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Kangaroo Care vs. Infant Warmers in Reducing Mortality in Low Birth Weight Infants

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Chamberlain College of Nursing

NR 449: Evidence Based Practice

May, 2015

Kangaroo Care vs. Infant Warmers in Reducing Mortality in Low Birth Weight Infants

Clinical Question

The specific clinical question guiding the search for a quantitative article is: In low birth weight babies, does kangaroo mother care improve heart rate, oxygen saturation, respiration, and temperature?

The specific clinical question guiding the search for a qualitative article is: In mothers of premature infants in the NICU, what is the experience of kangaroo holding.

Problem

The problem this paper addresses is whether kangaroo care is an effective measure in increasing thermoregulation among low birth weight infants, thus reducing infant mortality. The significance of this problem is that low birth weight infants are less likely to achieve thermoregulation on their own and require specific interventions in regulating their body temperature. The World Health Organization (WHO) supported a study in Nepal in which an increased mortality was noted across all grades of hypothermia, and the risk was twelve times higher among preterm babies (Bera, et al., 2014). Interventions that may help reduce infant mortality related to ineffective thermoregulation include kangaroo care or infant warmers. According to Nimbalkar, et al. (2014), early skin to skin contact (SSC) can reduce the incidence of hypothermia in newborns within the first 48 hours of life and can contribute in the reduction of neonatal mortality due to hypothermia. The major pathophysiology of hypothermia in the newborn is the disturbance of its regulated temperature inside the womb to the sudden exposure to the colder environment outside the mother’s womb. At birth, newborns have limited control over regulating their own body temperature and require assistance through other means to help keep their body temperature up. The first 24 to 48 hours of life, especially in low birth weight infants, is the most crucial in preventing hypothermia, thus reducing the possibility of death.  

The purpose of this paper is to interpret the quantitative and qualitative articles identified to see whether they are or are not important to our group topic. The paper will compare and contrast the main components of the matrix table.

Description of Findings

Concepts

The independent variable studied between both quantitative and qualitative articles is kangaroo care. The quantitative describes how kangaroo care can impact a low birth weight infant and the 4 physiological parameters: heart rate, oxygen saturation, respiration, and temperature, which is the dependent variable. The variable of interest studied in the qualitative article is the mother’s reactions and/or experiences of kangaroo holing their preterm infant in the NICU. The concept of this study was for the mothers to express any behaviors or interactions while kangaroo holding.

Methods

The methods used between the quantitative and qualitative articles are studied differently from one another. The study design used in the quantitative article is a quasi-experimental with before and after subjects serving as their own control. Before the mothers participated they were counseled on the benefits of kangaroo mother care and then volunteer mothers demonstrated kangaroo mother care (Bera et al., 2014). Once mothers signed the consent to participate, they were asked to wear an open front dress with their babies in nothing but a cap. socks, and nappy. The mothers then placed their infant in a “frog like” position on their bare chest, with the baby in a flexed position. Using this method, data were obtained on days 1 with one hour of kangaroo mother care, day 2 with two hours of kangaroo care, and day 3 with three hours of kangaroo mother care. This procedure continued for as long as the mother felt comfortable during kangaroo mother care. Mothers who felt uncomfortable were allowed another demonstration and ones that failed after multiple demonstrations were withdrawn (Johnson, 2007).

The study design collected for the qualitative article was phenomenology. This method was used to describe the lived experiences of mothers and how kangaroo holding impacted their understanding of the advantage and importance it serves to preterm infants. The mothers were interviewed after their third sixty minute session of kangaroo holding in the NICU (Johnson, 2007). From then, data was collected from the mother’s behavior and interactions that were observed unobtrusively and then analyzed and recorded for the content analysis.

Participants

The participants studied in the quantitative article included low birth weight babies that were born at the Institute of Postgraduate Medical Education and Research, Kolkata and its associated SSKM Hospital, and mothers of these babies (Bera et al., 2014). The sample included 265 mother-baby pairs that were selected through purposive sampling over 3 years to collect the accurate amount of data needed to conduct the research. In comparison, the qualitative article interviewed eighteen mothers who kangaroo held their premature infants in the NICU over 5 months (Johnson, 2007). The difference between the quantitative study and the qualitative study is the quantitative studies both the mother and the baby and the effect kangaroo care has on the physiological parameters, whereas the qualitative article only focuses on the mother’s interactions and thoughts on kangaroo holding their preterm infants.

