KANGAROO MOTHER CARE

by drnieman on March 3, 2017

in Uncategorized

According to the World Health Organization, 10% of all births worldwide are either low birth weight (weight below 2500 grams) or premature (birth prior to 37 weeks of gestation). Premature birth and a lower weight at birth impact early brain development and set the stage for future neurological outcomes.

Both the American Academy of Pediatrics (AAP) and the Canadian Pediatric Society have embarked on programs to optimize early brain development. The AAP in particular has made early brain development a priority by educating both doctors and the public about the impact of toxic stress on the baby’s brain development; underscoring the importance of reading for babies at a young age; and limiting screen exposure to zero prior to age two years.

It also is becoming increasingly evident that early exposure to DHA (an omega 3 fatty acid) has been associated with better brain health. (See www.omega3.org)

What is less clear is the role of exposing babies to classical music such as Mozart (See www.mozarteffect.com)
In the 1970’s, a doctor in Bogota, Columbia, pioneered what was at that time an innovative and daring practise, focusing on early neurological stimulation of low birthweight infants in hospitals. Dr. Nathalia Charpak and several colleagues introduced the world to the Kangaroo mother care method (KMC)

KMC is based on placing a baby in a kangaroo position, strapped to the mom, providing continuous skin-to-skin contact and appropriate thermal regulation. It also involves exclusive breastfeeding when possible and timely early discharges with close follow-up.

As is the case so often with skeptical and conservative doctors, KMC when it first proposed was met with raised eye brows. Neonatologists and developmental pediatricians at the time demanded more evidence. Today the evidence is strong. In a recent editorial in Pediatrics, Dr. Lydia Fuhrman described KMC as “making the world a far better place for babies and families.”
The “Bible” to skeptical doctors is known as the Cochrane Review. In 2016 this Review examined 21 studies including 3042 infants and concluded that KMC for stabilized low birthweight infants in low resource settings was preferable to conventional neonatal care. Babies exposed to KMC had less infections and higher rates of breastfeeding.

Dr. Charpak, still based in Columbia, but working with like-minded peers globally, published data collected from 1993-1996, showing the neurological benefits of KMC. As is the case with outliers, she never settled for complacency and in January 2017 she and peers from Laval University published data showing that benefits documented at one year of age lasted well into young adulthood.

Her publication in the January 2017 edition of Pediatrics, “Kangaroo Mother Care 20 years later: Connecting Infants and families” summarizes the results of studying infants who were close to or less than 1800 grams at birth. The KMC group was studied for general health status, neurologic, cognitive and behavioral status, social functioning and subjected to neuroimaging. The premise was to see if the benefits of KMC seen at one year were still relevant 20 years later.

The KMC group, in contrast to a control group, showed better school attendances, less hyperactivity, reduced aggressiveness, less conduct disorders and neuroimaging differences such as a larger volume of the left caudate nucleus.

Variations of KMC exist such as briefer periods of infant being held by the mother or father, or skin-to-skin care (SSC) Baby Friendly Hospitals call for SSC. By placing babies in SSC with the mom immediately after birth, a baby’s crawl reflex is initiated, which ends up as beneficial to the brain of both the mom and baby (See http://www.breastcrawl.org/video.shtml)
Some neonatal units are so impressed by SSC that doctors allow even ventilator-dependant infants brief moments of close contact—this is a far cry from the 1970’s when parental access was severely restricted.

In addition to KMC and SSC doctors today are more aware of the lasting impact untreated pain in the neonatal unit can have on a still developing brain. Pain control has improved dramatically since the 1970’s, because memory of pain may impact the brain structure later in life.

Circumcision used to be done with minimal pain control and disturbing data showed that babies who were circumcised without pain control, had a lower pain threshold when they received their first immunization needle.

Dr. Charpak and her group are so convinced of the benefits of KMC that they feel this method should be extended to the 18 million infants born each year who are candidates for KMC.

As we gather more data about common-sense interventions such as not separating a baby from a mom early in life, and learn more about attachment parenting, the benefits of optimizing early brain development may in fact be more important than we ever realized. For more ideas on other ways to promote attachment parenting later in life, see www.AskDrSears.com

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