjuer med sjuksköterskor har genomförts via digitala videoverktyg. Resultatet visade att barnsjuksköterskor är positivt inställda till att vårda hud-mot hud. De anser att det är det viktigaste föräldrarna kan göra för sitt barn och ser det som sitt ansvar att göra dem delaktiga i vården och stötta dem så att anknytningen främjas. Diskussion har förts utifrån hur det är att vårda de mycket för tidigt födda och svårast sjuka barnen, vad hud-mot-hud betyder för anknytningen och familjecentrerad vård. Slutsatsen blir att barnsjuksköterskor med sin unika kompetens kan stärka föräldrarna i hud-mot-hud-vården så att barnens hälsa främjas.

ABSTRACT Background: Kangaroo-mother care (KMC) is a vital part of the neonatal care. The method is based on skin to skin contact, where the parent or another caregiver, holds the child on itsbare chest for an extensive period of time. This has been proven to have a positive effect on the childs physical and mental development. Less extensive research has been made on the methods effects on the parents.  Aim: The aim of this studie was to describe the parents experience of used KMC during their childs time on a NICU (neonatal intensive care unit).  Method: A literature study with descriptive design. Based off of 12 original qualitative studies from the databases PubMed, CINAHL and Web of Science.  Results: The parents experiences could be devided into four themes: Emotional- and physical experiences as a result of KMC, the unit’s effect on the experience of KMC and bonding. The method was appreciated by the parents and the overall experience was positive. However, the method can be demanding for the parents and the staff and environment on the NICU have a big influence on the experience.  Conclusion: Time on a NICU can be stressful for both child and parents. KMC has been proven to be beneficial for the child, but also for the parents’ experience of their childs care. The method should be practiced as much as possible, with the influence of the health care staff and unit’s environment. Keywords: Kangaroo-mother care method. Intensive care. Neonatal. Infant. Parents. / SAMMANFATTNING Bakgrund: Kängurumetoden (KMC) utgör en vital del av omvårdnaden på neonatala vårdavdelningar. Metoden utgörs av hud mot hud kontakt, där föräldern eller en annan vårdgivare har barnet vilande på bröstkorgen under en längre tid. Detta har visats ha positiv effekt på barnets fysiska och psykiska utveckling. Det finns mindre forskning gällande metodens effekt på föräldrarna . Syfte: Syftet var att beskriva föräldrarnas upplevelse av genomförd kängurumetod under sitt barns vårdtid på neonatal intensivvårdsavdelning. Metod: Litteraturstudie med beskrivande design och som är av kvalitativ karaktär. Baserat på 12 kvalitativa originalartiklar från databaserna PubMed, CINAHL och Webof Science.  Resultat: Föräldrarnas upplevelser kunde delas in i fyra kategorier; känslomässiga upplevelser till följd av KMC, kroppslig upplevelse till följd av KMC, vårdavdelningens påverkan på upplevelsen och anknytning. Metoden var något som uppskattades och upplevelsen var övervägande positivt. Dock ställer den krav på föräldrarna, där också vårdpersonal och vårdmiljö har en viktig påverkan. Slutsats: Tiden på en neonatal intensivvårdsavdelning kan vara påfrestande för både barn och föräldrar. Kängurumetoden har visats vara gynnsam för både barnet men också föräldrarnas upplevelse. Metoden bör tillämpas i så stor utsträckning som möjligt, där vårdpersonal och avdelning har en viktig roll. Nyckelord: Kängurumetoden. Intensivvård. Neonatal. Spädbarn. Föräldrar.

