Kangaroo Mother Care: Technique to be learned from developing countries and barriers for its use

Caring for low birth weight infants imposes a heavy economic burden with unpredictable results. An effective healthcare technique, Kangaroo Mother Intervention (KMI) started in 1978 in Colombia as a way of dealing with overcrowding and scarcity of resources in hospitals caring for low birth weight infants. KMC has shown new way of care of stable LBW newborn in under developed and developing countries. By using KMC technique developed countries can also decrease significant economic burden on health care system.


Introduction
Each year about 20 million infants of low birth weight are born worldwide, which imposes a heavy economic burden on healthcare and social systems in developing countries [1]. Medical care of low birth weight neonate is complex, demands an expensive infrastructure and highly skilled staff, un-predictive results and is often a very disruptive experience for families and doctors [2]. Studies have shown that kangaroo mother care improves oxygen saturation [3], regulation of stress responses [4] and brain growth [5] while reducing the risk of hypothermia and unstable heart and respiratory rates [6] and hospital acquired infections. Early KMC in the neonatal intensive care unit (NICU) also increases maternal milk supply and guards against insufficient lactation [7].
Kangaroo Mother Care technique was developed by Edger Rey, a Colombian pediatrician in 1978, after he faced the problems arising from a shortage of incubators and the impact of separating women from newborns in neonatal care unit. Kangaroo Mother Care (KMC), is a healthcare technique for low birth weight infants that is at least as effective as traditional care in a neonatal care unit [8][9][10]. In KMC, babies weighing 2000 g or less at birth and unable to regulate their body temperature remain with their mothers as incubators. Newborns are attached to mother's chests in skin to skin contact, wearing only a nappy and are kept upright 24 hours a day. Mothers can share the role of provider of the kangaroo position with others, especially the babies' fathers, without disrupting breastfeeding routines. The KMC begins as soon as the baby no longer requires other support from the neonatal care unit. Intermittent KMC has been also used in ventilated infants. Stop KMC once infant achieve regulation of their body temperature, at a median age of 37 weeks after conception.
It may be the best option if neonatal care units are unavailable [11]. If a neonatal care unit is available but overwhelmed by demand, by using KMC we can allows rationalized use of incubators by freeing up for sicker infants. [12] Even in well resourced neonatal care units, it still enhances bonding between mother and infant and breast feeding[13].
Resource limited countries like India, where infrastructure like incubator, electricity, trained staff are deficient to manage LBW babies, mother can work like a incubator and provide thermoneutral temperature that is essential for optimum growth of LBW newborn. Even in developed countries where there is overcrowding in NICU and high cost of healthcare, KMC can decrease burden on health care system and decrease the cost significantly.
Barriers/ Challenges-Despite the fact that there is sound evidence about the effectiveness and safety of KMC, a restraining inertia exists, forbidding massive implementation. Many low birth weight newborn never been exposed to KMC. Many pediatricians and nurses have no first-hand experience and thus feel unsure about initiating and sustaining KMC programs. There is lot of barriers of its use. Few are discussed below-(A) Barrier at Newborn level 1. Sick patient-Newborn on ventilatory support and oxygen supplementation. There was general agreement that infants needed to be clinically stable to be eligible for KMC.
2. Presence of umbilical catheters is a prohibiting factor in some NICUs but not in all.