Dissemination of the Kangaroo Method in Germany

Abstract

Since the early 1980s, programs to support the psychosocial care of premature babies have been reported. 1,2 The kangaroo method is one of those approaches. Encouragement of skin-to-skin contact is based on the idea that the closeness of parent and child will facilitate bonding. Although the studies that have examined the kangaroo approach have produced conflicting results with respect to the physiological effects, [3][4][5][6][7][8] it has been demonstrated clearly that this method does not cause a deterioration of the physical state of premature babies. The present study looks at the use of the kangaroo method by surveying German hospitals. We also asked about what problems had been encountered. METHODSFrom February to May of 1997, we sent questionnaires to all (307) German Departments of Neonatology involved in the management of premature babies. A total of 193 questionnaires have been returned (63%). The anonymous questionnaire was directed to all personnel of a neonatology department or neonatal intensive care unit. The questionnaire had been evaluated by the staff of our own department. Areas of interest were the structure of the respective department, the patient population, the introduction of the kangaroo method into routine care, the practical application of this method, and any problems encountered with it. The departments questioned remained anonymous, although we did ask for the federal state in which they were located. The explorative statistics were compiled using SPSS-PC.Episodes of desaturation were defined as a decrease in oxygen saturation to Ͻ88%; bradycardia was defined as a heart rate Ͻ90 beats per minute. Apnea was defined as pauses in respiration for Ͼ20 seconds; hypothermia was defined as a body temperature of Ͻ36.5°C. RESULTSThe departments that responded to our survey cared for a mean of 198 (4 to 750) premature babies per year (birth before the 37th week of pregnancy, birthweight of Ͻ2500 gm). The number of very low birth weight babies with a birth weight of Ͻ1500 gm averaged 35 (0 to 275) per year.A total of 175 departments of neonatology (91%) used the kangaroo method; in 18 hospitals (9.3%), this method of care was not applied. The hospitals that did not incorporate the kangaroo method into their concept of care formed a nonhomogenous group. Their size varied from 4 to 350 babies per year, and they were in different regions (federal state). Reasons given for the rejection of the kangaroo method included architectural constraints and, more commonly, too small a number of premature babies. For those hospitals using the kangaroo method, the date of introduction was between 1982 and 1996. A total of 33 departments (17.1%) established the concept before 1992. After 1992, the kangaroo method spread quickly, with a maximum of 38 initiations in 1994. Since 1995, the number of departments introducing the method has decreased. Nurses were usually responsible for initiating the kangaroo method (123 departments, 70.3%), followed by registrars (89 departments, 50.9%). It took an average of 8.1 ...

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