Bakgrund: Kängurumetoden (KMC) utgör en vital del av omvårdnaden av det för tidigt födda barnet. Metoden innefattar tre olika delar: hud-mot-hudkontakt mellan barn och förälder, exklusiv matning med bröstmjölk och strävan efter en tidigare hemgång alternativt flytt till en lägre vårdnivå. Evidensen för KMC belyser de positiva hälsoeffekterna som metoden har på barnet och dessutom lyfts metodens bidrag till att främja anknytningen mellan barnet och föräldern samt familjecentrerad omvårdnad. Vårdtiden på neonatalavdelningen är ofta förenad med separation mellan barn och förälder, något som kan motverkas med KMC. För en förbättrad implementering av metoden som rutin på neonatalvårdsavdelningar krävs en ökad förståelse för föräldrarnas upplevelser av KMC. Syfte: Syftet var att undersöka föräldrars upplevelser av att vårda sitt för tidigt födda barn med kängurumetoden på neonatalvårdsavdelning. Metod: Litteraturstudie med beskrivande design som inkluderade nio originalartiklar av studier med kvalitativ ansats från databaserna PubMed, CINAHL och Web of Science. Resultat: Föräldrarnas upplevelser presenterades utifrån fyra teman: (I) förutsättningar för KMC, (II) emotionell upplevelse av KMC, (III) upplevd påverkan på barnet och (IV) teamwork & jämställdhet. Föräldrarna beskrev KMC som en övervägande positiv och känslosam upplevelse som bidrog till att etablera föräldrarollen och främja den tidiga anknytningen. Samtidigt lyfte de vikten av en lugn och bekväm miljö, vårdpersonalens stöd och tillräckligt med information om KMC för att kunna genomföra metoden. Slutsats: KMC var en uppskattad metod hos föräldrar och beskrevs som essentiell för anknytningen. Föräldrar upplevde en rad faktorer som förutsättningar för utförandet av KMC. Dessa faktorer går att påverka i omvårdnadsarbetet och därför betonas sjuksköterskans väsentliga roll i främjandet av kängurumetoden. / Background: Kangaroo mother care (KMC) is a vital part of the care of the premature infant. The method includes three different aspects: skin-to-skin contact between infant and parent, exclusive feeding with breast milk and the pursuit of an earlier hospital discharge or transition to a lower level of care. The evidence for KMC highlights the positive health effects that the method has on the infant, while also describing the method's contribution to foster both bonding between infant and parent, as well as family-centered care. Care of the infant in neonatal care units (NICU) is often associated with separation between child and parent, which can be counteracted with KMC. For an improved implementation of the method as a routine in NICUs, an increased understanding of parents’ experiences of KMC is required. Aim: The aim was to investigate parents' experiences of caring for their premature infant with the kangaroo method in the NICU. Method: A literature review with a descriptive design that included nine original articles of studies with a qualitative approach from the databases PubMed, CINAHL and Web of Science. Results: The parents' experiences were divided into four themes: (I) preconditions for KMC, (II) emotional experience of KMC, (III) perceived impact on the infant and (IV) teamwork & equality. Parents described KMC as a predominantly positive and emotional experience that helped establish the parental role and nurture the early attachment. Simultaneously, they highlighted the importance of a calm and comfortable environment, the support of the healthcare staff and sufficient knowledge of KMC to be able to implement the method.Conclusion: KMC was valued by parents and described as essential for attachment. Parents perceived many factors as preconditions for the implementation of KMC. These factors can be influenced by nursing care and therefore the essential role of the nurse in the promotion of KMC is emphasized.

Abstrakt Bakgrund: Nyfödda barn rekommenderas att läggas på mammans bröst direkt efterfödseln vilket innebär en hud-mot-hudkontakt och kallas för Kangaroo Mother Care(KMC). Denna kontakt innebär fördelar som bland annat förbättradevitalparametrar, för både mamma och det nyfödda barnet efter förlossningen. Motiv: Det finns idag sparsamt med studier som är gjorda på vårdpersonalenserfarenhet av att vårda det nyfödda barnet i KMC. Denna studie fokuserar därför påvårdpersonalens erfarenhet och upplevelser av vården som sker i KMC. Genom attbelysa vårdpersonalens erfarenhet av ämnet, skulle det kunna identifiera brister menäven leda till utveckling och fördjupad kunskap. Syfte: Syftet med studien var att belysa vårdpersonalens erfarenhet av att vårda detnyfödda barnet i KMC. Metod: Studien genomfördes med hjälp av individuella semistruktureradeintervjuer med vårdpersonal som hade erfarenhet av ämnet. Vårdpersonalen varspecialistsjuksköterskor, barnmorskor och undersköterskor, som arbetade påneonatalavdelning, förlossning och BB. Datainnehållet analyserades med kvalitativinnehållsanalys enligt Graneheim och Lundman. Resultat: Studien resulterade i tre kategorier och sex underkategorier. Den förstakategorin Vårdpersonal och föräldrars delaktighet och samspel med varandraresulterade i två underkategorier, den andra kategorin KMC möjliggörhälsofrämjande effekter resulterade i två underkategorier och den tredje kategorinUtmanande omständigheter i vården av KMC resulterade i två underkategorier. Konklusion: Studien tydliggör att vårdpersonalen inbringar en roll i vårdandet avdet nyfödda barnet i KMC, där kunskap, erfarenhet och lyhördhet är viktiga delar.Vårdpersonalen upplevde att de behöver vara tillmötesgående mot föräldrarna ochvara informativa samt delaktiga för att kunna ge en god och säker vård. Vikten av attsamarbeta genom hela vårdkedjan kommer vara en betydande roll för framtiden föratt främja likvärdig vård för alla nyfödda barn och deras föräldrar.

