Ordinarily, Jacqueline Garcia would experience her parents` love through the thick plastic walls of an incubator. Born 14 weeks premature, she would be touched through small holes in the plastic or lifted out wrapped in thick blankets for a lightning-quick visit.
But in a radical new approach, tiny Jacqueline is awash in human contact: she spends hours each day in bed with one of her parents, lying skin to skin, chest to chest. At these times, the parent becomes her incubator.
At five weeks, Jacqueline weighs only about 3 pounds and she is still frail. So her monitors and oxygen tubing go along when she joins her mother on a recliner in the Neonatal Intensive Care Unit at the Brigham and Women`s Hospital in Boston.
But once the two are settled in, they are just mother and baby.
”We talk, tell stories, sing or just sleep,” said Pamela Garcia, her mother. ”This has really been wonderful to be part of her care. It has really kept me sane.”
Inspired by marsupials, who nurture their young in pouches, ”kangaroo care” is challenging the high-technology philosophy of intensive care for babies.
Until recently, pediatricians thought that premature infants should be isolated and not stimulated, to conserve their strength for growth and maturation. But now, at the urging of intensive-care nurses, a few hospitals are supplementing machines with this hands-on treatment and are finding benefits for infants and their parents.
Kangaroo care allows the bonding between parent and child that usually is precluded in intensive-care units. And from those bonds may stem physical benefits: Some studies have suggested that premature babies who ”kangaroo”
have fewer breathing problems, gain weight faster and maintain a more stable body temperature than babies confined to incubators, or isolettes.
Kangaroo care allows the bonding between parent and child that usually is precluded in intensive-care units. And from those bonds may stem physical benefits: Some studies have suggested that premature babies who ”kangaroo”
have fewer breathing problems, gain weight faster and maintain a more stable body temperature than babies confined to incubators, or isolettes.
”A lot of babies seem to improve when they`re being held by their parents,” said Dr. Steven Ringer, director of neonatal services at Brigham.
Nurses who have supervised kangaroo visits observe that babies become calmer with their parents and waste fewer calories in the kind of restless fidgeting that occurs in incubators.
”There are lots of questions about what it does in terms of physiology, but in terms of psychological benefit to the parents, it is wonderful,”
Ringer said.
In early June, Edna Scannell and Earl McAllister began kangaroo visits with their daughter Lucretia, who was born April 22, at 1 pound, 12 ounces. Since the care began, she has started to gain weight, and although no one can prove that the skin-to-skin visits have contributed to her progress, her parents are converts.
”At first we couldn`t even touch her, and that was just awful,” Edna Scannell said. ”Once I started kangarooing, the improvement was amazing.”
This type of care was developed in Colombia about a decade ago, when doctors were facing a shortage of incubators for premature babies, who are unable to regulate their own body temperature.
Taking a cue from kangaroos, the doctors devised slings that allowed mothers to carry their infants next to their chests.
The program was so successful that the United Nations Children`s Fund promoted it throughout the underdeveloped world. And recently a few nurses at leading hospitals in the United States have sought to adapt it to their work. ”The idea here was to let parents have a piece of the infant`s recovery,” said Marie Field, the nurse in charge of the Newborn Intensive Care Unit at the Brigham. She said about a third of the 50 families with babies in the unit were in the program. Babies who are too sick cannot participate.
To prepare for kangaroo visits, nurses set up recliners and movable screens to provide privacy. Mothers and fathers wishing to participate are encouraged to wear loose clothing, so their babies may be easily placed next to their skin. Kangaroo visits may be as short as 20 minutes or as long as 6 hours.
The babies` respirators and feeding tubes continue to function, and nurses and technicians perform such duties as lung suctioning, drawing blood and performing brain ultrasound scans. Their parents` body heat keeps the infants warm.
Before kangaroo visits, parents sometimes could hold their babies, but wrapped in blankets and under warming lights.
”The babies would squint and the parents felt hot,” Field said. ”It was hardly a natural visit.”
Such visits always were short, since the babies started to fidget, the blankets disrupted their monitors and their body temperature proved impossible to maintain.
In contrast, parents` chests have proved to be impeccable natural thermostats, said Jennifer Wallace, a clinical nurse specialist at Brigham. The nurses have observed that if a baby`s temperature drops, the parent`s rises to respond to the baby`s need.
”Some people on the medical staff still think it`s a bad idea and some think it`s silly, but support is growing,” Ringer said.
The few studies of kangaroo care, mostly from overseas, suggest that the skin-to-skin visits result in better weight gain and fewer episodes of apnea, a condition in which premature babies stop breathing temporarily.
Mothers who kangaroo also have been found to experience sharp increases in milk production. For premature infants who cannot suckle, if the mother can produce enough milk, it can be pumped and fed to the infant through a feeding tube.
A randomized trial recently started by Gene Cranston Anderson and Brigette Syfertt at the University of Florida is yielding promising results. Babies born healthy but four to six weeks early lie skin-to-skin for prolonged periods with their mothers in the delivery room. In their small sample, Cranston Anderson said, mothers of these infants want to breastfeed. Babies given kangaroo care remain with their mothers until the mothers are discharged and then are placed in the normal newborn nursery until they are discharged. Infants given standard care are in the neonatal intensive care unit on an average of 1.3 days, Cranston Anderson said, and 4.3 days in the ”step-down” unit.
In that program, ”The babies stay very warm as long as they`re skin to skin, are competent breast feeders by 24 hours and within a few days they`ve started to gain weight,” said Cranston Anderson, professor of nursing, who introduced kangaroo care in this country.
Until more scientific data are available, doctors in the United States are reserving judgment. But parents and nurses in the Brigham intensive care unit have made similar observations.