Instruments

The instruments used in the quantitative study are the 4 physiological parameters; heart rate, oxygen saturation, respiration, and temperature. The physiological parameters were assessed immediately before and after kangaroo mother care was implemented in 3 consecutive days. When assessing the babies, axillary temperature was used by a digital thermometer in degrees Celsius, respirations were observed by chest rise and fall for one minute, where heart rate and oxygen saturation were measured through the pulse-oximeter (Bera et al., 2014). In comparison, the instrument used in the qualitative study was open-ended, transcribed audiotaped, face to face interviews. The interviews conducted were transcribed word for word by the investigator, but to ensure accuracy of each interview the audiotapes were played a second time while transcriptions were being read aloud. Once accuracy was assured, “transcriptions were then coded by descriptive phrases that conveyed the meaning of each section for the content analysis” (Johnson, 2007, pg. 570). Once this was implemented, the common meanings of each interview were grouped into the main themes from the interview content.

Evidence

In the article written by Bera et al., the researcher was able to assess the low birth weight babies physiological parameters; heart rate, oxygen saturation, respiration, and temperature. Table 1 in the quantitative article states the 4 physiological parameters that were measured and the mean values of before and after kangaroo mother care was implemented on 3 consecutive days. To give a better understanding, the mean temperature on day 1 before kangaroo mother care was 36.5+ 0.12 and after kangaroo mother care the mean value was 36.9+ 0.15. This shows there was a statistical increase in temperature after the implementing kangaroo mother care. On day 1, the inferential statistic using temperature on pre and post kangaroo mother care had a mean value of 0.34+ 0.17, a confidence interval of 0.320-0.36, and a P value of <0.001, making the results statistically significant.

In the article written by Johnson, the themes that were conducted by the analysis of data were maternal-infant benefits of kangaroo holding, need for support for holding, and the satisfaction with interactions. From the main themes, sub-themes were provides to expand on further evidence of the importance of kangaroo holding by the mothers. Although the sample size is small and only studies the mothers at a particular hospital on a particular floor, the experiences the mother had are still useful for this article. The evidence this article provides will benefit our group’s topic with supporting details of the mother’s experience, not just how the baby responded to this intervention, like the quantitative article explains.

The next step for our group would be to see what articles are most relevant to our overall group topic and answering our clinical question. We can depict the information that we need to help support our topic while identifying pertinent information and data that should be used. Another step for our group is to see if the articles we have provide enough evidence to answer the clinical questions from all the research articles each one of us found. The two articles I found are relevant to support and provide a better understanding to our group topic, and can add much detail on the effects of kangaroo care on preterm or low birth weight babies.

Conclusion

The purpose statement from the quantitative article supports the results of this study by assessing the 4 physiological parameters on low birth weight babies. The data collected from the research states that the physiological parameters showed improvements on the three consecutive days kangaroo mother care was implemented. The study found that there was a rise in temperature, a small but significant rise in heart rate and a huge impact on oxygen saturation. Since the study had its limitations because it was observational, not randomized and some mothers could not correctly demonstrate kangaroo mother care, it is stated that they cannot claim that the improvements would work in any setting. Aside from the limitations, it is concluded that low birth weight babies who received kangaroo mother care show a significant increase in all physiological parameters in this particular setting.

The purpose statement from the qualitative article supports the results from the interviews that were conducted because it increased the mothers understanding of the experiences and advantages of kangaroo holding. The main limitations to the study conducted are that the sample size was small, and only relative to the hospital, unit, and location for this specific research, and that mothers were only interviewed once, with the thought that their opinions might change over time. With these limitations, the results did add importance to the way new mothers interacted and felt towards using kangaroo holding for their preterm infants. The participants also stated that because of the experiences they had with kangaroo holding, they continued the intervention long after the study was conducted. This is essential in the fact that nurses in the NICU continue to encourage and educate their new mothers of the benefits kangaroo holding has on their infants.

References

Bera, A., Ghosh, J., Singh, A. K., Hazra, A., Som, T., & Munian, D. (2014). Effect of kangaroo mother care on vital physiological parameters of the low birth weight newborn. Indian Journal of Community Medicine, 39(4), 245-249. doi:10.4103/0970-0218.143030

Johnson, A. (2007). The maternal experience of kangaroo holding. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 36(6), 568-573. doi:10.1111/j.1552-6909.2007.00187.x

Nimbalkar, S., Patel, V., Patel, D., Nimbalkar, A., Sethi, A., & Phatak, A. (2014). Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: Randomized control trial. Journal of Perinatology, 34, 364-368. doi:10.1038/jp.2014.15