Kangaroo Mother Care, an example to follow from developing countries
http://www.100md.com
《英国医生杂志》
1 Clinical Epidemiology and Biostatistics Unit, School of Medicine, Javeriana University, Bogotá, Colombia, 2 Kangaroo Foundation and Kangaroo Mother Care Program, Bogotá, Colombia, 3 BMJ Knowledge, London WC1H 9JR
Correspondence to: N Charpak (herchar5@colomsat.net.co)
Caring for low birthweight infants imposes a heavy burden on poor countries. An effective healthcare technique developed in 1978 may offer a solution to this problem and additionally be of use in wealthy countries too
Introduction
Evidence backs the effectiveness and safety of KMC in stable, preterm infants. In low birthweight infants weighing 2000 g or less, who are unable to regulate their temperature, KMC is at least as safe and effective as traditional care with incubators.12 An open randomised controlled trial in Bogotá, Colombia, assessed the long term clinical effects of KMC by randomising 746 low birthweight infants.4 5 Follow up at the 12 months of age corrected for gestational age (93% children) found that KMC had improved successful breastfeeding rates and infections were milder in these children. Hospital stay was reduced in "Kangaroo" newborns weighing 1500 g or less. A non-significant reduction in mortality (3.1% v 5.5%; relative risk 0.57, 95% confidence interval 0.17 to 1.18) and slight improvements in developmental indices were found with KMC. The investigators found no significant differences in physical growth patterns or in the rates of cerebral palsy, failure to thrive, visual problems, deafness, or hip dysplasia.5 Blind assessments of bonding between mother and infant by using videos in a subsample of 488 mother-infant dyads found that bonding improved markedly with KMC,13 as did neurodevelopmental evaluations in infants at higher risk.14
In developing countries, other studies of varying methodological soundness have found similar results with regard to infections.w9 w10 Studies in wealthy countries have not found significant improvement in morbidity, but standard care has still failed to outperform KMC. Current evidence indicates that KMC is at least as good as standard care.1 12
KMC may not suit everyone and every circumstance. People travelling long hours to attend the KMC clinic while caring for other children may rather rely on care in hospital; harsh or risky environments (such as extreme climates, floods, landmines, or conflict areas) or dangerous traffic conditions may make it safer to remain in hospital. Nevertheless, during the one year follow up in the Bogotá study, no transport incidents between home and the KMC clinic were reported.
To overcome transport problems, KMC has been delivered in "Kangaroo wards," where mothers and infants stay for days or weeks until they can be safely discharged home once frequent monitoring is unnecessary. This is the standard way of delivering KMC in several large facilities in both developing countries (for example, Jose Fabella Hospital, Manila) and developed countries (for example, Helsingborg Hospital, Sweden).
KMC may be unsuitable for carers with important mental, cognitive, or behavioural problems. Some parents may feel intimidated or overwhelmed by caring for a premature baby, but most parents cope well with the demands of KMC.4 13 15 w11 Most caregivers prefer skin to skin contact over conventional care and find themselves empowered by KMC. Parental sense of fulfilment and confidence are improved, and these improvements are consistently found in affluent settings as well as impoverished settings.1 5 12-13 w11 w12
Where has KMC been implemented and where else can it be implemented?
Department of Reproductive Health and Research, World Health Organization. Kangaroo mother care: a practical guide. 1st ed. Geneva: WHO, 2003.
Mew AM, Holditch-Davis D, Belyea M, Miles MS, Fishel A. Correlates of depressive symptoms in mothers of preterm infants. Neonatal Netw 2003;22(5): 51-60.
Rey E, Martínez H. Manejo racional del ni?o prematuro. Bogotá, Colombia: Universidad Nacional, Curso de Medicina Fetal, 1983.
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Pediatrics 2001;108: 1072-9.
Ludington-Hoe SM, Ferreira CN, Goldstein MR. Kangaroo care with a ventilated preterm infant. Acta Paediatr 1998;87: 711-3.
Ruiz JG, Charpak N, Figuero Z. Predictional need for supplementing breastfeeding in preterm infants under Kangaroo Mother Care. Acta Paediatr 2002;91: 1130-4.
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ. Current knowledge of kangaroo mother intervention. Curr Opin Pediatr 1996;8: 108-12.
Lincetto O, Nazir AI, Cattaneo A. Kangaroo mother care with limited resources. J Trop Pediatr 2000;46: 293-5.
Charpak N, de Calume ZF, Ruiz JG. "The Bogota declaration on kangaroo mother care": conclusions at the second international workshop on the method. Second International Workshop of Kangaroo Mother Care. Acta Paediatr 2000;89: 1137-40.
Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003;(2): CD003519.
Conde-Agudelo A, Díaz-Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003;(2): CD002771.
Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics 1998;102: e17.
Tessier R, Cristo M, Nadeau L, Figueroa Z, Ruiz-Palaez JG, Charpak N. Kangaroo Mother Care: a method for protecting high-risk low birth weight and premature infants against developmental delay. Infant Behav Develop 2003;26: 384-97.
