Kangaroo Mother Care and the Bonding Hypothesis

Abstract

ABSTRACT. Background. Based on the general bonding hypothesis, it is suggested that kangaroo mother care (KMC) creates a climate in the family whereby parents become prone to sensitive caregiving. The general hypothesis is that skin-to-skin contact in the KMC group will build up a positive perception in the mothers and a state of readiness to detect and respond to infant's cues.Method. The randomized controlled trial was conducted on a set of 488 infants weighing <2001 g, with 246 in the KMC group and 242 in the traditional care (TC) group. The design allows precise observation of the timing and duration of mother-infant contact, and takes into account the infant's health status at birth and the socioeconomic status of the parents.Bonding Assessment. Two series of outcomes are assessed as manifestations of a mother's attachment behavior. The first is the mother's feelings and perceptions of her premature birth experience, including her sense of competence, feelings of worry and stress, and perception of social support. The second outcome is derived from observations of the mother and child's responsivity to each other during breastfeeding at 41 weeks of gestational age.Interventions. KMC has three components. The first is the kangaroo position. Once the premature infant has adapted to extrauterine life and is able to breastfeed, he is positioned on the mother's chest, in a upright position, with direct skin-to-skin contact. The second component is kangaroo nutrition. Although breastfeeding is the prime source of nutrition, infants also may receive preterm formula whenever necessary and vitamin supplements. The third component is the clinical control; infants are monitored on a regular basis, daily until they are gaining at least 20 g per day. Afterward, weekly clinic visits are scheduled until term, which constitutes the ambulatory minimal neonatal care.In the TC group, infants are kept in incubators until they are able to self-regulate their temperature and are thriving (ie, have an appropriate weight gain). Infants are discharged according to current hospital practice, usually not before their weight is ϳ1700 g. Afterward, as with the KMC group, weekly clinic visits are scheduled until term.Results. We observed a change in the mothers' perception of her child, attributable to the skin-to-skin contact in the kangaroo-carrying position. This effect is related to a subjective "bonding effect" that may be understood readily by the empowering nature of the KMC intervention. Moreover, in stressful situations when the infant has to remain in the hospital longer, mothers practicing KMC feel more competent than do mothers in the TC group. This is what we call a resilience effect. In these stressful situations we also found a negative effect on the feelings of received support of mothers practicing KMC. We interpret this as an isolation effect. To thwart this deleterious effect, we would suggest adding social support as an integral component of KMC.The observations of the mothers' sensitive behavior did not show a defin...

Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis

“…The 25 eligible trials were readily divided into three pre-specified distinct categories of intervention: developmental care of a specific type known as NIDCAP (n ¼ 5 trials), [42][43][44][45][46][47][48][49] kangaroo care (n ¼ 1 trial) 38,50,51 and other developmental interventions (n ¼ 19 trials). 36, Of these, the first two categories involved in-patient care, whereas the third was applied in hospital and/or at discharge from hospital.…”

“…One study was reported twice 55,56 and five interventions were reported at different ages or for different outcomes for the same cohort. 38,[46][47][48][49][50][51][52][53][62][63][64][65][69][70][71][72] The Infant Health and Development Program (IHDP) was a large trial included in the category of 'other Developmental Interventions.' Twelve additional articles reporting randomized analyses from the IHDP are also summarized in an Appendix.…”

“…Few studies described the method of randomization in detail. Only three studies 38,[50][51][52][53][62][63][64][65] reported clearly adequate concealment, while in the remainder of the studies this was unclear. Owing to the inability to blind the initial intervention, a blinded assessment of outcome was considered important to minimize bias, and in 21 36,42 -44,46 -49, 52-56,59 -77 of 25 selected studies, blinding of the outcome assessment was specifically undertaken.…”

“…Owing to the inability to blind the initial intervention, a blinded assessment of outcome was considered important to minimize bias, and in 21 36,42 -44,46 -49, 52-56,59 -77 of 25 selected studies, blinding of the outcome assessment was specifically undertaken. However, only four studies 38,43,50,51,59,60 succeeded in capturing X85% of outcome data at the last point of follow-up.…”

Implementation and Case-Study Results of Potentially Better Practices for Family-Centered Care: The Family-Centered Care Map

“…[1][2][3][4] Potential benefits include shorter length of stay (LOS), decreased readmissions, reduced parental stress, increased parental confidence after discharge, and increased staff satisfaction. [5][6][7] Adherence to the principles of FCC should result in improved attachment between the infant and the family. 8,9 The Institute for Family-Centered Care has identified 8 core concepts of FCC: respect, choice, information, collaboration, strengths, support, empowerment, and flexibility.…”