Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN.
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Transcript of Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN.
Evaluation of Kangaroo Care on Newborn Thermoregulation
Emily Forward, RN, Margaret Gerulski, RN, Mary Jacobs, RN, Michele Niles, RN, & Cheryl Rose, RN
Kangaroo Care
Evaluate the benefit of Kangaroo Care to the neonate
Providing evidence-based research to provide mothers and newborns a more natural birth experience
Minimize separation of the maternal-infant couplet to enhance birth experience
Provide cost effective care
Purpose of the research
“What does the literature say about kangaroo care (KC), also known as skin-to-skin care, in
the regulation of the thermoregulatory system of the
neonate?
Problem Statement
In term newborns born vaginally, will the axillary temperature remain within the normal range in infants placed skin-to-skin immediately after birth compared with infants placed within minutes of birth under a radiant warmer during the first hours of life?”
PICO
Literature Eliminated
Critical evaluation of ten selected articles Articles were examined for appropriateness
to the purpose statement, reliability, and validity (Nieswiadomy, 2008, p. 63)
Qualifications of the researchers and the ethical content was also analyzed (Nieswiadomy, p. 29)
Articles not meeting criteria were eliminated
Narrowing the Literature
Literature Eliminated A comparison of skin-to-skin contact and radiant
heaters in promoting neonatal thermoregulation (Fardig, J., 1980).This was an outdated source
Keeping infants warm: Challenges of hypothermia (Mance, 2008).Involved preterm infants which did not meet the criteria set in the purpose statement
Temperature variation in newborn babies: Importance of physical contact with the mother (Fransson, Karlsson, & Nilsson, 2005).Article did not discuss skin-to-skin content and the research did not start until four to eight hours after birth
The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial (Ferber & Makhoul, 2004).Focused on infants neurological behavior with minimal discussion regarding temperature
Kangaroo mother care: 25 years after (Charpak et al., 2005).Difficult to follow, and mainly pertained to the unhealthy newborn in underdeveloped countries with a minimal discussion regarding temperature
Early skin-to-skin contact for mothers and their healthy infants (Anderson, Moore, Hepworth, & Bergman, 2003).Article only consisted of one page and required advance knowledge of statistics in order to understand
Literature Eliminated- continued
Literature Selected
Gretchen A. Dabrowski RN, BSN
Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies
Qualitative evidence-based discussion
Utilizes historical studies
The article’s findings provided evidence that “newborns placed skin-to-skin with mothers remained considerably warmer during the first three hours of life” (Dabrowski, p. 66)
Skin-to-Skin Contact: Giving Birth Back to Mothers and Babies
Kangaroo Care at Birth for Full Term Infants: A Pilot
Study
Mary W. Walters, MS, RN.Kim M. Boggs, MSN, RN, BC.
Susan Ludington-Hoe, PHD, CNM, FAAN.Kimberly M. Price, RN, IBBCLC.
Barbara Morrison, PHD, FNP, CNM.
Level I qualitative research study
Approval obtained from hospital review board
All of the researchers practiced in women's health
Clear purpose statement
Outlined clearly in a systematic process discussing the descriptive design
Kangaroo care at birth for full term infants: A pilot study.
Judith S. Mercer CNM, DNScDebra A. Erickson-Owens CNM, Ms
Barbara Graves CNM, MN, MPH Mary Muford Haley CNM, MS
Evidence-based Practices for the Fetal to Newborn
Transition
Article listed additional findings to benefit neonate.
Clear summarization of articles reviewed Findings significant for the benefit of this
intervention (p<or =0.02-0.03) Large population used for study and randomized
controlled trials Benefits of KC care shown for long and short-
term. Article supports the benefit of maintaining and
increasing temperature when infant placed skin-to-skin
Recommendation made of KC care
Evidence-based practices for the fetal to newborn transition
Rintaro Mori, MD, PHD, MSc, FRCPCHRajesh KhannaDebbie Pledge
Takeo Nakayama
Meta-analysis of Physiological Effects of
Skin to Skin Contact for Newborns
Peer reviewed journal Recent publication 2010 Significantly related to the research
question Directly evaluated physiological parameters
affecting infants before-and-after the KC intervention to evaluate safety
Consisted of both systematic reviews and random-controlled trials
Methods categorized
Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers
Meta-analysis included 23 studies, consisting of 13 before-after studies, five randomized control trials, a cross-over trial, and four cohort studies
Limitations of studies were acknowledged Confounding variables were eliminated to
increase validity p value was < 0.05 making this study
significant in findings Findings of this article showed an increase in
body temperature during skin-to skin contact
Meta-analysis of physiological effects of skin-to-skin contact for newborns
and mothers (cont’d)
Barriers to the implementation of Kangaroo
Care
