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Kangaroo care

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Kangaroo care is defined as a method of holding a nappy-clad infant in skin-to-skin contact, prone and upright on the chest of the parent. The infant is enclosed in the parent's clothing in order to maintain temperature stability. It is recommended that Kangaroo Care should be employed regularly and consistently with medically stable premature infants and their parents due to its beneficial effects.

Standing transfer where a parent is supported to pick up baby directly from incubator/heat table to the chair has been found to be the least stressful method of transfer for baby. This method also enhances the parents autonomy to facilitate Kangaroo Care unassisted once baby stable.

Criteria for administering Kangaroo Care

  • Medically stable infants
  • Infants receiving palliative care
  • Within the first 5 days for infants less than 30 weeks gestation discuss with consultant on duty.

Exclusion Criteria

  • Chest drains
  • Inotrope infusions
  • Unstable on respiratory support (CPAP or ventilation)
  • After major procedures or treatment
  • Umbilical arterial or venous lines are not a contraindication but need to be firmly secured
  • If a post caesarean section mother is unable to stand up consider two persons transfer.

Benefits of Kangaroo Care

Infant Outcomes

  • Decreased variation in heart and respiratory rates, improved oxygenation, less bradycardia, fewer and shorter apnoeic episodes.
  • Maintains skin and core temperatures through conduction of heat from the parent.
  • Promotes optimal infant growth and development.
  • Beneficial effects on the sleep-awake state organisation in infants.

Maternal Outcomes

  • Improves parent-infant bonding process.
  • Increases mother's milk production ( an oxytocin-releasing agent) and unlimited access to breast.
  • Enhances parental emotional and psychological wellness.
  • Promotes parent/infant attachment.

 Preparation for Kangaroo care

  1. Ensure baby and parent are prepared:
    - Offer parent information on Kangaroo Care
    - Provide a quiet, calm environment, ensure lazy boy chair is available
    - Offer privacy screen and handheld mirror
  2. Parent Preparation:
    - Plan a suitable time for Kangaroo Care (as infant's condition allows)
    - Advise to bring a drink, go to the toilet and/or express first
    - Offer to change top clothes with a hospital gown (with its opening in front)
  3. Infant preparation:
    - Check infant's temperature. Secure skin temperature probe to monitor infant's temperature if appropriate.
    - Suction if necessary and allow recovery time prior to transfer commencing.
    - Remove infant's clothing except for the nappy.
  4. There are no time constraints for providing Kangaroo Care. Ideally, allow an infant to remain out for at least one hour to allow for recovery time (from the transfer process) and allow for one full sleep cycle.
    Sleeping parents are less vigilant in maintaining an infant's position. Ensure the infant is well tucked in against the chest using a sheet or similar and secure right around the parent. A nurse should be available to provide direct supervision if a mother is going to sleep.
  5. Document infants intolerance of Kangaroo Care (KC)

Kangaroo care for all infants should follow the steps below:

  1. Wrap the infant with a cloth nappy or leave the infant in a snuggle- up
  2. Parent picks infant up and places infant on the chest, with legs and arms in a flexed position and head to one side.
  3. Nurse assists with any equipment attached i.e. respiratory tubing, IV fluids lines, SpO2 and/ ECG leads.
  4. Parent lowers him/herself into the lazy boy chair/ breastfeeding chair with a foot stool.
  5. Nurse secures the respiratory tubing's to the lazy boy and parent's top using sleek adhesive tape (allowing for some movement).
  6. Cover infant with blanket and apply hat to maintain body temperature
  7. N.B. If the baby is >30 wks gestation and requiring no ventilator support, allow baby to nuzzle at the breast as this is a step towards initiating lactation and breastfeeding.

Criteria for returning infant to the incubator

  • Increased O2 requirement of 20%
  • Infant shows signs of distress i.e. apnoea/ bradycardia/ desaturation/ colour change, despite providing stimulation
  • Hypothermia
  • Baby remains unsettled and distressed.



