The Kangaroo Mother Care

Kangaroo mother care (KMC) is on–going in the Regional hospital in terms of keeping all premature and Low Birth Weight babies’(less than 37 weeks gestation and weight of less than 2.0kg) skin- to- skin with their mothers/relatives every two hours in order to keep them warm, alert and observe them for any change in condition since the year 2010. These babies would be in kangaroo position for a maximum of eight hours in a day for two hours interval to be fed interruptedly. These babies  

remain admitted on the ward from three weeks to two months and even more depending on how small they are, before they are discharge to go home for follow-up review at the general kids O.P.D. Until November 2015 when three staff was selected from the Regional Hospital, Koforidua in the categories of a Nurse, Psychologist and a Medical Officer to visit the Kangaroo Mother land in Colombia, Bogota where kangaroo mother care was discovered way back in the year 2000. These three staff namely Cynthia Martey (Nurse), Mr. Jacob Sarfo ( Psychologist), Diana Apanga (Medical Officer) went through two weeks comprehensive and intensive training in KMC Program scheduling working duties in SAN-IGNACIO and SAN JOSE hospitals for proficiency in KMC. The standard KMC Program  was initiated in the Regional Hospital, Koforidua in December 2016 when the adjudged/ accredited Kangaroo Ambassadors for Ghana came back to their hospital,  with the intra- hospitality/ in- patient kangaroo mother care. This was a continuation and addition of what was already done at the NICU for our Pre-terms babies.

DEFINITION

The Kangaroo Mother Care Program is a comprehensive multi-professional management for premature and Low Birth Weight (LBW) babies (less than 37 weeks gestation and <2.0kg) from birth to one year corrected age.  

PROFESSIONALS INVOLVED

Doctors, Nurses /Public and Community nurses, Psychologist, Ophthalmologist, Audiologist, Physiotherapist, Pharmacist, Social Workers and other paramedics etc

COMPONENTS/ ELEMENTS OF KANGAROO MOTHER CARE PROGRAM 

The first component of KMC

The Kangaroo Position (the hall mark) This is skin-to-skin contact in between the breast of mother/relative/partner and baby and holding both firmly in position with a girdle or cloth to cover from baby’s neck and flexed legs and keep head supported regularly. Must be for almost all the time in the day, because the mother can  sleep with it and perform menial chores as well, like washing and others. 

NOTE: can be kangaroo father care, sister care, uncle/aunties/ grandparent care etc. Anybody can do it and that is why they need support from all.

IMPORTANCE OF THE KMC POSITION

a. Provides neutral warmth for the baby at all times.

b. Keeps baby stimulated and alert as mother cuddles, sings and perform other chores with baby in kangaroo.

c. The presence of baby in between the breast promotes and enhances lactation by Letdown reflex action.

d. Change in baby’s condition is early detected and intervene promptly, like apnea (baby suddenly ceasing breathing) and aspiration/     vomiting. This is common with pre-term babies since they forget to breathe sometimes. 

e. Kangaroo position promotes good bonding between mother and baby/ the career.

f. Evidence from a research conducted in Colombia indicates that the heartbeat of the mother/career sends impulses to the baby’s     brain cells there by growing faster than the pace of the premature baby. This then has positive effect on the IQ of the baby. 

The second component of KMC

Kangaroo Feeding and Nutritional Policies

The kangaroo baby feeds solely on breast milk if only the mother is available and stable to produce breast milk. Babies are put on special feeds if the mothers unfortunately pass out or on special medications that may negatively affect the baby. Feeding is done every two hours with strict monitoring and timing. It is documented on the feed chart when baby is on the ward.  

MEANS OF FEEDING IN KMC

Breast feeding, positioning and attaching baby properly to the breast and continuous teaching and supervising the mum.

Cup feeding, expressing breast milk (EBM) to feed babies so they can have enough for growth since the jaw is not fully matured to suck well.  top ups done foe even those babies who suck. N G tube feeding, the EBM is passed through an oro or naso pharyngeal tube for babies with poor swallowing or other factors. 

Third Component of KMC

Early Discharge and Follow –up Reviews with Support system.The kangaroo mother care program enables us to reduce congestion at the NICU, because premature do not spend months on the ward anymore but are discharged as soon as mother baby are stable and adapted to the program. The routine drugs given to them are also started on the ward to monitor how well they are tolerated by the babies and mothers supervised on how to administer them; Caffeine Citrate, Folic acid, Haematovite and other specifics when needed. These babies are made to come for frequent follow-ups depending on the conditions of the babies.  

Visits start from 3-7days intervals initially, then gradual extending the days, weeks and months of visits. 

The KMC Program is in two main parts

1. The Intra-Hospital or In-Patient Adaptation to KMC; this involves identifying on daily basis the birth of anew born premature or Low Birth Weight(LBW) and mother/relative and initiating KMC as soon as they are stable as the protocol stipulates. This is done after educating mother or partners involved on the humane and best mothering skills with KMC.The psychologist must be involved in the initiation process to assist the mother or partners to reduce or overcome all fears, and  also to give special therapies if the need arises.In –patient conferences are organized for the mothers of KMC to share experiences and feelings and to visit the  

out-patient clinic before they are discharged.

2. Out –Patient follow up review with support system 

This is a clinic set up solely to monitor and review the growth and development of the premature and LBW babies who were discharged from the ward in the KMC in-patient adaptation program. Although new clients are received from referral points who do not know about KMC to the clinic. The setup has an in-patient  adaptation room, psychological assessment room, an open Drs review point and same open measuring point for nurses for modeling purposes. So mothers will learn from  each other as encouragement.

At the clinic, the following takes place:

Welcoming of clients with snapshots of KMC position , devotion and exhortation Health talk on vital topics by nurses and psychologist on; KMC program, exclusive breastfeeding, and ways of feeding the baby Child Welfare Clinic and immunizations,  

sharing of success stories of KMC, complementary feeding, stress and depression, massage therapy and so on.

In-patient adaptation for new clients , measuring of vital signs; weight, Head Circumference, Full Length, Temperature, SPO2 prn, etc.

Cord care and ear piercing

Out-Patient Clinic Started at R.H.K on the 16th of February 2016 with 8 clients without structures.

237 Clients in 2016, comparing of 120 and 117 of males and females respectively.

WEIGHT OF BABIES ENTERING K.MC

 Less than 1.0kg………………….21

 1.0kg -1.49kg ………………….. 73

 1.5kg - 1.99kg …………………. 8

 2.0kg – 2.3kg……………………47

                       

GESTATIONAL AGES (MATURITY)

 Less than 28 weeks ……..……. 13

 28 – 30 …..……………………... 45

 31 – 35 …………………………. 150

 36 -37 ………...............….…...... 11

KMC VISITATION

The facility was visited by Columbian KMC Team specifically a Pediatrician and a nurse ( Sandra Pedro). Their visit was part of the monitoring and evaluation of

the K.M.C excellent center in Ghana as planned during the training of the ambassador. They were very much impressed of how far the program has been fully

emulated with a lot of success stories. They were amazed at the rate at which 0.5kg – 1.0 pre-term were thriving on KMC outpatient basis