Syfte. Undersöka användningen av kängurumetoden hos extremt för tidigt födda barn. Bakgrund. Kängurumetoden (KM) är en evidensbaserad metod som innebär att barnet bärs hud mot hud på förälderns bröst i upprätt ställning. Metoden har många fördelar för det för tidigt födda barnet och har visat sig vara effektiv för att skapa starka band föräldrar och barn emellan. Forskning visar att det är en säker vårdmetod även för extremt för tidigt födda barn.   Design. En retrospektiv explorativ journalgranskningsstudie med både kvantitativ och kvalitativ ansats. Journaler granskades för de 49 extremt för tidigt födda barn vårdade vid Norrlands universitetssjukhus mellan oktober 2011 och oktober 2013. Metod. Statistiska beräkningar gjordes med icke parametrisk korrelation enligt Spearman och Wilcoxon signed ranks test. I den kvalitativa delen utfördes textanalys av journalanteckningar. Resultat. Medianålder vid kängurudebuten var fyra dagar. De flesta barn kängurudebuterade med mamman, och pappor utövade känguruvård i mindre utsträckning än mammor. Ju tidigare barnet var fött, desto längre dröjde kängurudebuten, men känguruvård har förekommit så tidigt som dag fyra hos de mest för tidigt födda barnen. Slutsats. Neonatalvården har mycket att vinna på om vårdpersonalen lyckas hjälpa föräldrar i allmänhet, och pappor i synnerhet, till att tidigt våga närma sig och känguruvårda sina extremt för tidigt födda barn. Med utbildning och träning för personal och stöd till föräldrarna, kan KM användas i större utsträckning för de extremt för tidigt födda barnen. Kliniska implikationer. Resultaten av denna studie bidrar till insikter och djupare kunskap om användningen av KM för extremt för tidigt födda barn. Resultatet kan användas för att identifiera utvecklingsmöjligheter men även för att utvärdera framtida förbättringsarbete. Kunskapen om och tron på vinsterna med KM kan rädda liv. / Aims. To study the use of the KMC for extremely preterm infants. Background. Kangaroo-Mother care (KMC) is an evidence-based method that involves carrying the infant skin to skin on the parent’s chest in an upright position. The method brings many benefits for the preterm infant and has proven to be effective for creating strong bonds between parents and infants. Research shows that KMC is a safe method even for extremely preterm infants. Design. A retrospective exploratory medical records review using both quantitative and qualitative approach. Medical records were reviewed for the 49 extremely preterm infants cared for at Norrland’s University Hospital between October 2011 and October 2013. Methods. Statistical analysis were made by non-parametric correlation by Spearman and Wilcoxon´s signed ranks test. In the qualitative part text analysis of medical records was performed. Results. KMC onset was in a median age of four days after birth. The kangaroo onset was most often with the mother, and fathers performed less KMC than mothers. The more preterm the infant was born, the later kangaroo onset, but KMC has occurred as early as day four for the most preterm infants. Conclusion. Neonatal care has much to gain if nursing staff succeed in helping parents in general, and fathers in particular, to an early KMC onset. With education and training for staff and support to the parents, KMC can be used for the extremely preterm infants to a greater extent. Relevance to clinical practice. The results of this study contribute to the understanding and deeper knowledge about the use of KMC for extremely preterm infants. The result can be used to identify needs for development, but also to evaluate future improvements. Knowledge of and belief in the benefits of KMC can save lives.

