Heart rate variability responses of a preterm infant to kangaroo care.

OBJECTIVE: To examine the effect of kangaroo care on heart rate variability in a healthy preterm infant. DESIGN: Case study. SETTING: Private room on a postpartum unit. PARTICIPANT: A mother-preterm infant dyad. INTERVENTION: Kangaroo (skin-to-skin) care. MAIN OUTCOME MEASURE: Heart rate variability, a noninvasive measurement of the sympathetic and parasympathetic components of the autonomic nervous system's influence on heart rate. RESULTS: Heart rate variability, especially the parasympathetic component, was high when the infant was fussy in the open crib, indicating increased autonomic nervous system activity. With kangaroo care, the infant fell asleep, and both sympathetic and parasympathetic components of heart rate variability decreased. CONCLUSIONS: The wide fluctuations in the parasympathetic component of heart rate variability suggest immaturity of the sympathovagal response. Overall, kangaroo care produced changes in heart rate variability that illustrate decreasing stress.

Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants.

PURPOSE: To determine the safety and effects on healthy preterm infants of three continuous hours of kangaroo care (KC) compared to standard NICU care by measuring cardiorespiratory and thermal responses. DESIGN: Randomized controlled trial-pretest-test-posttest control group design. SAMPLE: Twenty-four healthy preterm infants (33-35 weeks gestation at birth) nearing discharge. Eleven of the infants received KC; 13 received standard NICU care. MAIN OUTCOME VARIABLES: Heart rate, respiratory rate, oxygen saturation, and abdominal skin temperature were manually recorded every minute. Apnea, bradycardia, periodic breathing, and regular breathing were captured continuously on a pneumocardiogram printout. Three consecutive interfeeding intervals (three hours each) on one day constituted the pretest, test, and posttest periods. RESULTS: Mean cardiorespiratory and temperature outcomes remained within clinically acceptable ranges during KC. Apnea, bradycardia, and periodic breathing were absent during KC. Regular breathing increased for infants receiving KC compared to infants receiving standard NICU care.

Mother-newborn contact in a randomized trial of kangaroo (skin-to-skin) care.

OBJECTIVE: To describe the type and percent time of contact 0-48 hours postbirth for mother-preterm newborn (infant) dyads given kangaroo care (skin-to-skin) or standard care (controls). DESIGN: Randomized controlled trial with assignment by computerized minimization to kangaroo care (n = 48) or control (n = 43). SETTING: Postpartum units and neonatal intensive-care units (NICU). PARTICIPANTS: Preterm infants 32 to less than 37 weeks gestation and their mothers. INTERVENTION: Kangaroo (skin-to-skin, SS) care (KC). MAIN OUTCOME MEASURES: Type and percent time of mother-infant contact (SS versus holding wrapped in blankets). RESULTS: Analyses were based on four groups: assignment for infants in each group to postpartum or NICU. For KC dyads, SS postpartum was 22.0%; SS NICU was 7.5%. KC wrapped holding postpartum was 11.6%; NICU was 1.8%. For control dyads, wrapped holding postpartum was 13.9%; NICU was 6.1%. CONCLUSION: Amount of SS was much less than expected. Reasons include unavailability of infants or mothers and hospital staff interrupting contact. However, KC postpartum dyads were held wrapped almost as often as control postpartum dyads. Total contact time for KC dyads (SS plus wrapped) was more than double that of controls. These data suggest that hospital and social supports for families are needed to facilitate early initiation of SS, prolonged periods of mother-infant SS contact, and reduction of maternal stress.

Kangaroo (skin-to-skin) care with a preterm infant before, during, and after mechanical ventilation.

Using kangaroo care (KC) with unstable and/or ventilated infants remains controversial. In this article, potential advantages for ventilated infants and their mothers are discussed. The 33-week-gestation infant in this case study presented with mild respiratory distress at birth, requiring supplemental oxygen at hour 2. With no improvement by hour 18, KC was also begun, first for 1.25 hours and then, 2 hours later, for 3.5 hours. The infant was intubated at hour 45 for increasing respiratory distress, and KC resumed 24 hours later for 1 hour and 3 hours after that for an additional 3 hours. Extubation occurred at hour 90. Kangaroo care resumed 2 hours later for periods of 1.5, 1.5, and 1 hour over the next 8 hours, 2.5 hours more later that day (day 5, the last day of data collection). Thereafter, KC was done intermittently until discharge on day 9. Total KC times for pre-vent, vent, and immediate post-vent periods were 4.75, 4, and 6.5 hours, respectively. The data from this study suggest that KC may assist in, rather than retard, recovery from respiratory distress. KC may also foster maternal relaxation and minimize maternal stress.