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Preemies Thrive When Mom's the Incubator

'Kangaroo' care stresses breast milk, constant skin contact

WEDNESDAY, Nov. 21 , 2001 (HealthDayNews) -- Premature babies whose mothers breast-feed them and give them skin-to-skin contact all day and night end up being healthier, a new study shows.

Those babies show better growth and have fewer infections after one year than preemies whose first days or months are spent in incubators, the Colombian study says.

In this technique, called kangaroo mother care (KMC), the babies are placed on their mother's chest as soon as possible after birth; the mother's body heat acts as an incubator. They are also fed an almost exclusive diet of breast milk during their first three months. It is an alternative to standard hospital care, especially in developing countries where medical resources may be scarce. Advocates say KMC is cheaper, effective and reduces the abandonment of premature babies, which is a problem in a breast-feeding culture like Colombia.

"I was impressed with the technique when I first went to Colombia in 1986 to study KMC," says study author Dr. Nathalie Charpak, director of the Kangaroo Foundation in Bogota. But she adds that she was equally impressed by the lack of scientific study on KMC, so she began her own work in 1989. She later co-founded the foundation.

KMC was developed by neonatologists in Bogota in 1985 as a way of providing care for premature infants where incubators are scarce, explains American KMC authority Gene Cranston Anderson, a professor of nursing at Case Western Reserve University's Bolton School of Nursing.

"The data had begun to come out on the value of breast milk, and so the doctors thought, 'Why not give premature babies breast milk?' Expressing breast milk was labor-intensive for the nurses, so they let the mothers breast-feed their premature babies, and then the doctors noticed the babies did better."

Charpak and her colleagues followed 746 premature babies for a year, after assigning 382 to KMC shortly after they were born and the rest to traditional incubator care.

"Overall mortality was much lower, almost half of that of the control group," Charpak says. "There was no excess risk of infection associated with kangaroo care; in fact, there is a reduction in hospital-acquired infection and the cumulative incidence of severe infections requiring hospital admission."

The researchers found that the growth charts in the two groups were almost identical after six months, Charpak says. Moreover, the heads of KMC babies were larger after one year than those in the incubators, "and this condition was independent of breast-feeding." The researchers do not know why the babies' heads were larger, Charpak says.

Not only were the babies healthier, but they had shorter stays in the hospitals after they were born. "Kangaroo mothers felt more competent to care for and raise their premature infants," Charpak says. "They were more sensitive to the health and developmental needs of the infants."

And family ties were strengthened, Charpak contends. "Fathers were also happy in the KMC program. They are participating in the care of the little, immature infants with a strange pleasure. That is not the way it is in Colombia, and it was a surprise for us."

The findings appear in the November issue of Pediatrics.

Babies born before 37 weeks are considered premature. Premature babies have difficulty maintaining body temperature because of low birth weight. They may have problems breathing, feeding, and gaining weight and are prone to brain hemorrhages, bowel problems, disease and infection.

About 15 percent of premature infants develop minor disabilities: short attention span; learning problems in school, such as difficulty with math or reading; poorer than average coordination; and poorer eye-hand coordination. According to the National Center for Health Statistics, up to 10 percent of pregnancies in the United States result in early delivery, accounting for up to 450,000 births each year.

Breast-feeding is at the heart of KMC, says Anderson. "Skin-to-skin contact, the stimulation of the child with the mother, not only causes the hormones that promote milk production, but one of those hormones, oxytocin, which also starts labor, also helps the uterus to contract and helps the mother let down her milk."

Skin-to-skin contact may also boost the baby's ability to fight disease, Anderson contends. "That skin-to-skin contact is doing something physiologically to the child. We know there are 19 different gastrointestinal hormones that are stimulated in both the baby and the mother during breast-feeding. And something is stimulating the baby's immune system. Researchers have found substances in the baby's urine that indicate the baby is producing these substances, which kick-start the immune system."

Although kangaroo mother care may be the way to go in developing countries, is it appropriate in the technologically and medically savvy United States?

"It is," Anderson says. "But the nurses really need to believe in the method of kangaroo care and be confident in assisting mother, so that they can relax with their premature infants. There's a potential here for less use of incubators and shorter hospital stays for these infants."

What to Do: For more on kangaroo mother care, see the University of Manitoba. And for more on premature babies, visit Kinderstart.

SOURCES: Interviews with Nathalie Charpak, M.D., director, Kangaroo Foundation, Bogota, Colombia; Gene Cranston Anderson, Ph.D., F.A.A.N., professor of nursing, Bolton School of Nursing, Case Western Reserve University, Cleveland; November 2001 Pediatrics
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