Barrier Bridge
The desire by the mother to allow visitors to hold the baby was reported (Anderson et al, 2003)
Provide education and encouragement to mothers regarding what KC is and the benefits KC has been shown to provide
Barrier Bridge
The attitude of health care providers is noted to be a barrier to KC. This may be due to a lack of knowledge regarding the benefits of KC or fear of a change in practice
The provision of adequate education to both healthcare providers and patients, including their families, is a potential way to solve these barriers (Dabrowski, p. 65)
Patient preference is an important aspect of implementing any evidence-based nursing practice (Nieswiadomy, 2008, p. 8)
Nurses should provide education and support for kangaroo care, but allow patients to express their preference about the utilization of kangaroo care
Patient preference
The evidence highly supports a change in practice, encouraging skin-to-skin contact at birth
The evidence correlates well with the expectations of evidenced-based medicine research
Each of the articles selected clearly defines the purpose of the study
All of the selected articles are rated as level I or Level II, with the exception of one article, according to hierarchy of evidence
The articles chosen contain recent findings, with the oldest article being from 2007
Application of the Evidence
Skin-to-Skin Contact
“Birthing units that separate mothers and babies with the intention of preventing cold stress unwittingly increase the risk of cold stress, and at the same time deprive the pair of intimacy and bonding while delaying breastfeeding initiation” (Mercer et al., 2007, p. 267)
“The evidence suggests that skin-to-skin contact should be the mainstay of newborn thermoregulation” (Mercer et al., 2007, p. 267)
The benefit of increasing fetal well-being is the primary focus in these studies
Summary
Initiation of skin-to-skin contact immediately after birth is an evidence-based nursing practice
More effective than the use of radiant warmers
Has many other benefits
Cost effective and more natural extension of the birth process
Summary (cont’d)
Recommendation
Anderson, G., Shiu, S., Dombrowski, M., Swinth, J., Albert, J., & Wada, N. (2003). Mother-newborn contact in a randomized trial of kangaroo (skin-to-skin) care. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(5), 604-611. doi: 10.1177/0884217503256616
Anderson, G. C., Moore, E., Hepworth, J., and Bergman, N. (2003). Early skin-to-skin contact for mothers and their healthy newborn infants. Birth, 30(3), p. 206–207. doi: 10.1046/j.1523-536X.2003.00247.x
References
Charpak, N., Gabriel Ruiz, J., Zupan, J., Cattaneo, A., Figueroa, Z., Tessier, R., Cristo, M., Anderson, G., Ludington, S., Mendoza, S., Mokhachane, M., and Worku, B. (2005), Kangaroo mother care: 25 years after. Acta Pædiatrica, 94(5), p. 514–522. doi: 10.1111/j.1651-2227.2005.tb01930.x
Dabrowski, G. (2007). Skin-to-skin contact: Giving birth back to mothers and babies. Nursing for Women's Health, 11(1), p. 64–71. doi: 10.1111/j.1751-486X.2007.00119.x
Fardig, J. A. (1980). A comparison of skin-to-skin contact and radiant heaters in promoting neonatal thermoregulation, Journal of Nurse-Midwifery, 25(1), p. 19-28. doi: 10.1016/0091-218(80)90005-1
Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. Pediatrics, 113, 4. p.858(8). Retrieved from: http://www.pediatrics.org/cgi/content/full/113/4/858
▶ Ford, L. C. (2010). Evidence based nursing practice project: NURS 350 Research in nursing. Retrieved from Ferris State University School of Nursing, Ferris Connect website: http://myfsu.ferris.edu/webct/urw/lc1399024356061.tp1406116086031/displayContentPage.dowebct?pageID=1463932005011&resetBreadcrumb=false&displayBCInsideFrame=true
▶ Fransson, A., Karlsson, H., Nilsson, K. (2005). Temperature variation in newborn babies: Importance of physical contact with the mother. Archives of Disease in Child: Fetal Neonatal Edition, 90(6), p. F500-504. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1721966/ doi:10.1136/adc.2004.066589
Galligan, M. (2006). Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN: The American Journal of Maternal Child Nursing, 31(5), 298-306. Retrieved from: http://www.nursingcenter.com/_PDF_.aspx?an=00005721-200609000-00007 .
Mance, M. (2008) Keeping infants warm: Challenges of hypothermia. Advances in Neonatal Care, 8(1), 6-12. doi:10.1097/01.ANC.0000311011.33461.a5
Mercer, J. S., Erickson-Owens, D. A., Graves, B., Mumford Haley, M. (2007). Evidence based practices for the fetal to newborn transition. Journal of Midwifery & Women’s Health, 52(3), p.262-272. doi:10.1016/j.jmwh.2007.01.005
Mori, R., Khanna, R., Pledge, D. and Nakayama, T. (2010). Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatrics International, 52(2), p. 161–170. doi: 10.1111/j.1442-200X.2009.02909.x
Nieswiadomy, R. (2006). Foundations of nursing research. (5th ed.). Upper Saddle, New Jersey: Pearson Prentice Hall.
Walters, M. W., Boggs, K. M., Ludington-Hoe, S., Price, K. M., Morrison, B. (2007). Kangaroo care at birth for full term infants: A pilot study. The American Journal of Maternal/Child Nursing, 32(6), p. 375-381. doi:10.1097/01.NMC.0000298134.39785.6c