Charpak N, Ruiz Pelaez JG, Charpak Y. Rey-Martinez. Kangaroo mother program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Pediatrics 1994;94: 804-10.(Juan Gabriel Ruiz-Peláez,)
Correspondence to: N Charpak (herchar5@colomsat.net.co)
Caring for low birthweight infants imposes a heavy burden on poor countries. An effective healthcare technique developed in 1978 may offer a solution to this problem and additionally be of use in wealthy countries too
Introduction
Evidence backs the effectiveness and safety of KMC in stable, preterm infants. In low birthweight infants weighing 2000 g or less, who are unable to regulate their temperature, KMC is at least as safe and effective as traditional care with incubators.12 An open randomised controlled trial in Bogotá, Colombia, assessed the long term clinical effects of KMC by randomising 746 low birthweight infants.4 5 Follow up at the 12 months of age corrected for gestational age (93% children) found that KMC had improved successful breastfeeding rates and infections were milder in these children. Hospital stay was reduced in "Kangaroo" newborns weighing 1500 g or less. A non-significant reduction in mortality (3.1% v 5.5%; relative risk 0.57, 95% confidence interval 0.17 to 1.18) and slight improvements in developmental indices were found with KMC. The investigators found no significant differences in physical growth patterns or in the rates of cerebral palsy, failure to thrive, visual problems, deafness, or hip dysplasia.5 Blind assessments of bonding between mother and infant by using videos in a subsample of 488 mother-infant dyads found that bonding improved markedly with KMC,13 as did neurodevelopmental evaluations in infants at higher risk.14
In developing countries, other studies of varying methodological soundness have found similar results with regard to infections.w9 w10 Studies in wealthy countries have not found significant improvement in morbidity, but standard care has still failed to outperform KMC. Current evidence indicates that KMC is at least as good as standard care.1 12
KMC may not suit everyone and every circumstance. People travelling long hours to attend the KMC clinic while caring for other children may rather rely on care in hospital; harsh or risky environments (such as extreme climates, floods, landmines, or conflict areas) or dangerous traffic conditions may make it safer to remain in hospital. Nevertheless, during the one year follow up in the Bogotá study, no transport incidents between home and the KMC clinic were reported.
To overcome transport problems, KMC has been delivered in "Kangaroo wards," where mothers and infants stay for days or weeks until they can be safely discharged home once frequent monitoring is unnecessary. This is the standard way of delivering KMC in several large facilities in both developing countries (for example, Jose Fabella Hospital, Manila) and developed countries (for example, Helsingborg Hospital, Sweden).
KMC may be unsuitable for carers with important mental, cognitive, or behavioural problems. Some parents may feel intimidated or overwhelmed by caring for a premature baby, but most parents cope well with the demands of KMC.4 13 15 w11 Most caregivers prefer skin to skin contact over conventional care and find themselves empowered by KMC. Parental sense of fulfilment and confidence are improved, and these improvements are consistently found in affluent settings as well as impoverished settings.1 5 12-13 w11 w12
Where has KMC been implemented and where else can it be implemented?
Department of Reproductive Health and Research, World Health Organization. Kangaroo mother care: a practical guide. 1st ed. Geneva: WHO, 2003.
Mew AM, Holditch-Davis D, Belyea M, Miles MS, Fishel A. Correlates of depressive symptoms in mothers of preterm infants. Neonatal Netw 2003;22(5): 51-60.
Rey E, Martínez H. Manejo racional del ni?o prematuro. Bogotá, Colombia: Universidad Nacional, Curso de Medicina Fetal, 1983.
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Pediatrics 2001;108: 1072-9.
Ludington-Hoe SM, Ferreira CN, Goldstein MR. Kangaroo care with a ventilated preterm infant. Acta Paediatr 1998;87: 711-3.
Ruiz JG, Charpak N, Figuero Z. Predictional need for supplementing breastfeeding in preterm infants under Kangaroo Mother Care. Acta Paediatr 2002;91: 1130-4.
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ. Current knowledge of kangaroo mother intervention. Curr Opin Pediatr 1996;8: 108-12.
Lincetto O, Nazir AI, Cattaneo A. Kangaroo mother care with limited resources. J Trop Pediatr 2000;46: 293-5.
Charpak N, de Calume ZF, Ruiz JG. "The Bogota declaration on kangaroo mother care": conclusions at the second international workshop on the method. Second International Workshop of Kangaroo Mother Care. Acta Paediatr 2000;89: 1137-40.
Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003;(2): CD003519.
Conde-Agudelo A, Díaz-Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003;(2): CD002771.
Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics 1998;102: e17.
Tessier R, Cristo M, Nadeau L, Figueroa Z, Ruiz-Palaez JG, Charpak N. Kangaroo Mother Care: a method for protecting high-risk low birth weight and premature infants against developmental delay. Infant Behav Develop 2003;26: 384-97.
Charpak N, Ruiz Pelaez JG, Charpak Y. Rey-Martinez. Kangaroo mother program: an alternative way of caring for low birth weight infants? One year mortality in a two cohort study. Pediatrics 1994;94: 804-10.(Juan Gabriel Ruiz-Peláez,)