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  3. Bakewell-Sachs, S. (2001). Commentary: the impact of two transfer techniques used during skin-to-skin care on the physiologic and behavioural responses of preterm infants (towards evidence-based practice). The American Journal of Maternal and Child Nursing, 26(2), 109.
  4. Bauer, J., Sonthaimer, D., Fischer, C. and Linderkamp, O. (1996). Metabolic Rate and Energy Balance in Very Low Birth Weight Infants During Kangaroo Holding by their Mothers and Fathers. The Journal Of Paediatrics. 129(4), 608-611.
  5. Beal, J. A. and Wood, S. H. (2001). Toward Evidence-based Practice: Implications of Kangaroo Care for Growth and Development in Preterm Infants. The American Journal of Maternal/Child Nursing: 30(5), 338-338.
  6. Bergman, N. (2005).Kangaroo Mother Care Promotions: Overview - Physiology and Research of Kangaroo Mother Care.
  7. Bosque, E. M., Brady, J. P., Affonso, D. D. and Wahlberg, V. (1995). Physiologic Measures of Kangaroo versus Incubator Care in a Tertiary-Level Nursery. Journal of Obstetrical Gynaecological and Neonatal Nursing. 24(3), 219-226.
  8. Bowden, V., Greenberg, C. and Donaldson, N. (2000). Developmental care of the newborn. [CINAHL] Accession Number: 2001029526
  9. Charpak, N., Ruiz-Pelaez, J., FIGUEROA, Z. and Charpak, Y. (1997). Kangaroo Mother versus Traditional Care for Newborn Infants =<2000 grams: A Randomized, Controlled Trial. Paediatrics. 100(4), 682-688.
  10. Di Menna, L. (2006). Considerations for Implementation of a neonatal Kangaroo Care Protocol. Neonatal Network, 25(6) 405-412.
  11. Fieldman, R., Eidelman, A. I., Sirota, L.,Weller, A. (2002). Comparison of skin-to-Skin (Kangaroo) and Traditional Care: Parenting Outcomes and Preterm Infant Development. Official Journal of the American Academy of Pediatrics. 110(1), 16-26.
  12. Kenner, C., and McGrath, J. M. (2010). Kangaroo care is Developmetal care. Developmental Care of Newborns and Infants. (2nd ed., pp. 349-375. National association of Neonatal Nurses. (13), 9-22.
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  17. Ludington- Hoe, S., Anderson, G. and Hollingsead, A. (1999) Birth-related Fatigue in 34-36 week Preterm Neonates: Rapid Recovery withVery Early Kangaroo (Skin-to-Skin) Care. ). Journal of Obstetrical Gynaecological and Neonatal Nursing. 28(1), 94-
  18. Ludington- Hoe, S. M., Ferreira, C., Swinth, J., and Ceccardi, J.J. (2003). Safe criteria and procedure for kangaroo care with intubated preterm infants. Journal of Obstetrics and neonatal Nursing. 32 (2),579-588.
  19. Richarson, H. (1997). Midwifery Today. Kangaroo Care: Why Does It Work? Issue 44.
  20. Simkiss, D. (2013). Kangaroo Mother Care Revisited. Journal of Tropical Pediatrics. 59 (1), 1-2.
  21. Svensson et al. (2013). Effects of Mother-Infant skin-to-skin contact on severe latch-on problems in older infants: a randomiswd trial. International Breastfeeding Journal. 8 (1), 1-13.
  22. Tessier, R., C, M., Velez, S., Giron, M., Figueroa De Calume, Z., Ruiz-Palaez, J. G., Charpak, Y. and Charpak, N. (1998). Paediatrics. Kangaroo Mother Care and the Bonding Hypothesis. Journal of Obstetrical Gynaecological and Neonatal Nursing. 102(2), 390-391.
  23. Valizadeh, L., Ajoodaniyan, N., Namnabati, M., Zamanzadeh, V., and Layegh, V. (2013). Nurses' viewpoint about the impact of kangaroo Mother Care on the mother-infant attachment. Journal of Neonatal Nursing. 19. 38-43.

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Document Control

  • Date last published: 01 September 2015
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years