A dor no recém-nascido é um fenômeno complexo, constituído por diferentes estímulos e tipos de dor, que pode envolver várias combinações de receptores e mecanismos do sistema nervoso em desenvolvimento. No Brasil, é direito de cidadania da criança e do adolescente não sentir dor, quando existirem meios de evitá-la. Esse direito também está previsto na Declaração Universal dos Diretos do Prematuro, segundo a qual a dor do prematuro deverá ser sempre considerada, prevenida e tratada por meio dos processos disponibilizados pela ciência atual. Entre as medidas não farmacológicas para o manejo da dor aguda decorrente de procedimentos de apoio ao diagnóstico e terapêuticos, tem-se particular interesse no contato materno pele a pele, por sua comprovada efetividade no alívio da dor em prematuros. Pesquisadores do Grupo de Pesquisa em Enfermagem no Cuidado à Criança e ao Adolescente da EERP-USP, preocupados com a problemática da dor em recém-nascidos a termo e pré-termo e crianças, desenvolveram pesquisas que comprovaram a eficácia deste contato também para o alívio da dor durante a coleta do teste do pezinho. O intuito do grupo, assim como o de outros pesquisadores, é reduzir a lacuna entre o conhecimento produzido e a prática clínica para a avaliação e o manejo da dor em crianças, incentivando a participação materna e da família. A atual motivação reside em investigar a perspectiva materna no processo de alívio da dor aguda do recém-nascido pré-termo mediada pelo contato pele a pele. Assim, o objetivo do presente estudo é analisar os significados atribuídos pela mãe em sua vivência de contato pele a pele com seu filho prematuro para o alívio da dor decorrente da coleta do teste do pezinho em unidade neonatal. Trata-se de estudo descritivo, na abordagem qualitativa, tendo como quadro teórico o cuidado humanizado, integral e centrado na família. Realizou-se a investigação na unidade de cuidado intermediário neonatal do hospital universitário de Ribeirão Preto - SP. Os dados foram coletados mediante entrevista semiestruturada com 15 mães de prematuros. Da análise de conteúdo dos discursos emergiram seis eixos temáticos: Pele a pele mãe e filho gera prazer; Pele a pele tranquiliza e acalma o bebê; Contato materno pele a pele alivia a dor do prematuro; Contato pele a pele insere a mãe no cuidado do filho mesmo durante procedimento doloroso - resgata o papel materno; Desejo de realizar o contato pele a pele durante outros procedimentos com o filho prematuro; e Indicando e incentivando o pele a pele para outras mães. Constata-se que as mães possuem sentimentos positivos reconhecendo que o contato pele a pele com o filho promove alívio da dor, com consequente redução de manifestações comportamentais durante o teste do pezinho. Os significados atribuídos a esta vivência materna corroboram estudos que mostram a redução da reatividade biocomportamental do prematuro em posição canguru, cuja prática deve ser amplamente utilizada para o alívio da dor decorrente de procedimentos dolorosos / Pain among newborns is a complex phenomenon composed of different stimuli and types of pain, which may involve various combinations of receptors and mechanisms of the developing nervous system. In Brazil, children and adolescents are entitled not to suffer pain whenever it is avoidable. In addition, there is the Universal Declaration of the Rights of Preterm Infants, in which it is stated that the pain of a premature infant should also taken into account, prevented and treated using processes enabled by current science. Among the non-pharmacological measures used to handle acute pain accruing from procedures that support diagnosis and therapeutic action, there is special interest in skin-to-skin contact with the mother, the effectiveness of which has been proven to alleviate pain among preterm infants. Researchers from the Research Group in Nursing Care Provided to Children and Adolescents at EERP-USP, concerned with pain among at term and preterm infants and children conducted research that proved the efficacy of skin-to-skin contact in the alleviation of pain during the heel prick screening test, among others. They work to reduce the gap between knowledge and clinical practice in regard to assessment and handling pain among children, encouraging the participation of both mother and family. Currently, the motivation is to investigate the maternal perspective of the process of alleviating acute pain in preterm newborns, mediated by skin-to-skin contact. This study\'s objective was to analyze the meanings assigned by mothers to their experience of skin-to-skin contact with their preterm children to alleviate the pain accruing from the heel prick test in a neonatal ward. The theoretical framework of this descriptive study with qualitative approach is integral, humanized and family- centered care. The study was conducted in the neonatal intermediate care unit at the University hospital at Ribeirão Preto, SP, Brazil. Data were collected through semi- structured interviews conducted with 15 mothers of preterm infants after free and informed consent forms were signed. Content analysis was used to analyze data, from which six thematic axes emerged: Mother and child skin-to-skin contact generates pleasure; Skin-to-skin reassures and calms down the baby; Maternal skin- to-skin contact alleviates pain in preterm infants; Skin-to-skin contact included the mother in the care provided to the child even during a painful procedure - redeems the maternal role; Desire to have skin-to-skin contact during other procedures with the preterm child; and Encouraging other mothers to practice skin-to-skin contact. The mothers reported positive feelings, acknowledging that skin-to-skin contact with their children promotes pain relief and that behavioral manifestations decreased during the heel prick test. The meanings assigned to this maternal experience corroborate studies that show reporting reduced biobehavioral reactiveness among preterm infants in the kangaroo position, a practice that should be widely used to alleviate pain accruing from painful procedures